bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimated Prevalence of Elder Orphans Using National Health and Aging Trends Study
Authors: Roofeh Regina , Smith Dylan M. , Clouston Sean A. P. 
Published: June 2020

Objectives: By 2050, individuals aged 65 years and older will comprise over 20% of the American population. A portion is at risk for becoming elder orphans: older adults living in the community who lack caregivers or surrogates. Methods: Using the first wave of the National Health and Aging Trends Survey, we estimated the prevalence of older adults who reside in the community, who are socially or physically isolated, and who lack caregivers. Individuals who are “at risk” meet all of these criteria, with the exception that they live with and receive caregiving from their spouse. Results: We estimated the elder orphan prevalence for this population to be 2.62% (2.24–3.00), with an additional 21.29% determined to be at risk. Discussion: As the population of the United States ages, an understanding of the prevalence and demographics of elder orphans will be useful to guide policies and services to assist this population.
Human rights education in patient care: A literature review and critical discussion
Authors: Newham Roger , Hewison Alistair , Graves Jacqueline , Boyal Amunpreet 
Published: June 2020

The identification of human rights issues has become more prominent in statements from national and international nursing organisations such as the American Nurses Association and the United Kingdom’s Royal College of Nursing with the International Council of Nursing asserting that human rights are fundamental to and inherent in nursing and that nurses have an obligation to promote people’s health rights at all times in all places. However, concern has been expressed about this development. Human rights may be seen as the imposition of legal considerations for nurses and other healthcare workers to bear in mind, as yet more responsibilities with the consequent fear of litigation. Although a more hopeful scenario is that consideration of human rights is something that is supportive of good practice. If this more hopeful scenario is to be realised, the role of education will be crucial. As with human rights generally, human rights education is a global phenomenon, a practice-orientated expression of the Universal Declaration of Human Rights, and the goal of human rights education is to build a culture of respect and action for human rights for all. However, the nature of human rights has long been contested. A ‘mapping exercise’ of the academic literature on human rights identified ‘four schools’ or ‘ideal types’ that have shaped thinking about human rights. This sets out the conceptual context in which human rights problems are defined and solutions are proposed, which is particularly important for human rights education. However, it also complicates the picture. The different approaches taken by the four ‘types’ would likely lead to different outcomes in terms of human rights education. It is timely to discuss the nature of human rights education and examine its potential for impact on patient care. This will involve identifying the challenges and potential benefits of this approach and analysing the implications for professional practice.
Threshold Retinopathy of Prematurity with Persistent Corneal Defect
Authors: Narnaware Shilpi H. , Bawankule Prashant K. 
Published: June 2020

Aim: A case which highlights the challenges faced in treating a case of type 1 early treatment of retinopathy of prematurity (ETROP) with persistent corneal defect. Case Report: We report a case of a preterm boy born at 28 weeks with birth weight of 700 g who presented with persistent corneal defect along with type 1 ETROP disease. Because of the inability to complete LASER, intravitreal ranibizumab was given as a rescue therapy to buy some time. But unfortunately, baby succumbed to disease because of associated systemic problems. Conclusion: ROP can present with persistent corneal defect which can challenge the treatment of underlying pathology.
Can Clinical Score Be Used to Guide Investigations and Management of Infants Born Through Meconium Stained Amniotic Fluid? A Prospective Observational Study*
Authors: Sanghvi Urvi , Diwakar Krishna Kumar 
Published: June 2020

Objective: To evaluate if Downes– Vidyasagar score (Downes score) for assessing respiratory distress could be used to determine the duration for observation and requirement for investigations like chest X-ray and blood gases, in an infant born through meconium stained amniotic fluid (MSAF). Materials and Methods: Prospective observational study was done in 2 phases—the initial phase to assess the role of the Downes score and the second phase to assess if the conclusions drawn from the initial phase could be applied in clinical practice. Results: In the initial phase, a total of 285 of the 302 infants born through MSAF were included for assessing the role of Downes score. The score reduced with time and did not worsen beyond 6 h. A significant association was noted between Downes score 2 or more at beyond 6 h of life and umbilical cord pH 7.15, higher AaDO2, and chest X-ray suggestive of meconium aspiration syndrome (MAS). In the second phase, applying the criteria of clinical monitoring derived from the initial phase resulted in 75% (110/147) of infants born through MSAF being shifted to the mother’s side by 6 h of life without being subjected to any investigation, Conclusion: Radiological evaluation and blood gas analysis could be restricted to only infants with persistently high or rising Downes score beyond 6 h of life. Infants having a score of <2 by 6 h of life can be shifted to mother’s side, without any further investigations or interventions.
Can Statin Treatment Reduce the Risk of Hepatocellular Carcinoma? A Systematic Review and Meta-Analysis
Authors: Chang Yue , Liu Qinyu , Zhou Zidong , Ding Yuping , Yang Mei , Xu Wei , Chen Kai , Zhang Qing , Wang Zhenguo , Li Hai 
Published: June 2020

Background: Whether statins can reduce the incidence of cancers has been an interesting topic in recent years. This meta-analysis aimed to determine the relationship between statin treatment with the risk of hepatocellular carcinoma. Methods: Studies published up to July 2019 were screened from databases. The data from approved studies were pooled. Random-effects or fixed-effects model was used to calculate the relative risk with 95% CIs in the overall group and subgroups. Sensitivity and meta-regression analyses were performed, and publication bias was evaluated. Results: A total of 18 studies involving 1 611 596 patients were included in this meta-analysis. The overall result showed a significantly reduced risk of hepatocellular carcinoma (relative risk = 0.54, 95% CI: 0.42-0.66) in statin users. In comparison to the risk in nonstatin users, the risk of hepatocellular carcinoma was reduced in all subgroups. The dose of statins and their pharmacokinetics can partly explain the heterogeneity in the overall meta-analysis ( I 2 = 94.6%, P = .000). A dose-dependent effect of statin use for the reduced risk of hepatocellular carcinoma was found. Conclusions: Findings from this meta-analysis support that statin use can significantly reduce the incidence of hepatocellular carcinoma.
Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms
Authors: Gummerer Maria , Kummann Moritz , Gratl Alexandra , Haller Daniela , Frech Andreas , Klocker Josef , Fraedrich Gustav , Gruber Hannes 
Published: June 2020

Introduction: Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI). Materials and Methods: Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed. Results: A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI. Conclusion: Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.
Impact of COVID-19 on orthopaedic care: a call for nonoperative management
Authors: Phillips Mark R. , Chang Yaping , Zura Robert D. , Mehta Samir , Giannoudis Peter V. , Nolte Peter A. , Bhandari Mohit 
Published: June 2020

Background: Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods: A systematic search was conducted, and included guidance were categorized as either “Selective Postponement” or “Complete Postponement” of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results: A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion: Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.
Using the Middle Turbinate to Protect the Skull Base in Endoscopic Transsphenoidal Surgery: A Cadaver Study
Authors: Shah Janki , Tang Dennis , Grafmiller Kevin , Cappello Zachary J. , Roxbury Christopher , Sindwani Raj 
Published: June 2020

Objectives Inadvertent intracranial injury from nasogastric tube (NGT) placement is a described and potentially fatal complication following endoscopic transsphenoidal hypophysectomy (TSH). This cadaver study assessed the role of middle turbinate (MT) preservation and medialization in preventing accidental skull base injury from NGT insertion after TSH. Methods: Standard approach for TSH was performed on 3 human cadavers. MTs were placed into neutral position (MTN), then medialized via suture pexy to the septum (MTP), and subsequently resected (MTR). After each stage, 3 blinded individuals passed a 10 F Dobhoff and a 16 F NGT on each side of each cadaver (5 passes per side). Using endoscopic visualization, each pass was scored by a blinded reviewer based on the first contact point of the tube (0 = nasopharynx, 1 = inferior sphenoid face, 2 = sphenoid sinus), with higher scores suggestive of increased risk of intracranial injury. Results: There were 270 Dobhoff and 270 NGT passes scored. Data was divided into 3 groups based on presence and position of the MT. Significant differences were demonstrated between all three groups [one-way ANOVA: Dobhoff F(2,267) = 6.981, p = 0.001], [NGT F(2,267) = 17.582, p < 0.001]. There were significant differences between means for MTN versus MTP groups [Dobhoff (0.43 vs 0.22, p = 0.007), NGT (0.73 vs 0.28, p < 0.001)] and MTP versus MTR groups [Dobhoff (0.22 vs 0.55, p < 0.001), NGT (0.28 vs 0.81, p < 0.001)], indicating that the presence and position of the MT can significantly affect the accessibility of the sphenoid sinus interior after TSH. There was a trend toward lower means in the MTN group compared to the MTR group. Conclusion: MT preservation and deliberate medialization against the septum may reduce risk of inadvertent intracranial NGT injury in postop TSH patients. This simple maneuver should be considered in all routine TSH procedures.
Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program
Authors: Resman Fredrik 
Published: June 2020

Regardless of one’s opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
Alemtuzumab-related thyroid disease in people with multiple sclerosis is associated with age and brainstem phenotype at disease onset
Authors: Yap Siew Mei , Dillon Mary , Crowley Rachel K , McGuigan Christopher 
Published: June 2020

Background Autoimmune thyroid disease (AITD) occurs in 40%–50% of alemtuzumab-treated persons with multiple sclerosis (pwMS), most of whom will develop Graves’ Disease (GD). Objective To explore contributory factors for alemtuzumab-related AITD in pwMS. Methods A retrospective patient chart review was performed. Results Sixteen out of 52 (30.8%) pwMS developed AITD. GD occurred in 56.3% ( n = 9), the majority ( n = 7, 77.8%) symptomatic. All but one (85.7%) pwMS with symptomatic GD developed atypical, large and rapid fluctuations in thyroid hormone levels unexplained by effect of anti-thyroid medication alone. All symptomatic GD cases were age ≤32 years when starting alemtuzumab (ɸ = 0.60, p = 0.03). PwMS who started alemtuzumab at a younger age developed thyroid disease earlier ( r = 0.51, p = 0.04). PwMS with clinical and radiological evidence of brainstem involvement at onset of multiple sclerosis were 11 times more likely to develop symptomatic GD compared with those with other phenotypes ( p < 0.01). Conclusion Alemtuzumab-induced reconstitution GD may result from early and increased cross-reactivity between antigens common to the brainstem and thyroid, or presence of shared Human Leukocyte Antigen (HLA) alleles that determine brainstem and thyroid involvement. We suggest cautious use of alemtuzumab in younger (≤32 years) pwMS with early brainstem involvement, especially those actively planning pregnancy, where alternative therapies are readily available.
Positive effects of ferric iron on the systemic efficacy of nephrilin peptide in burn trauma
Authors: Mascarenhas Desmond D , El Ayadi Amina , Ravikumar Puja , Kang Gyeong Jin , Langer Tammy , Moreno Carlos , Amento Edward P 
Published: June 2020

Introduction: Nephrilin peptide is a designed inhibitor of Rictor complex (also known as mTORC2), an evolutionarily conserved assembly believed to modulate responses to cellular stress. We previously demonstrated the ability of nephrilin peptide to suppress neuroinflammation, loss of body mass, glycaemic control and kidney function in a rat scald model, as well as sepsis mortality in a mouse model. The present study explores the effect of nephrilin plus iron formulations on clinically relevant outcomes in the rat scald model. Methods: Animals were treated with nephrilin by subcutaneous bolus injection on post-burn days 1–7. Equimolar ferric iron in the formulation improved the positive systemic effects of nephrilin on kidney function, glycaemic control, oxidative stress, early hyperinflammation, late inflammasome activation, hyperangiogenesis and body mass, all variables previously shown to bear upon clinically relevant burn injury outcomes. The sparing effects of nephrilin-iron were demonstrated in both sexes. Discussion: Surprisingly, optimum daily treatment doses were in the range of 2–4 mg/kg, while 8 mg/kg was less effective, suggesting the possibility of marginal pro-oxidant effects from the ‘free’ iron fraction. Thus, although ferric iron in the nephrilin formulation is clearly helpful, care must be exercised to select an optimum treatment dose. Conclusion: Iron increases the efficacy of nephrilin peptide in burns.
The Relationship Between Orthographic Awareness and Chinese Reading in Hong Kong’s Young CSL Learners
Authors: Wong Yu Ka 
Published: June 2020

Purpose: This study investigates young Chinese as a second language (CSL) learners’ Chinese character reading performance and its relationship with their orthographic awareness. There is a pressing need to gain a better understanding of Hong Kong’s ethnic minority students’ CSL acquisition, so that more effective instruction can be provided. Design/Approach/Methods: A total of 157 Hong Kong ethnic minority CSL students in Grade 4 were evaluated using a range of assessments: orthographic awareness in identifying and utilizing character components, listening comprehension for vocabulary terms and short texts, and reading Chinese character lists with single- and two-character words. Findings: The students performed consistently across the two lists but made fewer errors when reading the two-character word list, most of which were orthographical. Multiple regression analysis showed that the students’ orthographic awareness contributed significantly to their character reading. Originality/Value: The findings suggest that orthographic awareness can help ethnic minority CSL learners improve their Chinese character reading skills. Chinese classes provided for such students, and for CSL learners in general, should place greater focus on literacy training.
Assessing Diabetes Risk Factors in Rural Dwelling Grandparent Caregivers
Authors: Smalls Brittany L. , Adegboyega Adebola , Contreras Omar A. , Palmer Kelly , Hatcher Jennifer 
Published: June 2020

Objective: The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment. Methods: Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson’s correlation and regression models. Results: By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides ( r = −.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = .39). Guardianship status had a significant association with BMI ( r = −.38). There was a significant association between low-density lipoprotein (LDL; r = −.32) and access to community shared resources. In the adjusted linear model, the number of grandchildren in the home had a significant relationship with HDL (β = .012, p = .021) whereas the number of individuals living in the home had a statistically significant relationship with HDL (β = .026, p < .000) and BMI (β = .046, p = .02). In addition, 15% of participants reported being food insecure. Discussion: Efforts are needed to identify and screen at-risk populations living in geographically isolated areas. Considerations should be given to leveraging existing community resources for grandparent caregivers via schools, health systems, and government agencies to optimize health and well-being.