bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19: smoke testing of surgical mask and respirators
Authors: Douglas J D M , McLean N , Horsley C , Higgins G , Douglas C M , Robertson E 
Published: September 2020

Abstract

Background
Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required.

Aims
To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage.

Methods
A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison.

Results
The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be ‘just right’ to prevent facial trauma. Facial barrier creams are an infection risk.

Conclusions
Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users
Estimated prevalence and viral transmissibility in subjects with asymptomatic SARS-CoV-2 infections in Wuhan, China
Authors: Zhang Kang , Tong Weiwei , Wang Xinghuan , Lau Johnson Yiu-Nam 
Published: September 2020

Abstract
The role of subjects with asymptomatic SARS-CoV-2 infection in the current pandemic is not well-defined. Based on two different approaches to estimate the culminative attack rate (seroprevalence of antibodies against SARS-CoV-2, and a four compartment mathematical model) and the reported number of patients with COVID-19, the ratio of asymptomatic versus symptomatic SARS-CoV-2 infection was estimated to be 7 (95% CI: 2.8–12.4) in Wuhan, Hubei, China, the first epicenter of this pandemic, which has settled with no new cases. Together with detailed recording of the contact sources in a cohort of patients, and applying the estimations to an established mathematical model, the viral transmissibility of the subjects with asymptomatic SARS-CoV-2 infection is around 10% of that of the symptomatic patients (95% CI: 7.6%–12.3%). Public health measures/policies should address this important pool of infectious source in combat against this viral pandemic.
Neural correlates of integrated self and social processing
Authors: Finlayson-Short Laura , Davey Christopher G , Harrison Ben J 
Published: September 2020

Abstract
Self-referential and social processing are often engaged concurrently in naturalistic judgements and elicit activity in overlapping brain regions. We have termed this integrated processing ‘self-other referential processing’ and developed a task to measure its neural correlates. Ninety-eight healthy young people aged 16–25 (M = 21.5 years old, 67% female) completed our novel functional magnetic resonance imaging task. The task had two conditions, an active self-other referential processing condition in which participants rated how much they related to emotional faces and a control condition. Rating relatedness required thinking about oneself (self-referential processing) and drawing a comparison to an imagined other (social processing). Self-other referential processing elicited activity in the default mode network and social cognition system; most notably in the ‘core self’ regions of the medial prefrontal cortex and posterior cingulate cortex. Relatedness and emotional valence directly modulated activity in these core self areas, while emotional valence additionally modulated medial prefrontal cortex activity. This shows the key role of the medial prefrontal cortex in constructing the ‘social-affective self’. This may help to unify disparate models of medial prefrontal cortex function, demonstrating its role in coordinating multiple processes—self-referential, social and affective processing—to allow the self to exist in a complex social world.
Gender differences in nighttime sleep patterns and variability across the adult lifespan: a global-scale wearables study
Authors: Jonasdottir Sigga Svala , Minor Kelton , Lehmann Sune 
Published: September 2020

Abstract

Study Objectives
Previous research on sleep patterns across the lifespan have largely been limited to self-report measures and constrained to certain geographic regions. Using a global sleep dataset of in situ observations from wearable activity trackers, we examine how sleep duration, timing, misalignment, and variability develop with age and vary by gender and BMI for nonshift workers.

Methods
We analyze 11.14 million nights from 69,650 adult nonshift workers aged 19–67 from 47 countries. We use mixed effects models to examine age-related trends in naturalistic sleep patterns and assess gender and BMI differences in these trends while controlling for user and country-level variation.

Results
Our results confirm that sleep duration decreases, the prevalence of nighttime awakenings increases, while sleep onset and offset advance to become earlier with age. Although men tend to sleep less than women across the lifespan, nighttime awakenings are more prevalent for women, with the greatest disparity found from early to middle adulthood, a life stage associated with child-rearing. Sleep onset and duration variability are nearly fixed across the lifespan with higher values on weekends than weekdays. Sleep offset variability declines relatively rapidly through early adulthood until age 35–39, then plateaus on weekdays, but continues to decrease on weekends. The weekend–weekday contrast in sleep patterns changes as people age with small to negligible differences between genders.

Conclusions
A massive dataset generated by pervasive consumer wearable devices confirms age-related changes in sleep and affirms that there are both persistent and life-stage dependent differences in sleep patterns between genders.
Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial
Authors: Miller Mary Beth , Deroche Chelsea B , Freeman Lindsey K , Park Chan Jeong , Hall Nicole A , Sahota Pradeep K , McCrae Christina S 
Published: September 2020

AbstractStudy ObjectivesMore than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes.MethodsYoung adults (ages 18–30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up.ResultsOf those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity.ConclusionsCBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted.Trial RegistrationU.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832
Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue
Authors: Gupta Sarika , Mall Pranaya , Alam Areesha 
Published: September 2020

Abstract

Background
Taking into consideration, the variable performance of WHO’s dengue case definition and the magnitude of epidemics in India, a score based on clinical and laboratory parameters is required for the early identification of severe dengue.

Methods
A retrospective observational study of children (aged ≤12 y) presenting with dengue, defined as per the WHO 2009 classification and NS1 antigen/IgM ELISA positivity, was conducted at a tertiary care hospital from 2013 to 2015. Clinical laboratory parameters were compared between severe/non-severe dengue using univariate and multivariate analysis. Areas under receiver operating characteristic curves (AUROCs), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for independent and composite markers.

Results
Of 135 dengue patients, 46 (34.1%) had non-severe dengue and 89 (65.9%) had severe dengue. Logistic regression determined prolonged capillary refill time (CRT), lactate ≥2.9 mmol/L and serum aspartate transaminase (AST) ≥135 IU/L as predictive for severe dengue. AUROCs of lactate, AST and combined score incorporating AST, lactate and prolonged CRT for identifying severity were 7.55, 7.23 and 8.5, respectively. The combined score cut-off ≥1 had 87.6% sensitivity, 65.2% specificity, 83% PPV and 73.2% NPV. The combined score cut-off ≥3 had 100% specificity and 100% PPV. However, AST &gt;135 IU/L and lactate &gt;2.9 mmol/L together had 97.8% specificity and 97.1% PPV for identifying severity.

Conclusions
The presence of either ‘prolonged capillary refill time with one deranged biochemical parameter’ or ‘both deranged biochemical parameters’ is nearly 100% specific for severity of dengue.
Nonimmune mechanisms in idiopathic inflammatory myopathies
Authors: Loredo Martinez Marta , Zampieri Sandra , Franco Chiara , Ghirardello Anna , Doria Andrea , Gatto Mariele 
Published: September 2020

Purpose of reviewThis review encompasses the main novelties regarding nonimmune mechanisms implicated in the pathogenesis of idiopathic inflammatory myopathies (IIM).Recent findingsIn recent years, growing data support a role for endoplasmic-reticulum (ER) stress as a propagator of muscular damage, together with the release of interferon type I and reactive oxygen species in hypoxemic muscle fibers. Other studies evaluating the relationship between autophagy and Toll-like receptors (TLRs) in IIM subtypes have shown increased TLR3 and TLR4 expression in fibers of IIM patients and colocalization with LC3, an autophagy marker, submitting autophagy as a likely player in IIM pathogenesis. Most novel evidences concern the potential role of denervation of the neuromuscular junction in IIM, possibly connected to hyperexpression of MHC-I, and trafficking of extracellular vesicles, which may represent a connection between nonimmune and immune-mediated mechanisms of muscle inflammation and damage.SummaryNonimmune mechanisms contribute to the pathogenesis of IIM, likely cooperating with immune-mediated inflammation. Consistent data were released for ER stress, autophagy, mitochondrial dysfunction and hypoxia; in addition to, neuromuscular denervation and extracellular vesicles have been proposed as thoughtful links between muscle inflammation, damage and atrophy. Further understanding of nonimmune abnormalities and potential reversible pathways is needed to improve the management of IIM.
Chromium Metal Ion Release During Instrumented Spinal Surgery in Children
Authors: Cundy Peter J. , Antoniou Georgia , Mascarhenas Annika , Freeman Brian J.C. , Cundy William J. 
Published: September 2020

Study Design.
Prospective 2-year study with operative sampling and in-vitro analysis of chromium ions following spinal surgery in children.

Objectives.
To measure metal ion levels at preoperative, intraoperative, and postoperative times to determine patterns of metal ion release during instrumented spinal surgery.

Summary of Background Data.
Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis. The authors noted raised chromium levels in patients receiving implants that did not contain chromium. This prompted further work to establish the source. The electrosurgery tips used were discovered to contain 17% chromium.

Methods.
Chromium, cobalt, and titanium levels were measured before, during, and after surgery in serum and local intraoperative fluid samples in 11 children undergoing posterior instrumentation for scoliosis. Administered drugs, cell-saver fluids, and intraoperative fluids, both local and intravenous, were investigated to exclude these as sources of chromium ions. An in-vitro study was also performed to elucidate sources of intraoperative chromium ions.

Results.
High chromium levels were detected in all samples from the wound irrigation fluid prior to insertion of metal implants. Immediate postoperative chromium serum ion levels were also elevated and returned to baseline by day 30. In-vitro sampling of fluids from test models using electrosurgery revealed high levels of chromium ions

Conclusion.
This finding of high chromium metal ion concentrations in intraoperative and early postoperative samples provides evidence of chromium release during the dissection phase of spinal surgery. This challenges existing beliefs that metal ion release occurs solely due to implants and now implicates the electrosurgery electrode tips as a source of raised chromium ion levels. Thorough irrigation of the operative site after the dissection phase of surgery to both dilute and reduce the intraoperative chromium ion load is suggested. Alternative electrosurgery electrode tips or other methods to coagulate during surgery could be considered.

Level of Evidence: 2
Risk Factors Associated With Development of Urinary Retention Following Posterior Lumbar Spinal Fusion: Special Attention to the Use of Glycopyrrolate in Anesthesia Reversal
Authors: Mormol Jeremy D. , Basques Bryce A. , Harada Garrett K. , Louie Philip K. , Alter Kevin , Goldberg Edward , Colman Matthew W. , An Howard S. 
Published: September 2020

Study Design.
The study is designed as a retrospective cohort study.

Objective.
The aim of this study was to identify modifiable and nonmodifiable risk factors of postoperative urinary retention in spine surgery patients.

Summary of Background Data.
Postoperative urinary retention is a common complication in patients undergoing operative procedures requiring anesthesia. Current studies have shown significant risk factors for postoperative urinary retention, but most are nonmodifiable and subsequently of limited usefulness in preventing this complication. Several new studies have shown possible modifiable risk factors, but current data are inconsistent in terms of their statistical significance.

Methods.
A total of 814 consecutive patients who underwent open posterior lumbar laminectomy and fusion were included in the retrospective cohort study. Pre, intra-, and postoperative characteristics were collected in all patients to identify risk factors for postoperative urinary retention.

Results.
Glycopyrrolate use (odds ratio [OR] 2.60; P = 0.001), decreased body mass index (OR 0.96; P = 0.018), previous diagnosis of benign prostate hyperplasia (OR 3.34; P ≤ 0.001), and postoperative urinary tract infection (OR 5.60, P = 0.005) were associated with postoperative urinary retention. Previous history of lumbar spine surgery (OR 0.55; P = 0.019) was associated with decreased rates of postoperative urinary retention.

Conclusion.
Glycopyrrolate use, benign prostate hyperplasia, and postoperative urinary tract infection were independent risk factors for postoperative urinary retention. The use of glycopyrrolate is a potentially modifiable risk factor for postoperative urinary retention.

Level of Evidence: 3
Effect of Multimodal Drugs Infiltration on Postoperative Pain in Split Laminectomy of Lumbar Spine
Authors: Kraiwattanapong Chaiwat , Arnuntasupakul Vanlapa , Kantawan Rungthiwa , Woratanarat Patarawan , Keorochana Gun , Langsanam Nantida 
Published: September 2020

Study Design.
A randomized, double-blinded controlled trial.

Objective.
This study tested the effect of single-dose wound infiltration with multiple drugs for pain management after lumbar spine surgery.

Summary of Background Data.
Patients undergoing spine surgery often experience severe pain especially in early postoperative period. We hypothesized that intraoperative wound infiltration with multiple drugs would improve outcomes in lumbar spine surgery.

Methods.
Fifty-two patients who underwent one to two levels of spinous process splitting laminectomy of lumbar spine, were randomized into two groups. Infiltration group received intraoperative wound infiltration of local anesthetics, morphine sulfate, epinephrine, and nonsteroidal anti-inflammatory drugs at the end of surgery, and received patient-controlled analgesia (PCA) postoperatively. The control group received only PCA postoperatively. The primary outcome measures were amount of morphine consumption and visual analogue scale (VAS) for pain. The secondary outcome measures were Oswestry Disability Index (ODI), Roland-Morris Low Back Pain and Disability Questionnaire (RMDQ), patient satisfaction, length of hospital stay, and side effects.

Results.
A total of 49 patients (23 patients for local infiltration group, and 26 patients for control group) were analyzed. There were statistically significant [P < 0.001, the effect size −5.0, 95% CI (−6.1, −3.9)] less morphine consumptions in the local infiltration group than the control group during the first 12 hours, 12 to 24 hours, and 24 to 48 hours after surgery. The VAS of postoperative pain reported by patients at rest and during motion was significantly lower in the local infiltration group than the control group at all assessment times (P < 0.001). The effect size of VAS of postoperative pain at rest and during motion were −2.0, 95% CI (−2.5, −1.4) and −2.0, 95% CI (−2.6, −1.4) respectively. ODI and RMDQ at 2 week and 3 month follow-ups in both groups had significant improvement from baseline (P < 0.001). No significant differences were found between groups (P = 0.262 for ODI and P = 0.296 for RMDQ). There were no significant differences of patient satisfaction, length of stay, and side effects between both groups (P = 0.256, P = 0.262, P = 0.145 respectively).

Conclusion.
Intraoperative wound infiltration with multimodal drugs reduced postoperative morphine consumption, decreased pain score with no increased side effects.

Level of Evidence: 1
Correlations and Age-Related Changes of Cervical Sagittal Parameters in Adults Without Symptoms of Cervical Spinal Disease
Authors: Hu Liu , Lv Yongman , Lin Yang 
Published: September 2020

Study Design.
Retrospective study.

Objective.
To determine the correlations and age-related changes of cervical sagittal parameters in adults without obvious cervical spinal disease.

Summary of Background Data.
Cervical sagittal parameters play essential roles in the pathogenesis and therapy of cervical spinal diseases. However, few studies have investigated the correlations and age-related changes of cervical sagittal parameters.

Methods.
The enrolled participants were divided into three age groups and their cervical sagittal parameters were collected. Correlations and age-related changes of these parameters were analyzed.

Results.
Significant differences in the C2–C7 angle, center of gravity of the head–C7 sagittal vertical axis (CGH–C7 SVA), C2–C7 SVA, neck tilt (NT), and thoracic inlet angle (TIA) were found among the three age groups. Pearson correlation analysis showed positive correlations between the C0–C2 angle and CGH–C7 SVA, C0–C2 angle and C2–C7 SVA, C2–C7 angle and T1 slope, C2–C7 angle and TIA, CGH–C7 SVA and C2–C7 SVA, C2–C7 SVA and T1 slope, T1 slope and TIA, and NT and TIA as well as negative correlations between the C0–C2 angle and C2–C7 angle, C2–C7 angle and CGH–C7 SVA, and C2–C7 angle and C2–C7 SVA. Paired t tests showed significant changes in the C2–C7 angle in groups I and II, and in the CGH–C7 SVA and C2–C7 SVA in all age groups with increasing age.

Conclusion.
The results indicate that cross correlations exist between different cervical sagittal parameters in adults without symptoms of cervical spinal disease, and the lower cervical curvature and SVA change obviously with increasing age.

Level of Evidence: 3
Disaster Nursing
Authors: Weeks Maranatha 
Published: September 2020

ABSTRACT:
National and global disasters require immense resources, including nurses. Personal, professional, and spiritual preparation is strongly recommended for healthcare workers who desire to serve in disaster settings. Most nurses are underprepared for this role; options for preparation are described along with the ministry of nursing and spiritual care that expresses God's heart of mercy and care for hurting and desperate people.
Setting up a Research Poster During COVID-19 Lockdown
Authors: Kazmierczak Thomas , Bistany Belle 
Published: September 2020

ABSTRACT:
Students at a Christian nursing school faced unanticipated challenges in preparing and presenting research projects during the COVID-19 pandemic. Students and faculty rapidly adapted to a virtual environment and overcame obstacles to complete and present their work. The students demonstrated resilience and additional learning outcomes as a result of the enforced virtual experience.