bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Risk Factors for Early Seizures in Traumatic Brain Injury
Authors: Parmontree Porntip , Tunthanathip Thara , Doungngern Thitima , Rojpitbulstit Malee , Kulviwat Wattanachai , Ratanalert Sanguansin 
Published: October 2019

Abstract
Background Early posttraumatic seizure (PTS) is a significant cause of unfavorable outcomes in traumatic brain injury (TBI). This study was aimed to investigate the incidence and determine a predictive model for early PTS.
Materials and Methods A prospective cohort study of 484 TBI patients was conducted. All patients were evaluated for seizure activities within 7 days after the injury. Risk factors for early PTS were identified using univariate analysis. The candidate risk factors with p < 0.1 were selected into multivariable logistic regression analysis to identify predictors of early PTS. The fitting model and the power of discrimination with the area under the receiver operating characteristic (AUROC) curve were demonstrated. The nomogram for prediction of early PTS was developed for individuals.
Results There were 27 patients (5.6%) with early PTS in this study. The final model illustrated chronic alcohol use (odds ratio [OR]: 4.06, 95% confidence interval [CI]: 1.64–10.07), epidural hematoma (OR: 3.98, 95% CI: 1.70–9.33), and Glasgow Coma Scale score 3–8 (OR: 3.78, 95% CI: 1.53–9.35) as predictors of early PTS. The AUROC curve was 0.77 (95% CI: 0.66–0.87).
Conclusions The significant predictors for early PTS were chronic alcohol use, epidural hematoma, and severe TBI. Our nomogram was considered as a reliable source for prediction.
Anthropometric Measures of the Posterior Condyles: Gender Differences and Correlation to Implant Sizing
Authors: Ehmke Thomas , Aghazadeh Mehran , Bono Olivia J. , Robbins Claire , Bono James V. 
Published: October 2019

AbstractThere is abundant data concerning morphological dimensions of the distal femur, particularly in women, which has led to redesign of the femoral component in total knee arthroplasty (TKA). Clinical experience reveals existing asymmetry of the femoral posterior condyles, yet current implant designs have a symmetrical femoral component. The objectives of this study were to analyze the dimensions of posterior condylar bone resection from a group of patients undergoing TKA and correlate the measurements to one prosthetic system. We retrospectively reviewed single surgeon morphological data from the posterior condyles of 105 knees during TKA. The study included 54 males and 51 females. Measurement of the posterior condylar bones was performed with a standard metric metal ruler by one investigator. Known dimensions of a single type of implant design were compared with the resection data. The average difference of posterior medial and lateral condylar width was 5.7 and 5.3 mm in males and females, respectively. The average host posterolateral condylar bone was 5.4 mm less than the trial implant across five sizes in both males and females. Results suggest that the dimension of the posterior lateral condyle is much smaller than the dimension of the implant in both groups of patients. Dimension of the posterior medial is close to dimension of the implant. Overhang of the component posterolaterally can create soft tissue irritation and result in postoperative pain and decreased range of motion. Our results increase awareness of the dimensions of the native posterolateral condyle and may influence future design of femoral implants used in total knee arthroplasty.
Psychiatric Comorbidity and Co-Occurring Opioid Misuse: Depression Mediates the Relationship between Post-Traumatic Stress Disorder and Opioid Misuse in Community Pharmacy Settings
Authors: Hruschak Valerie , Hildenbrand Aimee K. , Cochran Gerald 
Published: October 2019

Background Individuals who misuse opioids frequently have comorbid psychiatric issues, including post-traumatic stress disorder (PTSD) and depression. However, little is known about the mechanisms by which these disorders are associated with opioid misuse and specifically in community pharmacy settings. The current study examined whether depression mediated the relationship between PTSD and opioid misuse in patients filling opioid prescriptions. Methods We administered a health survey in four community pharmacies among patients filling opioid medications in southwestern Pennsylvania. Univariate statistics were used to assess relationships among demographic and clinical characteristics of PTSD, depression, and opioid misuse behaviors. We then examined whether depression mediated the relationship between PTSD and opioid misuse using ordinary least squares path analysis with bootstrapping. Results A total of 333 participants completed the health survey. Opioid misuse was reported among 15.9% of all participants, 33.3% among those with a positive PTSD screen, and 29.3% of those who screened positive for depression. Depression significantly mediated the relationship between PTSD and opioid misuse. Specifically, there was a statistically significant indirect effect (ab) of PTSD on opioid misuse through a pathway mediated by depression (ab = .06, SE ab = .02, 95% CI = .02–.10). The direct effect (c’) of PTSD on opioid misuse was also significant (c’ = .12, SE c’ = .05, P = .01, 95% CI = .03–.22), suggesting partial mediation. Conclusions Results suggest an indirect pathway by which clinical intervention may help ameliorate outcomes in patients with PTSD. Further, there is an increased need for screening, assessment, and intervention protocols for this patient population in which community pharmacy is a novel setting to expand future efforts within the patient population.
The Lock-In Loophole: Using Mixed Methods to Explain Patient Circumvention of a Medicaid Opioid Restriction Program
Authors: Roberts Andrew W. , Skinner Asheley C. , Lauffenburger Julie C. , Galt Kimberly A. 
Published: October 2019

Background Lock-in programs are proliferating among private and public payers to restrict access to controlled substance prescriptions and enhance care coordination for patients exhibiting high-risk use of, primarily, opioids. Patients enrolled in lock-in programs are required to seek opioids from a designated provider and pharmacy for insurance coverage of their opioid and benzodiazepine prescriptions. Lock-in program restrictions are often circumvented by patients through out-of-pocket cash purchases of opioid prescriptions, undermining the program's intended function. This study sought to construct and explain trajectories of Medicaid-covered and cash pay opioid prescription fills among adults enrolled in an opioid lock-in program. Methods We used sequential explanatory mixed methods, which involved a quantitative retrospective cohort analysis of opioid fill trajectories using North Carolina Medicaid administrative claims data linked with state prescription drug monitoring program data, followed by qualitative semi-structured interviews with North Carolina pharmacists. The quantitative component included adults enrolled in the North Carolina Medicaid lock-in program between 10/1/2010-3/31/2012. The qualitative component included a maximum variation sample of community pharmacists in North Carolina delivering care to lock-in patients. Quantitative outcomes included group-based trajectories of monthly Medicaid-covered and cash pay opioid prescription fills six months before and after LIP enrollment, and qualitative analyses generated themes explaining observed trajectories. Results Two-thirds of subjects exhibited reduced Medicaid-covered opioid prescription fills and no increase in cash pay fills after lock-in enrollment, with one-third exhibiting increased cash pay fills after lock-in. Pharmacists attributed increases in cash pay fills primarily to illicit behaviors, while some cash pay behavior likely reflected new unintended barriers to care. Conclusions Lock-in programs appear to reduce prescription opioid use for most enrolled patients. However, lock-in programs may have limited capacity to deter illicit behaviors among patients intent on abusing, misusing, or diverting these medications and may introduce new access barriers to necessary care for some.
Genetic Epidemiology Reveals 3 Chronic Reservoir Areas With Recurrent Population Mobility Challenging Poliovirus Eradication in Pakistan
Authors: Akhtar Ribqa , Mahmood Nayab , Alam Muhammad Masroor , Naeem Muhammad , Zaidi Syed Sohail Zahoor , Sharif Salmaan , Khattak Zainab , Arshad Yasir , Khurshid Adnan , Mujtaba Ghulam , Rehman Lubna , Angez Mehar , Shaukat Shehzad , Mushtaq Nighat , Umair Massab , Ikram Aamer , Salman Muhammad 
Published: October 2019

Abstract

Background
Pakistan is among 3 countries endemic for wild poliovirus type 1 (WPV1) circulation that are still struggling for eradication of poliomyelitis. Active clinical and environmental surveillance with meticulous laboratory investigations provide insights into poliovirus transmission patterns and genomic diversity to inform decisions for strategic operations required to achieve eradication.

Methods
We analyzed epidemiological and virological data to comprehend the current epidemiological status of WPV1 in Pakistan during 2015–2017. Stool specimens of patients with acute flaccid paralysis (AFP) and sewage samples collected from 60 environmental sites were tested. Viral culturing, intratypic differentiation by real-time polymerase chain reaction, and nucleic acid sequencing of the VP1 region of the poliovirus genome to determine genetic relatedness among WPV1 strains were applied.

Results
Poliovirus isolates were grouped into 11 distinct clusters, which had ≥95% nucleotide homology in the VP1 coding region. Most of the poliovirus burden was shared by 3 major reservoirs: Karachi, Peshawar, and Quetta block (64.2% in 2015, 75.4% in 2016, and 76.7% in 2017).

Conclusions
Environmental surveillance reveals importations and pockets of unimmunized children that dictate intensive target mop-up campaigns to contain poliovirus transmission. A decrease in the number of orphan isolates reflects effective combination of AFP and environmental surveillance in Pakistan. The genetic data reflect sustained transmission within reservoir areas, further expanded by periodic importations to areas of high immunity reflected by immediate termination of imported viruses. Improved immunization coverage with high-quality surveillance is vital for global certification of polio eradication.
Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama
Authors: Ara�z-Ledezma Ana B , Massar Karlijn , Kok Gerjo 
Published: October 2019

AbstractAdolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents’ health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents’ decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social–emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents’ love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents’ decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum.
Kinetic and solvent isotope effects in oxidation of halogen derivatives of tyramine catalyzed by monoamine oxidase A
Authors: Pająk Małgorzata 
Published: October 2019

AbstractThe isotope effects approach was used to elucidate the mechanism of oxidative deamination of 3′-halotyramines, catalyzed by monoamine oxidase A (EC 1.4.3.4). The numerical values of kinetic isotope effect (KIE) and solvent isotope effect (SIE) were established using a non-competitive spectrophotometric technique. Based upon KIE and SIE values, some of the mechanistic details of investigated reaction were discussed.
Pollination interactions reveal direct costs and indirect benefits of plant–plant facilitation for ecosystem engineers
Authors: Losapio Gianalberto , Schöb Christian 
Published: October 2019

AbstractAimsEcosystem engineers substantially modify the environment via their impact on abiotic conditions and the biota, resulting in facilitation of associated species that would not otherwise grow. Yet, reciprocal effects are poorly understood as studies of plant–plant interactions usually estimate only benefits for associated species, while how another trophic level may mediate direct and indirect feedback effects for ecosystem engineers is hardly considered.MethodsWe ran a field experiment with two ecosystem engineers (Arenaria tetraquetra and Hormathophylla spinosa) blooming either alone or with associated plants to decompose net effects and to test the hypothesis that pollinator-mediated interactions provide benefits that balance costs of facilitation by ecosystem engineers.Important FindingsWe found that net costs of facilitation are accompanied by pollinator-mediated benefits. Despite ecosystem engineers producing fewer flowers per plant, they were visited by more and more diverse pollinators per flower when blooming with associated plants than when blooming alone. Although seed production per plant was higher when ecosystem engineers bloomed alone, fruit set and seed set varied between species. In one case (A. tetraquetra), fruit and seed sets were negatively affected by the presence of associated plants, whereas, in another case (H. spinosa), fruit set and seed set were higher and unaffected when ecosystem engineers bloomed with associated plants, respectively. Our findings suggest that besides experiencing direct costs, ecosystem engineers can also benefit from facilitating other species via increasing their own visibility to pollinators. Thus, we highlight that pollination interactions can compensate for costs of facilitation depending on ecosystem engineer species. This study illuminates how the outcome of direct plant–plant interactions might be mediated by indirect interactions including third players.
Money, Death, and Agency in Catholic Ireland, 1850–1921
Authors: Doyle Patrick , Roddy Sarah 
Published: October 2019

Abstract
Between the end of the Great Famine and the end of the union with Britain, the Irish Catholic Church was almost exclusively funded by ordinary lay people. This article examines the financial relationship between clergy and laity, focusing on payments related to death. In doing so, it argues three main points. First, it suggests that previous conceptions of lay people coerced into giving their money to the church are too simplistic and deny the complex agency of the people of many social classes who gave the money. Second, it argues that using the financial transactions of ordinary people gives historians a much-needed methodology for recovering lives about which the archives are otherwise silent. Third, it posits that the mediation of faith through money, specifically, must be added to the growing body of work on “material religion.”
Amyotrophic Lateral Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S. Conflicts
Authors: Sagiraju Hari Krishna Raju , Živković Sasa , VanCott Anne C , Patwa Huned , Gimeno Ruiz de Porras David , Amuan Megan E , Pugh Mary Jo V 
Published: October 2019

Abstract

Introduction
Amyotrophic lateral sclerosis (ALS) is a recognized military service-connected condition. Prior prevalence studies of ALS among U.S. war Veterans were not able to address concerns related to neurodegenerative sequelae of traumatic brain injury (TBI) and disregarded risk heterogeneity from occupational categories within service branches.

Materials and Methods
We identified the prevalence of definite and possible ALS and cumulative incidence of definite ALS among Post-9/11 U.S. Veterans deployed in support of Post-9/11 conflicts (mean age 36.3) who received care in the Veterans Health Administration during fiscal years 2002–2015. Using a case-control study design, we also evaluated the association of TBI and major military occupation groups with ALS adjusting for demographics and comorbidities.

Results
The prevalence of ALS was 19.7 per 100,000 over 14 years. Both prevalence and cumulative incidence of definite ALS were significantly higher among Air Force personnel compared to other service branches and among tactical operation officers and health care workers compared to general and administrative officers. Neither TBI nor younger age (&lt;45 years) was associated with ALS. Depression, cardiac disease, cerebrovascular disease, high blood pressure, and obstructive sleep apnea were clinical comorbidities significantly associated with ALS in this population of Veterans.

Conclusion
This study among a cohort of relatively young Veterans showed a high ALS prevalence, suggesting an early onset of ALS among deployed military service members. The higher prevalence among some military specific occupations highlights the need to determine which occupational exposures specific to these occupations (particularly, Air Force personnel, tactical operations officers, and health care workers) might be associated with early onset ALS.
83. During A Million Patient-Days of Surveillance, Low Levels of Infection Prevention Staff Correlated with Higher Rates of Some Healthcare-Associated Infections
Authors: Lesho Emil P , Clifford Robert , Bronstein Melissa , Sosa Carlos , Laguio-Vila Maryrose 
Published: October 2019

Abstract

Background
Reports regarding the correlations between infection preventionist (IP) staffing levels and healthcare-associated infections (HAI) are scarce, conflicting, and crucial for resource allocation and effort prioritization. We evaluated such correlations from January 1, 2012 to March 1, 2019 at a 528-bed teaching hospital in Rochester, NY; a period when IP staffing levels fluctuated between the recommended ratio of 1 IP: 80 patients and a critically low of 1 IP: >375.

Methods
Standardized National Health Safety Network (NHSN) definitions, along with laboratory events, re-admissions, interactions with surgical teams, and an independent data management company were used for case finding of catheter-associated urinary tract infection (CAUTI), Clostridiodes difficile (CDI), central line-associated bloodstream infection (CLABSI), carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus (MRSA). Colon, prosthetic knee and hip joint, hysterectomies, and coronary artery bypass graft surgical site infections (SSI) were also studied. Standardized infection ratios (SIR) were extracted from NHSN. Staffing levels were grouped into low (/ = 7 FTE). Correlations between HAI rates, SIR, and staffing levels were examined using Poisson and T-tests with the R statistical package.

Results
The average daily census of 451 resulted in 1.18 million total patient-days of surveillance. Periods of low and recommended IP levels occurred at similar seasons and for similar durations. There were fewer CDI, CAUTI, CLABSI, and MRSA infections when IP staff were at recommended levels than when IP staff were at the lowest level, but only CDI and CLABSI rates were significantly lower (P = 0.003 and 0.005, respectively). CLABSI SIR was 1.07 and 0.64 during periods of low and recommended staffing levels, respectively (P = 0.004). No significant differences occurred in SSI, either by type or by combined.

Conclusion
Hospitals often cannot achieve or maintain recommended IP staffing levels. Our findings suggest that, during critical personnel shortages, IP may have more impact by focusing on the types of HAI that correlated with preventionist staffing levels. This is among the largest such study to date, and uniquely includes the most types of HAI.

Disclosures
All Authors: No reported Disclosures.
851. Validation of Quick Pitt Bacteremia Score in Patients with Staphylococcus aureus Bloodstream Infection
Authors: Elizabeth. Battle Sarah , Ann Justo Julie , Bookstaver P Brandon , Kohn Joseph , Al-hasan Majdi 
Published: October 2019

Abstract

Background
A quick version of the Pitt Bacteremia Score (qPitt) was recently derived based on five binary variables each assigned one point (Table 1). The qPitt broadened respiratory failure definition, simplified mental status, and eliminated fever from the original Pitt bacteremia score. The qPitt had high discrimination in predicting mortality in patients with Gram-negative bloodstream infection (BSI) and outperformed other acute severity of illness scores. This retrospective cohort study aims to evaluate the qPitt performance in patients with Staphylococcus aureus BSI and compare its discrimination to quick Sepsis Related Organ Failure Assessment (qSOFA).

Methods
Hospitalized adult patients with S. aureus BSI at Prisma Health-Midlands hospitals in South Carolina from January 1, 2015 to December 31, 2017 were identified. Multivariate logistic regression was used to examine risk factors for 28-day all-cause mortality. The area under receiver operating characteristic curve (AUROC) was used to evaluate discrimination of qPitt and qSOFA in predicting 28-day mortality (primary outcome). In-hospital and 90-day mortality were examined as secondary outcomes.

Results
Among the 398 patients with S. aureus BSI, the median age was 63 years, 241 (61%) were men, 173 (43%) had methicillin-resistant S. aureus (MRSA) BSI, and 95 (24%) died within 28 days of BSI. After adjustments for age, clinical and microbiological characteristics in the multivariate model, all five individual components of qPitt were independently associated with 28-day mortality (Table 1). There was a 3-fold increase in 28-day mortality for each point increase in qPitt (odds ratio 3.11, 95% confidence intervals: 2.40–4.02, P < 0.001). Mortality was 2% in patients with qPitt of 0 and increased to 14%, 24%, 50%, and 82% in patients with qPitt of 1, 2, 3, and ≥4, respectively. The qPitt had higher discrimination in predicting 28-day mortality than qSOFA (AUROC 0.82 vs. 0.77, P = 0.001). The qPitt also performed well in predicting in-hospital and 90-day mortality (AUROC 0.80 and 0.76, respectively).

Conclusion
The qPitt has good discrimination in predicting mortality in patients with S. aureus BSI. These results support using the qPitt as an acute severity of illness score in future studies.

Disclosures
All Authors: No reported Disclosures.