bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can hope elevate microfinance? Evidence from Oaxaca, Mexico
Authors: Rojas Valdes Ruben Irvin , Wydick Bruce , Lybbert Travis J 
Published: September 2020

AbstractRecent evidence suggests that the average effects of microfinance on borrowers is more modest than previously claimed. We carry out an experiment to test whether an intervention designed to increase aspirational hope among borrowers can elevate microfinance impacts. In collaboration with a microfinance lender in Mexico, we produced a documentary featuring successful borrowers within the organization and designed and implemented a hope curriculum rooted in positive psychology (Snyder, 1994), which conceptualizes hope as aspirations, agency, and pathways. Bank officers incorporated this curriculum into their regular weekly meetings with a randomly treated half of 52 women’s savings and credit groups with 733 women over the course of one year. We find that the intervention modestly increased indices measuring both aspirational hope and microenterprise performance over this time period. The intervention significantly increased employment and plans to hire new employees. Increases in microenterprise sales and profits were positive but statistically insignificant.
Clinical Trials Increase Off-Study Drug Use: A Segmented Time-Series Analysis
Authors: Butler-Laporte Guillaume , Cheng Matthew P , Thirion Daniel J G , De L’Étoile-Morel Samuel , Frenette Charles , Paquette Katryn , Lawandi Alexander , McDonald Emily G , Lee Todd C 
Published: September 2020

Abstract

Background
The effect of participation in a clinical trial on concomitant off-study investigational drug use has not been described. We sought to determine if participation in the Daptomycin as Adjunctive Therapy for Staphylococcus aureus bacteremia (DASH) trial increased overall daptomycin prescribing at study sites.

Methods
We retrospectively analyzed daptomycin use for 8 years preceding the trial, off-study daptomycin use during the trial itself (31 months), and daptomycin use for 6 fiscal months after trial completion. We used a segmented linear regression analysis of an interrupted time series to analyze changes in each drug’s defined daily doses (DDD) per 1000 patient-days. As a control, we analyzed use of linezolid over these periods and also accounted for rates of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections.

Results
For 1.5 years before the DASH trial, daptomycin use was decreasing by –0.30 DDD per 1000 patient-days per fiscal period (95% CI, –0.52 to –0.07). Following the initiation of the study, there was a statistically significant increase in daptomycin use of 0.28 DDD per 1000 patient-days per fiscal period (95% CI, 0.03 to 0.52), despite low, stable rates of MRSA and VRE infections. Following trial completion, daptomycin use decreased back toward prestudy rates. Use of linezolid remained stable throughout.

Conclusions
Despite the DASH trial being a negative study, it impacted the prescribing habits of local clinicians during recruitment. Trialists should be aware of potential off-target study effects, and prescribers should be wary of early uptake of interventions before definitive study results.
Genetic Determinants of Antibody-Mediated Immune Responses to Infectious Diseases Agents: A Genome-Wide and HLA Association Study
Authors: Butler-Laporte Guillaume , Kreuzer Devin , Nakanishi Tomoko , Harroud Adil , Forgetta Vincenzo , Richards J Brent 
Published: September 2020

AbstractBackgroundInfectious diseases are causally related to a large array of noncommunicable diseases (NCDs). Identifying genetic determinants of infections and antibody-mediated immune responses may shed light on this relationship and provide therapeutic targets for drug and vaccine development.MethodsWe used the UK biobank cohort of up to 10 000 serological measurements of infectious diseases and genome-wide genotyping. We used data on 13 pathogens to define 46 phenotypes: 15 seropositivity case–control phenotypes and 31 quantitative antibody measurement phenotypes. For each of these, we performed genome-wide association studies (GWAS) using the fastGWA linear mixed model package and human leukocyte antigen (HLA) classical allele and amino acid residue associations analyses using Lasso regression for variable selection.ResultsWe included a total of 8735 individuals for case–control phenotypes, and an average (range) of 4286 (276–8555) samples per quantitative analysis. Fourteen of the GWAS yielded a genome-wide significant (P &lt; 5 ×10-8) locus at the major histocompatibility complex (MHC) on chromosome 6. Outside the MHC, we found a total of 60 loci, multiple associated with Epstein-Barr virus (EBV)–related NCDs (eg, RASA3, MED12L, and IRF4). FUT2 was also identified as an important gene for polyomaviridae. HLA analysis highlighted the importance of DRB1*09:01, DQB1*02:01, DQA1*01:02, and DQA1*03:01 in EBV serologies and of DRB1*15:01 in polyomaviridae.ConclusionsWe have identified multiple genetic variants associated with antibody immune response to 13 infections, many of which are biologically plausible therapeutic or vaccine targets. This may help prioritize future research and drug development.
Maximizing the impact of the Canada Child Benefit: Implications for clinicians and researchers
Authors: Pentland Maximilian , Cohen Eyal , Guttmann Astrid , de Oliveira Claire 
Published: September 2020

Abstract
Child poverty remains a persistent problem in Canada and is well known to lead to poor health outcomes. The Canada Child Benefit (CCB) is a cash transfer program in effect since 2016, which increased both the benefit amount and number of families eligible for the previous child benefit. While the CCB has decreased child poverty rates, not all eligible families have participated. Clinicians can play an important role in screening for uptake of the program and helping families navigate the application process through several free resources. While prior research on past programs has shown benefit of similar cash transfer programs to both child and parental outcomes (both health and social), the CCB has not yet been extensively studied. Research would be valuable in both assessing the cost effectiveness of the program, especially across different income groups, and improving implementation in hard-to-reach populations.
Fault-Controlled Magma Ascent Recorded in the Central Series of the Rum Layered Intrusion, NW Scotland
Authors: Troll V R , Mattsson T , Upton B G J , Emeleus C H , Donaldson C H , Meyer R , Weis F , Dahrén B , Heimdal T H 
Published: September 2020

Abstract
The Palaeogene layered ultrabasic intrusion of the Isle of Rum forms the hearth of the Rum Igneous Centre in NW-Scotland. The regional Long Loch Fault, which is widely held to represent the feeder system to the layered magma reservoir, dissects the intrusion and is marked by extensive ultrabasic breccias of various types. Here we explore the connection between the layered ultrabasic cumulate rocks and breccias of central Rum that characterize the fault zone (the ‘Central Series’) and evaluate their relationship with the Long Loch Fault system. We show that fault splays in the Central Series define a transtensional graben above the Long Loch Fault into which portions of the layered units subsided and collapsed to form the extensive breccias of central Rum. The destabilization of the cumulate pile was aided by intrusion of Ca-rich ultrabasic magmas along the faults, fractures and existing bedding planes, creating a widespread network of veins and dykelets that provided a further means of disintegration and block detachment. Enrichment in LREE and compositional zoning in intra cumulate interstices suggest that the collapsed cumulates were infiltrated by relatively evolved plagioclase-rich melt, which led to extensive re-crystallization of interstices. Clinopyroxene compositions in Ca-rich gabbro and feldspathic peridotite veins suggest that the intruding magma was also relatively water-rich, and that pyroxene crystallized dominantly below the current level of exposure. We propose that the Long Loch Fault opened and closed repeatedly to furnish the Rum volcano with a pulsing magma conduit. When the conduit was shut, pressure built up in the underlying plumbing system, but was released during renewed fault movements to permit dense and often crystal-rich ultrabasic magmas to ascend rapidly from depth. These spread laterally on arrival in the shallow Rum magma reservoir, supplying repetitive recharges of crystal-rich magma to assemble the rhythmic layering of the Rum layered intrusion.
Evaluating the relationship between fecal egg count, FAMACHA score, and weight in dewormed and non-dewormed Katahdin rams during a parasite challenge
Authors: Galyon Hailey R , Zajac Anne M , Wright D Lee , Greiner Scott P , Bradford Heather L 
Published: September 2020

Abstract
The objective of this study was to evaluate and to estimate the relationship between fecal egg counts (FECs) and FAMACHA score and the body weight of growing Katahdin rams during a parasite challenge. One of the largest factors negatively influencing reproduction and economics in the sheep industry is gastrointestinal nematode (GIN) parasites. Due to anthelmintic resistance of these parasites, animals are selected for parasite resistance using FEC and FAMACHA scores. Data were used from the Virginia Tech Southwest Agricultural Research and Extension Center Ram Test in Glade Spring, VA, from the year 2012 to 2018 in which animals were tested in 14-d intervals for 70 d. Mixed models for repeated weight measurements were made from backward stepwise selection to evaluate the relationships between weight and GIN FEC. A total of 576 animals within 23 contemporary groups derived from test year and pasture group were analyzed. Ram, contemporary group, and consignor were considered random effects, and fixed effects were birth type, test day, age, age squared, starting weight, FEC, and FAMACHA score. Pairwise contrasts were used in the statistical analysis of parameters and their interactions. Weight and age were found to have a quadratic relationship. Increased FEC was associated with weight loss at a rate of 0.00030 kg/FEC (P &lt; 0.0001). Animals dewormed at any point during the trial weighed less than those that were not and increased with test day to a maximum difference of 4.66 kg (P &lt; 0.001). FAMACHA score was found to be significant (P &lt; 0.05), but a direct relationship with weight was not conclusive. Overall, rams with severe enough parasite load to require deworming had lesser weights, which could impact the profitability of sheep production and reinforced the need to select animals that had greater innate parasite resistance.
Safety Evaluation of Biportal Endoscopic Lumbar Discectomy
Authors: Kang Min-Seok , Park Hyun-Jin , Hwang Jin-Ho , Kim Ju-Eun , Choi Dae-Jung , Chung Hoon-Jae 
Published: September 2020

Study Design.
A prospective study.

Objective.
To evaluate the change in cervical epidural pressure (CEP) during biportal endoscopic lumbar discectomy (BELD).

Summary of Background Data.
In percutaneous uniportal endoscopic lumbar discectomy, irrigation fluid (IF) introduced into the spinal canal during surgery can compress the thecal sac, and act as a potential risk for neurological complications by disturbing cerebrospinal fluid (CSF) circulation and increasing intracranial pressure.

Methods.
Thirty consecutive patients, who underwent BELD, which was performed under automated pump system, an infusion pressure of 30 mmHg were enrolled. The change in CEP on C7–T1 level was measured. CEP was measured in each of the five phases of the procedure (1st phase—making surgical portals; 2nd phase—creating a workspace; 3rd phase—performing neural decompression and discectomy; 4th phase—factitious increase of pressure by clogging the outflow; 5th phase—dismission from fluid irrigation system). Neurological complications and independent risk factors were evaluated.

Results.
In the final 27 patients, changes in CEP during surgery were similar. The baseline CEP was 14.8 ± 2.8 mmHg, and the mean CEP in the 3rd phase 18.8 ± 5.1 mmHg was not significantly higher. In the 4th phase, however, the CEPs rose with linear correlation as the pressure increased. In the 5th phase, the elevated CEP returned to baseline in 2.5 ± 5.6 minutes. No patient had neurological complications. No statistically significant risk factors were observed.

Conclusion.
In BELD, which is performed to allow continuous lavage with infusion pressure set to 30 mmHg, CEP does not increase beyond the physiological range. Therefore, BELD may be considered as a potentially safe technique.

Level of Evidence: 4
Urinary bladder stone due to retained indwelling ureteral stent
Authors: Zhang Fuxun , Yu Jianhong , Wang Qianlong , Lu Yiping 
Published: September 2020

Abstract

Rationale:
The indwelling ureteral stents is a common procedure in routine urological practice. The double-J (D-J) stent is the most common type of stents used and is indicated mainly for short-term urinary drainage and prevention of obstruction and infection. However, prolonged indwelling stents may result in disastrous complications, such as hematuria, infection, encrustation, and stone formation. In this context, the persistence of stent in situ might play a key role as a nidus in deposition of urinary sediment, then forming calculus. Although the encrustation may become more serious as time goes on, large bladder stones are relatively rare. However, the serious encrustation and giant stone may complicate or exacerbate the conditions in turn.

Patient concerns:
A 45-year-old female patient who underwent right ureteral stent placement after open ureterolithotomy 6 years ago complained of dysuria, urinary frequency, and urgency over 2 months.

Diagnosis:
The kidney ureter bladder (KUB) x-ray showed the presence of a giant stone in the bladder and an entire D-J stent. The computed tomography (CT) urography scans revealed normal left kidney, right hydronephrosis, and an encrusted D-J stent with the significant stone, diameter 4.2 cm with a CT value of 1211.0 ± 221.6 HU, on the vesical coil. On the basis of these auxiliary examinations, the case was diagnosed as cystolith and prolonged-indwelling stents.

Interventions:
Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent.

Outcomes:
No residual stone was detected on postoperative KUB x-ray and CT urography scans. Patient recovered well and was discharged 10 days after surgery. Semi-annual ultrasound examination was suggested to monitor the effect of therapy.

Lessons:
This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.
Acquired hemophagocytic lymphohistiocytosis as initial manifestation of multiple myeloma
Authors: Mendes Fernanda Rodrigues , Sobral Karine Marques , Culler Hebert Fabricio , Couto Samuel Campanelli Freitas , Pereira Juliana , Rocha Vanderson , Martinez Gracia Aparecida , Lage Luís Alberto de Pádua Covas 
Published: September 2020

Abstract

Introduction:
Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by a hyperinflammatory state and persistent macrophage activation, resulting in reactive phagocytosis of the hematopoietic elements. In children, it is usually a hereditary disorder, while in adults it is usually acquired secondary to viral infections, collagenoses, or tumors. Although accounting for 10% of hematologic malignancies, HLH is rarely associated with multiple myeloma (MM) and other plasmacytic dyscrasias.

Patient concerns:
A 64-year-old Brazilian man seeked medical care with a 3-month history of intermittent fever, weight loss, night sweats, and progressive anemic symptoms.

Diagnosis:
Total blood count showed severe bicytopenia (normocytic-normochromic anemia and thrombocytopenia), biochemical exams showed elevation of creatinine, as well as monoclonal peak in serum protein electrophoresis, high IgA dosage, and serum immunofixation with IgA kappa paraprotein. Bone marrow biopsy showed 30% of monoclonal and phenotypically anomalous plasmocytes, confirming the diagnosis of MM. Diagnosis of HLH was established by the presence of clinical and laboratory criteria: fever, splenomegaly, cytopenias, hypofibrinogenemia, hyperferritinemia, elevation of triglycerides, and several figures of erythrophagocytosis in bone marrow aspirate.

Interventions:
The patient experienced pulse therapy with methylprednisolone for hemophagocytic lymphohistiocytosis, followed by initial therapy for multiple myeloma with cyclophosphamide and dexamethasone.

Outcomes:
Once the diagnosis of MM and secondary hemophagocytic syndrome was established, the patient had a rapid clinical deterioration despite the established therapeutic measures, evolving with cardiovascular failure, acute liver failure, acute disseminated intravascular coagulation, worsening renal dysfunction requiring dialysis support, respiratory dysfunction, and lowering of consciousness, characterizing rapid multiple organ dysfunction, ultimately leading to the death of the patient.

Innovation:
Here, we aimed to describe the sixth reported case of HLH associated with MM, according to cases cataloged in the PubMed database, and the first case evaluated by 18-fluordeoxyglucose positron emission tomography (18-FDG-PETCT).

Conclusion:
Our case report seeks to provide support for a better clinical and laboratory characterization of this rare paraneoplastic entity associated with MM, and aims to call the attention of hematologists and intensivists to this condition that falls within the scope of the differential diagnosis of rapid onset multiple organ failure in patients with plasmacytic neoplasms.
Complete blood count reflecting the disease status of giant cell arteritis
Authors: Yin Yue , Zhang Yun , Wang Dongmei , Han Xinxin , Chu Xiaotian , Shen Min , Zeng Xuejun 
Published: September 2020

Abstract
Giant cell arteritis (GCA) is the most common vasculitis in elderly, with ischemic and constitutional symptoms caused by vascular involvement and systemic inflammation. Early initiation of therapy results in prompt remission, while patients may still experience flares or severe complications during glucocorticoid tapering. This study was to identify the characteristics of Chinese GCA patients with different prognosis.
Ninety-one patients diagnosed with GCA in Peking Union Medical College Hospital in the last 20 years were followed up. Those who were lost to follow up or were followed up for less than 1 year were excluded. According to the prognosis, patients were divided into the group of favourable prognosis (patients who sustained disease remission for over 1 year) and unfavorable prognosis (patients who had relapses or severe complications). Clinical data at disease onset and after treatment were collected and analysed between the 2 groups.
Thirty-seven patients with favourable prognosis and 40 patients with unfavourable prognosis were admitted into the study. Fever as an onset symptom was less common in favourable group (P=.016). As for presentations of GCA, fever, tenderness and abnormal pulsation of temporal artery and jaw claudication were less frequently observed in patients with favourable prognosis (P=.029, .049, .043, respectively). At onset, medium-size arteries were affected more in unfavorable prognosis group (P = .048), and involvement of branches below the aortic arch were more common in favorable prognosis group (P = .034). Erythrocyte sedimentation rate in group of favourable prognosis were significantly lower after treatment (P = .041). Compared with healthy subjects, GCA patients had increased monocytes and decreased lymphocytes at disease onset (P < .01). Monocyte counts were higher in patients with favourable prognosis at disease onset (P = .043), while no significant differences were seen between the 2 groups after treatment. Lymphocyte counts were lower in patients with unfavourable prognosis (P = .014) after treatment.
Complete blood count may reflect the disease status of GCA. Little change in monocyte during treatment and lower lymphocytes after treatment may serve as potential predictors of unfavourable clinical prognosis.
From Hospital to Home: A Resident-Driven Quality Improvement Project to Overcome Discharge Prescription Barriers
Authors: Patel Parimal A. , Dillon John R. , Mazique Derek C. , Lee Jennifer I. 
Published: September 2020

Background and Objectives:
Inability to obtain timely medications is a patient safety concern that can lead to delayed or incomplete treatment of illness. While there are many patient and system factors contributing to postdischarge medication nonadherence, availability and insurance-related barriers are preventable.

Purpose:
To implement a systematic process ensuring review of discharge prescriptions to ensure availability and resolve insurance barriers before patient discharge.

Methods:
A prospective single-arm quality improvement intervention study to identify and address insurance-related prescription barriers using nonclinical staff. Intervention was pilot tested with sequential spread across general medicine resident teams. The primary outcome was successful obtainment of postdischarge prescriptions confirmed by phone calls to patients or their pharmacies.

Results:
From April to August 2015, 59 of 161 patients included in the improvement process (36.6%) had one or more insurance or availability-related barriers with their prescriptions, totaling 89 issues. Forty-three of the 59 patients (72.9%) responded to postdischarge phone calls, 39 of whom (39/43, 90.7%) successfully filled their prescriptions on the first pharmacy visit.

Conclusions:
In our study, we preemptively identified that over a third of patients discharged would have encountered barriers filling their prescriptions. This interdisciplinary quality improvement project using nonclinical team members removed barriers for over 90% of our patients to ensure continuation of medical therapy without disruption and a safer postdischarge plan.
Reducing Door-to-Needle Time for Tissue Plasminogen Activator Administration in a Community Hospital: An Operations Study
Authors: Pitre Tyler , Evans Kyle , Tang Xinxin , Shamsuddin Adib , Mir Adhora , Lee Catherine , Zia Zaka , Costa Andrew P. , Giilck Stephen 
Published: September 2020

Background and Objectives:
The benefit of tissue plasminogen activator (tPA) in acute ischemic stroke is time dependent. A 15-minute decrease in door-to-needle (DTN) time has been associated with increased odds of ambulating independently, faster discharge, and decreased odds of death. We investigated common causes of delay in DTN times in a community hospital setting in order to identify areas for improvement.

Methods:
A retrospective medical record review was conducted at a 574-bed community hospital. This included 100 patients who received tPA from 2016 to 2019. Time segments were classified a priori to reflect key work elements from the time between hospital arrival to tPA and recorded for each chart. Linear regression models were used to identify work elements associated with increased DTN time.

Results:
Median DTN time was 54:29 minutes. Linear regression analyses determined that differences in NIHSS score (P = .030), triage to computed tomography (CT) start (P = .017), triage to stroke physician page (P = .016), and CT report to tPA administration (P < .001) were associated with increased DTN time. CT report to tPA administration was most strongly associated with a Pearson coefficient of 0.868 (P < .001) with increased DTN time.

Conclusions:
The DTN time at our institution was above the recommended target. Our findings suggest that reducing the CT report time interval may decrease DTN time.