bluuebunny/crossref_metadata_2025_split huggingface dataset:
International Medical Graduates: Promoting Equity and Belonging
Authors: Zaidi Zareen , Dewan Mantosh , Norcini John 
Published: September 2020

International medical school graduates (IMGs) play a vital role in the health care system of the United States. They constitute roughly one-quarter of the physician workforce, comprising a significant proportion of the primary care providers in high-need rural and urban areas, where they provide equal and, in some instances, better care than U.S. graduates. Nonetheless, they face a series of hurdles in entering U.S. residency programs and throughout their training experiences.
IMGs must expend significant resources to obtain Education Commission for Foreign Medical Graduates certification, which includes Steps 1, 2 Clinical Knowledge and 2 Clinical Skills of the United States Medical Licensing Examination. They encounter the uncertainty of matching and, if successful, obtaining a visa to enter the United States. Once here, they need to adapt to the complexities of the health care system and familiarize themselves with the cultural nuances, professional behaviors, and communication skills of another country. They encounter biases and microaggressions and lack support groups and mentors. Those who choose an academic career are less likely to obtain leadership positions.
This Perspective provides an overview of these challenges and highlights opportunities for change at local and national levels. Specifically, it identifies strategies that would assist IMGs before entry, at entry, during training, at the transition to practice, and in practice. The current COVID-19 pandemic highlights the shortage of physicians in the United States and illustrates the importance of ensuring that IMGs, who are essential health care workers, feel welcome, valued, and recognized for their contributions.
It Can Be Done! A Skills-Based Elective in Implicit Bias Recognition and Management for Preclinical Medical Students
Authors: Gonzalez Cristina M. , Walker Sydney A. , Rodriguez Natalia , Karp Elisa , Marantz Paul R. 
Published: September 2020

Purpose
Students perceive bias in learning environments. Curricula targeting implicit bias recognition and management increase student awareness and achieve strategy identification, but fall short of actual skill development to address bias. In light of this gap, the authors developed and evaluated a skills-based elective to recognize and manage implicit bias in the learning environment.

Method
Nine 1.5-hour sessions were delivered to 15 first-year medical students from 2017 to 2019. An evidence-based conceptual framework and transformative learning theory informed the instructional design; it incorporated active learning exercises. Skills assessment occurred through direct observation of student performances in role-play exercises. Using thematic analysis, the authors conducted a program evaluation based on focus groups with students and data from notes taken by the investigative team.

Results
Students engaged with all aspects of instruction, including role-plays. Authors identified 3 themes from the program evaluation: (1) Student engagement can be enhanced, (2) Instruction is empowering, and (3) It (addressing bias in one’s own and witnessed encounters) can be done! Analysis additionally highlighted opportunities for improvement and lessons learned.

Conclusions
This innovative course achieved skill development and practice for medical students in implicit bias recognition and management as it pertains to 3 facets of clinical care present at every stage of a health professional’s career. These include interpersonal encounters, advocating for patients when bias is perceived in witnessed encounters with peers and supervisors, and addressing comments made by others within the learning environment. Outcomes could inform novel, skills-based curricula across the spectrum of health professions training and practice.
Sample Pooling is a Viable Strategy for SARS-CoV-2 Detection in Low-Prevalence Settings
Authors: Chong Brian SW , Tran Thomas , Druce Julian , Ballard Susan A , Simpson Julie A , Catton Mike 
Published: September 2020

ABSTRACTBACKGROUNDThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has significantly increased demand on laboratory throughput and reagents for nucleic acid extraction and polymerase chain reaction (PCR). Reagent shortages may limit the expansion of testing required to scale back isolation measures.AIMTo investigate the viability of sample pooling as a strategy for increasing test throughput and conserving PCR reagents; to report our early experience with pooling of clinical samples.METHODSA pre-implementation study was performed to assess the sensitivity and theoretical efficiency of two, four, and eight-sample pools in a real-time reverse transcription PCR-based workflow. A standard operating procedure was developed and implemented in two laboratories during periods of peak demand, inclusive of over 29,000 clinical samples processed in our laboratory.RESULTSSensitivity decreased (mean absolute increase in cycle threshold value of 0.6, 2.3, and 3.0 for pools of two, four, and eight samples respectively) and efficiency increased as pool size increased. Gains from pooling diminished at high disease prevalence. Our standard operating procedure was successfully implemented across two laboratories. Increased workflow complexity imparts a higher risk of errors, and requires risk mitigation strategies. Turnaround time for individual samples increased, hence urgent samples should not be pooled.CONCLUSIONSPooling is a viable strategy for high-throughput testing of SARS-CoV-2 in low-prevalence settings.
The methodological quality of COVID-19 systematic reviews is low, except for Cochrane reviews: a meta-epidemiological study
Authors: Kataoka Yuki , Oide Shiho , Ariie Takashi , Tsujimoto Yasushi , Furukawa Toshi A. 
Published: September 2020

ABSTRACTObjectivesThe objective of this study was to investigate the methodological quality of COVID-19 systematic reviews (SRs) indexed in medRxiv and PubMed, compared with Cochrane COVID Reviews.Study Design and SettingThis is a cross-sectional meta-epidemiological study. We searched medRxiv, PubMed, and Cochrane Database of Systematic Reviews for SRs of COVID-19. We evaluated the methodological quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) checklists. The maximum AMSTAR score is 11, and minimum is 0. Higher score means better quality.ResultsWe included 9 Cochrane reviews as well as randomly selected 100 non-Cochrane reviews in medRxiv and PubMed. Compared with Cochrane reviews (mean 9.33, standard deviation 1.32), the mean AMSTAR scores of the articles in medRxiv were lower (mean difference -2.85, 95%confidence intervals (CI): -0.96 to -4.74) and those in PubMed was also lower (mean difference -3.28, 95% CI: -1.40 to -5.15), with no difference between the latter two.ConclusionsIt should be noted that AMSTAR is not a perfect tool of assessing quality SRs other than intervention. Readers should pay attention to the potentially low methodological quality of COVID-19 SRs in both PubMed and medRxiv but less so in Cochrane COVID reviews.PROTOCOL AND REGISTRATIONWe developed the protocol before conducting this study (Kataoka Y, Oide S, Ariie T, Tsujimoto Y, Furukawa TA. Quality of COVID-19 research in preprints: a meta-epidemiological study protocol. Protocols.io 2020.https://doi.org/10.17504/protocols.io.bhm8j49w.).What is new?Key findings-The methodological quality of COVID-19 systematic reviews (SRs) in medRxiv and PubMed were lower than Cochrane COVID reviews.-The methodological quality of reviews in medRxiv and PubMed did not differ.What this study adds to what was known-Expert opinions and a preliminary review suggested the low quality of COVID-19 SRs but this hypothesis has not been examined empirically.-We evaluated the methodological quality of COVID-19 SRs using comprehensive search and confirmed that the quality was low except for Cochrane reviews.What is the implication and what should change now?Readers should pay attention to the potentially low methodological quality of COVID-19 SRs in both PubMed and medRxiv but less so in Cochrane COVID reviews.The methodological quality of COVID-19 SRs except for Cochrane COVID reviews needed to be improved.
Delineation of the Clinical Features and Treatment Response of Oromandibular Dystonia: A Multicenter Summary of 2,057 Cases
Authors: Scorr Laura M. , Factor Stewart A. , Parra Sahyli Perez , Kaye Rachel , Paniello Randal C. , Norris Scott A. , Perlmutter Joel , Bäumer Tobias , Usnich Tatiana , Berman Brian , Mailly Marie , Roze Emmanuel , Vidailhet Marie , Jankovic Joseph , LeDoux Mark S. , Barbano Richard , Chang Florence , Fung Victor , Richardson Sarah Pirio , Blitzer Andrew , Jinnah H.A. ,   for the Dystonia Coalition Investigators
Published: September 2020

AbstractObjectiveTo better characterize oromandibular dystonia (OMD) to facilitate early diagnosis and test the hypothesis that botulinum toxin treatment alleviates symptoms, regardless of etiology, to provide guidance on treatment strategies.MethodsTo better characterize this condition we utilize a three-pronged approach. First, we provide a comprehensive summary of the world’s literature encompassing 1157 cases in 27 separate manuscripts. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter database. Finally, we provide details of the treatment approach and response from two expert centers where large numbers of OMD patients are followed. Cases from expert centers were utilized to analyze whether response to botulinum toxin varied by etiology of OMD.ResultsIn all cohorts, typical age at onset was in the 50s and approximately 70 % of cases were female. Although the literature OMD more commonly described as a focal dystonia, analysis of the DC database revealed it more commonly appears as part of a segmental dystonia. Expert center review of 173 cases revealed botulinum toxin injections improved symptom severity by more than 50% in approximately 78% of subjects. Among the patients at expert centers, analysis revealed that treatment response did not vary by etiology.ConclusionsBotulinum toxin injections are an effective treatment for OMD, regardless of etiology. By providing a more comprehensive description of OMD and the therapeutic efficacy of botulinum toxin for this type of dystonia, we hope to improve clinical recognition to aid in timely diagnosis and inform treatment strategies.
Cytotoxic lymphocytes are dysregulated in multisystem inflammatory syndrome in children
Authors: Beckmann Noam D. , Comella Phillip H. , Cheng Esther , Lepow Lauren , Beckmann Aviva G. , Mouskas Konstantinos , Simons Nicole W. , Hoffman Gabriel E. , Francoeur Nancy J. , Valle Diane Marie Del , Kang Gurpawan , Moya Emily , Wilkins Lillian , Berichel Jessica Le , Chang Christie , Marvin Robert , Calorossi Sharlene , Lansky Alona , Walker Laura , Yi Nancy , Yu Alex , Hartnett Matthew , Eaton Melody , Hatem Sandra , Jamal Hajra , Akyatan Alara , Tabachnikova Alexandra , Liharska Lora E. , Cotter Liam , Fennessey Brian , Vaid Akhil , Barturen Guillermo , Tyler Scott R. , Shah Hardik , Wang Ying-chih , Sridhar Shwetha Hara , Soto Juan , Bose Swaroop , Madrid Kent , Ellis Ethan , Merzier Elyze , Vlachos Konstantinos , Fishman Nataly , Tin Manying , Smith Melissa , Xie Hui , Patel Manishkumar , Argueta Kimberly , Harris Jocelyn , Karekar Neha , Batchelor Craig , Lacunza Jose , Yishak Mahlet , Tuballes Kevin , Scott Leisha , Kumar Arvind , Jaladanki Suraj , Thompson Ryan , Clark Evan , Losic Bojan ,   The Mount Sinai COVID-19 Biobank Team, Zhu Jun , Wang Wenhui , Kasarskis Andrew , Glicksberg Benjamin S. , Nadkarni Girish , Bogunovic Dusan , Elaiho Cordelia , Gangadharan Sandeep , Ofori-Amanfo George , Alesso-Carra Kasey , Onel Kenan , Wilson Karen M. , Argmann Carmen , Alarcón-Riquelme Marta E. , Marron Thomas U. , Rahman Adeeb , Kim-Schulze Seunghee , Gnjatic Sacha , Gelb Bruce D. , Merad Miriam , Sebra Robert , Schadt Eric E. , Charney Alexander W. 
Published: September 2020

AbstractMultisystem inflammatory syndrome in children (MIS-C) presents with fever, inflammation and multiple organ involvement in individuals under 21 years following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To identify genes, pathways and cell types driving MIS-C, we sequenced the blood transcriptomes of MIS-C cases, pediatric cases of coronavirus disease 2019, and healthy controls. We define a MIS-C transcriptional signature partially shared with the transcriptional response to SARS-CoV-2 infection and with the signature of Kawasaki disease, a clinically similar condition. By projecting the MIS-C signature onto a co-expression network, we identified disease gene modules and found genes downregulated in MIS-C clustered in a module enriched for the transcriptional signatures of exhausted CD8+T-cells and CD56dimCD57+NK cells. Bayesian network analyses revealed nine key regulators of this module, includingTBX21, a central coordinator of exhausted CD8+T-cell differentiation. Together, these findings suggest dysregulated cytotoxic lymphocyte response to SARS-Cov-2 infection in MIS-C.
Estimating Unreported Deaths from Natural Causes during COVID-19
Authors: Stear Benjamin , Hernandez Kyle M. , Manian Vidya , Taylor Deanne , Conley Catharine A. 
Published: September 2020

AbstractEfforts to mitigate the spread of coronavirus disease 2019 (COVID-19) in the United States require an accurate understanding of how the epidemic is progressing. The National Center for Health Statistics (NCHS) releases weekly numbers of deaths attributed to a set of ‘select causes’, including deaths from COVID-19 in the entire United States (US), by state, and cumulatively for individual counties. Comparing US and state level deaths from select causes recorded in 2020 with values from 2014-2019 identifies a number of differences that exceeded 95% confidence limits on historical mean values, including three states with deaths possibly from COVID-19 in December 2019. Comparing county-level NCHS datasets with county-level data on deaths from COVID-19 compiled by four public pandemic tracking sites suggests that a large number of COVID-19 deaths have not yet been reported to the NCHS. Dividing the numbers of COVID-19 deaths counted by the public tracking sites by the percentage of COVID-19 deaths reported to the NCHS suggests that approximately 20% of all US deaths from Natural Causes, as many as 200,000, may not yet have been reported to the NCHS. Evaluating changes in the fractions of deaths attributed to COVID-19 and other specific causes or nonspecific outcomes during the epidemic, relative to 2020 totals or historical mean values, can provide a valuable perspective on the public health consequences of COVID-19.Significance StatementEstimating total deaths from natural causes using the percentage of natural cause deaths from COVID-19 reported to the CDC and the number of COVID-19 deaths counted by public tracking sites suggests that up to 200,000 deaths from natural causes between 22 April and 15 August, 2020, around 20% of the total recorded as of 26 August, have not yet been reported to the CDC.
Are COVID-19 proximity tracing apps working under real-world conditions? Indicator development and assessment of drivers for app (non-)use
Authors: Wyl Viktor von , Höglinger Marc , Sieber Chloé , Kaufmann Marco , Moser André , Serra-Burriel Miquel , Ballouz Tala , Menges Dominik , Frei Anja , Puhan Milo A. 
Published: September 2020

AbstractDigital proximity tracing (DPT) apps have been released to mitigate SARS-CoV-2 transmission, but it remains unclear how their effectiveness should be monitored. The aim of this study was to formalize indicators for measuring the fulfillment of assumptions for appropriate proximity tracing app functioning.Six indicators were developed to monitor the SwissCovid app functioning and effectiveness in the Swiss population. Using official statistics and survey data, we calculated indicator values and examined socio-demographic factors associated with the SwissCovid app utilization. Indicators show that 1 in 3 adults in Switzerland have downloaded the app. However, only 15% of new cases also triggered DPT-app notifications, and indicators also reveal ignored app notifications. In the full survey sample (n=2’098), higher monthly household income or being a non-smoker were associated with higher SwissCovid app uptake; older age or having a non-Swiss nationality with a lower uptake. In a subsample including more detailed information (n=701), high trust in health authorities was associated with higher SwissCovid app uptake.The indicators help to monitor key drivers of DPT-apps effectiveness and hint to non-compliance issues. Streamlining procedures, removing technical hurdles, and communicating the usefulness of DPT-apps are crucial to promote uptake, compliance, and ultimately effectiveness of DPT-apps for pandemic mitigation.
Sleep Duration and the Risk of Metabolic Syndrome: a Systematic Review and Meta-analysis
Authors: Hua Jianian , Jiang Hezi , Fang Qi 
Published: September 2020

AbstractObjectiveEpidemiologic studies have reported inconsistent findings about the association between sleep duration and metabolic syndrome. We aimed to clarify this association by method of metaanalysis.MethodsMedline, Embase, CINAHL and PsycINFO databases were searched from inception to May 2020. We collected data from 235,895 participants from 9 prospective cohort studies, and 340,492 participants from 26 cross-sectional studies. Risk ratios (RR) or odds ratios (OR) were calculated separately for cohort studies and cross-sectional studies, through meta-analysis of adjusted data from individual studies.ResultsFor cohort studies, short sleep duration was associated with an increased risk of metabolic syndrome (RR, 1.15; 95% CI, 1.05-1.25). Long sleep duration was not associated with new onset metabolic syndrome (RR, 1.02, 0.85-1.18). For cross-sectional studies, both short (OR, 1.12, 95% CI, 1.08-1.18) and long (OR, 1.06, 1.01-1.11) sleep duration was associated with high prevalence of metabolic syndrome.ConclusionsOnly short sleep duration was associated with an increased risk of metabolic syndrome. Future studies should address whether the association is casual and modifiable.
Pan-cancer analysis reveals unique molecular patterns associated with age
Authors: Shah Yajas , Verma Akanksha , Marderstein Andrew , Bhinder Bhavneet , Elemento Olivier 
Published: September 2020

AbstractOlder age is a strong risk factor for several diseases, including cancer. In cancer, older age is also frequently associated with a more aggressive, treatment-refractory tumor phenotype. The etiology and biology of age-associated differences among cancers are poorly understood. To address this knowledge gap, we sought to delineate the differences in tumor molecular characteristics between younger and older patients across a variety of tumor types. We found that tumors in younger and older patients exhibit widespread molecular differences. First, we observed that tumors in younger individuals, unlike those in older ones, exhibit an accelerated molecular aging phenotype associated with some hallmarks of premature senescence. Second, we found that tumors from younger individuals are enriched for driver gene mutations resulting in homologous recombination defects. Third, we observed a trend towards a decrease in immune infiltration and function in older patients and found that, immunologically, young tumor tissue resembles aged healthy tissue. Taken together, we find that tumors from young individuals possess unique characteristics compared to tumors in older individuals, which can potentially be leveraged for differential therapeutic strategies.
Motor and cognitive outcomes of low birth weight neonates born in a limited resource country: a systematic review
Authors: Radaelli Graciane , Leal-Conceição Eduardo , Neto Felipe K. , Taurisano Melissa R. G. , Majolo Fernanda , Bruzzo Fernanda T. K. , Linda Booij , Nunes Magda L. 
Published: September 2020

AbstractObjectiveTo examine the outcomes of motor and cognitive development among neonates born with low birth weight (LBW) or very low birth weight (VLBW).Data sourcesSystematic review carried out in PubMed, Cochrane Library and Web of Science using the search strategy using combinations of the following keywords and terms: preterm birth OR prematurity OR premature Infants OR premature children AND low birth weight children OR very low birth weight children AND neurodevelopment OR cognitive development OR Motor development OR follow up AND humans. Articles searched were published from inception until July, 2019, and involved children born and evaluated in Brazil. The bias risk analysis was adapted from the STROBE scale, used to evaluate the methodology of the included studies.Data synthesisThe search identified 2,214 publications. After screening for titles and abstracts and removing duplicate entries, full texts of 38 articles were reviewed. After reading full texts, 24 articles met the inclusion criteria (articles in Portuguese and English), dated from 1998 to 2017). Endnote Version X9 software was used for data extraction. Two reviewers performed the literature search and study selection independently. Disagreements were solved by consensus or by a third reviewer.Resultsit was evidenced an inferior motor development of children with LBW when compared to the control population, the standardized mean difference of [-1.15 (95% CI - 1.56, -0.73), I2 80%], children with LBW have lower cognitive development according the standardized mean difference of [-0,71 (95% CI -0.99, -0.44) I2 67%].ConclusionOur review reinforces that impaired motor and cognitive outcome is a significant long-term outcome associated with LBW. The risk of impairment in those domains increases with decreasing gestational age.
Prevalence of SARS-CoV-2 Infections in a Pediatric Orthopedic Hospital
Authors: Bardai Ghalib , Ouellet Jean A. , Engelhardt Thomas , Bertolizio Gianluca , Wu Zenghui , Rauch Frank 
Published: September 2020

AbstractThis project assessed the prevalence of active and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a specialized pediatric institution that did not provide care for coronavirus disease 2019 (Covid-19). The study was performed in Montreal, the city with the highest number of Covid-19 cases in Canada during the early phase of the pandemic. Testing for SARS-CoV-2 RNA in 199 individuals (39 children, 61 accompanying persons, 99 hospital employees) did not reveal active infection in any of the study participants. However, 22 (11%) of study participants had SARSCoV-2 IgG antibodies, indicating prior infection. Ten of these participants did not report symptoms compatible with Covid-19 in the 6 months prior to the study. Thus, although no evidence for active infection was found within the institution, consideration should be given to regular staff testing to detect asymptomatic spreading of SARS-CoV-2. In addition, it could be useful to test accompanying persons in children presenting for surgical procedures.