bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retention and motivation of health workers in remote and rural areas in Cross River State, Nigeria: a discrete choice experiment
Authors: Okoroafor S C , Ongom M , Salihu D , Mohammed B , Ahmat A , Osubor M , Nyoni J , Nwachukwu C , Bassey J , Alemu W 
Published: December 2020

ABSTRACT

Background
Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers.

Methods
Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations.

Results
Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided.

Conclusion
Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc., as well as improving opportunities for career advancement will support retention in rural health posts.
The first fossil Microweiseini (Coleoptera: Coccinellidae) from the Eocene of Europe and its significance for the reconstruction of the evolution of ladybird beetles
Authors: Szawaryn Karol 
Published: December 2020

AbstractMolecular studies on the evolution of ladybird beetles date their origin somewhere in the Cretaceous, but no fossils are known from that period. The oldest representatives come from the Eocene, with the richest diversity found in Baltic amber. Until now, representatives of only three tribes (from around 40 known) have been recognized. Recent investigation of Baltic amber have revealed representatives of the fourth tribe (Microweiseini), which are described here as Baltosidis gen. nov. with three new species: B. damgaardi sp. nov., B. damzeni sp. nov. and B. szadziewskii sp. nov. In order to test the systematic placement of this extinct genus, a phylogenetic analysis of Microweiseinae was conducted. The results place Baltosidis in a cluster with four modern genera of Microweiseini distributed exclusively in the New World. Such a distribution pattern is surprising because no close relatives of the newly described fossil genus are known from Europe or even from the Palaearctic region. Analysis of the distribution of Microweiseini genera leads to the conclusion of a possible Gondwanan origin of the tribe. Further comparison of the diversity of the ladybird beetles from modern ecosystems with those known from Baltic amber suggests substantial differences between these communities and a recent radiation of modern fauna.
Leveraging Telehealth and Medical Student Volunteers to Bridge Gaps in Education Access for Providers in Limited-Resource Settings
Authors: McLeod Megan E. , Oladeru Oluwadamilola T. , Hao Jinxuan , Malhotra Sameeksha H. , Chang Betty T. , Li Benjamin C. 
Published: December 2020

Problem
High-quality training opportunities for providers in limited-resource settings are often scarce or nonexistent. This can lead to a dearth of boots-on-the-ground workers capable of translating knowledge into effective action. The tested telehealth education model of Project ECHO (Extension for Community Healthcare Outcomes) can help address this disparity. However, the planning and logistical coordination required can be limiting.

Approach
Medical student volunteers interested in health disparities and global health can be leveraged to reduce the costs of administration for Project ECHO programs. From mid-2018 to present (2020), student organizations have been formed at Vanderbilt University School of Medicine, University of California, San Francisco, School of Medicine, and Albert Einstein College of Medicine. These organizations have recruited and trained volunteers, who play an active role in assessing the needs of local clinics and providers, developing curricula, and coordinating the logistical aspects of programs.

Outcomes
In the first 4 student-coordinated Project ECHO cohorts (2019–2020), 25 clinics in 14 countries participated, with a potential impact on over 20,000 cancer patients annually. Satisfaction with the telehealth education programs was high among local clinicians and expert educators. Students’ perceived ability to conduct activities important to successfully orchestrating a telehealth education program was significantly greater among students who had coordinated one or more Project ECHO programs than among students who had yet to participate for 7 of 9 competencies. There also appears to be an additive effect of participating in additional Project ECHO programs on perceived confidence and career path intentions.

Next Steps
The student-led model of coordinating telehealth education programs described here can be readily expanded to medical schools across the nation and beyond. With continued expansion, efforts are needed to develop assessments that provide insights into participants’ learning, track changes in patient outcomes, and provide continuing medical education credits to local clinicians.
Incidence of radiographic findings of femoroacetabular impingement in a healthy Egyptian population: a cross-sectional study
Authors: Abdelazeem Ahmed Hazem , Akef Amr Houssien , El Hadiedy Talaat , Fahmy Mahmoud 
Published: December 2020

Background:
Femoroacetabular impingement (FAI) is a unique pathological problem affecting young adults. It can be defined as the impingement between the proximal femur and the acetabular rim. Although clinical presentation usually is hip pain, it can be asymptomatic. Radiographic FAI findings are quite common in a population of healthy young adults and must be correlated to the clinical presentation. The aim of our study was to evaluate the incidence of radiographic findings of FAI among a cohort of healthy Egyptian participants.

Methods:
From March 2017 to April 2019, a cross-sectional study was conducted among a cohort of 160 Egyptians (100 men and 60 women) from 20 to 40 yr old. Anteroposterior and frog-leg lateral views were obtained for 320 hips. By using computer software (ICONICO Screen Protractor, ICONICO, Inc., New York, NY), we measured central edge crossover sign alpha angle and the acetabular index.

Results:
Pincer type FAI was found in 86 hips on the right side (53.27%) and in 104 hips on the left side (65%). Cam type of FAI was found in 54 hips on the right side (34.2%) and in 54 hips on the left side (34.2%). Mixed type was found in 26 hips on the right side (16.25%) and in 32 hips on the left side (20%).

Conclusions:
Radiographic FAI findings are quite common in Egyptian healthy young adults who have no hip symptoms. Clinical diagnosis is necessary for FAI and must be correlated with the radiographic data.

Level of Evidence:
Level II.
Predictors of outcome after total talectomy: a retrospective case series
Authors: Hosseinzadeh Pooya , James Loren , Stirton Jacob , Hamilton Hunter , Minaie Arya , Muchow Ryan D. , Iwinsky Henry J. , Talwalkar Vishwas R. , Walker Janet L. , Milbrandt Todd A. 
Published: December 2020

Background:
Talectomy has been used as a salvage procedure to correct severe and rigid foot deformities in patients with underlying neuromuscular conditions. Previous clinical reports have failed to compare outcomes based on the underlying condition. We report predictors of outcomes in patients who were treated with talectomy over 23 yr.

Methods:
We retrospectively reviewed the patients who underwent total talectomy from 1987 to 2010. Clinical results were graded as “good” and “poor” depending on postoperative pain, degree of equinus, skin findings, and the ability to brace. Postoperative lateral radiographs of the ankle were reviewed to determine tibiocalcaneal angle and retained talus. Statistical analysis was used to evaluate the effect of underlying diagnosis and tibiocalcaneal angle on the clinical outcome.

Results:
Thirty-eight patients (58 feet) were included in the study. The average length of follow-up was 5.1 yr. Fifty operated feet (86.2%) had a “good” outcome. Average tibiocalcaneal angle was 73.92 degrees in patients with outcomes categorized as good compared to 99.75 degrees in patients with outcomes categorized as poor (P=0.012). Of the feet with myelomeningocele, 96.3% (26 feet) had outcomes categorized as good compared to 75% of feet (9 of 12) with arthrogryposis. The clinical outcome was significantly better in patients with myelomeningocele compared to patients with arthrogryposis (P=0.04).

Conclusions:
Talectomy can be used as a salvage procedure to achieve a pain-free, plantigrade, and braceable foot in patients with a variety of musculoskeletal disorders. A tibiocalcaneal angle of less than 90 degrees at final follow-up and a diagnosis of myelomeningocele correlated with “good” clinical outcomes, aiding clinicians in preoperative stratification based on underlying diagnosis.

Level of Evidence:
Level III.
Development of a Training Curriculum for Hospital Security About Autism Spectrum Disorder
Authors: Christiansen Audrey , Harstad Elizabeth , Sideridis Georgios , Weissman Laura 
Published: December 2020

ABSTRACT:

Objective:
To evaluate whether a newly developed autism spectrum disorder (ASD)-training curriculum for hospital security officers improves comfort, knowledge, and practice.

Methods:
Participants were security officers. The ASD-training curriculum was a 45-minute interactive session, adapted from trainings developed for other types of hospital providers. The curriculum included information regarding the presentation of, and challenges faced by, children with ASD in the hospital setting. Officers completed surveys before (T1), immediately after (T2), and 3 months after (T3) the training to assess comfort, knowledge, and practice. Comfort (Likert scale 1–5; 5 = highest) and knowledge (11 yes/no questions) questions were adapted from previous measures. Application of skills was assessed using case scenarios (at T1, T2, and T3) and with officers' report of using various strategies (at T1 and T3; Likert scale 1–5; 5 = always). Data were analyzed using repeated-measures analysis of variance and a series of paired contrast.

Results:
For the 114 officers who completed surveys, mean comfort scores significantly increased from T1 to T2 (3.48 vs 3.9; p < 0.05), and these gains were maintained at T3 (4.1). Mean percent correct on knowledge questions significantly increased from T1 to T2 (74.6% vs 84.0%; p < 0.05) and was maintained at T3 (82.9%). Officers reported using 2 ASD-supportive strategies significantly more between T1 and T3: using pictures and written communication and asking the caregivers for advice.

Conclusion:
This newly developed ASD-training curriculum for hospital security officers resulted in an immediate increase of self-reported comfort and demonstrated knowledge with continued gains 3 months after training.
Femtosecond Laser-Assisted Cataract Surgery: Does It Improve Outcomes in Fuchs Endothelial Corneal Dystrophy?
Authors: Koo Ellen H. 
Published: December 2020

Abstract:
The role of femtosecond laser -assisted cataract surgery in patients with Fuchs endothelial corneal dystrophy remains poorly defined. This invited commentary examines the current evidence surrounding this often-debated topic.
Applying Computational Ethnography to Examine Nurses’ Workflow Within Electronic Health Records
Authors: Tolentino Dante Anthony , Subbian Vignesh , Gephart Sheila M. 
Published: December 2020

Background
Many existing electronic health record (EHR) workflow studies report conflicting results in time spent in the record, documentation demand, and usability and often do not explore the time-based navigation patterns of nurses.

Objective
The aim of this study was to describe computational ethnography as a contemporary and supplemental methodology in EHR workflow analysis and the relevance of this method to nursing research.

Methods
We explore the use of audit logs as a computational ethnographic data source and the utility of data mining techniques, including sequential pattern mining (SPM) and Markov chain analysis (MCA), to analyze nurses’ workflow within the EHRs. SPM extracts frequent patterns in a given transactional database (e.g., audit logs from the record). MCA is a stochastic process that models a sequence of states and allows for calculating the probability of moving from one state to the next. These methods can help uncover nurses’ global navigational patterns (i.e., how nurses navigate within the record) and enable robust workflow analyses.

Results
We demonstrate hypothetical examples from SPM and MCA, such as (a) the most frequent sequential pattern of nurses’ workflow when navigating the EHR using SPM and (b) transition probability from one record screen to the next using MCA. These examples demonstrate new methods to address the inflexibility of current approaches used to examine nursing EHR workflow.

Discussion
Within a clinical context, the use of computational ethnographic data and data mining techniques can inform the optimization of the EHR. Results from these analyses can be used to supplement the data needed in redesigning the EHR, such as organizing and combining features within a screen or predicting future navigation to improve the record that nurses use.
Positive MITF and NKI/C3 Expression in Cellular Neurothekeoma and Dermatofibroma
Authors: Abdaljaleel Maram , North Jeffrey P. 
Published: December 2020

Background:
Cellular neurothekeoma (CNT) is a benign mesenchymal tumor with uncertain cellular differentiation. Studies have found evidence of myofibroblastic differentiation and possible relation to dermatofibromas (DFs). As microphthalmia transcription factor (MITF) and NKI/C3 stains are routinely positive in CNT, we compared expression patterns of both markers in CNT and DF to assess their relationship.

Materials and Methods:
We assessed cases of CNT (n=25) and DFs (n=35) for histopathologic characteristics and MITF and NKI/C3 expression. Immunostaining results were classified as negative, focally positive (<50%), and diffusely positive (>50%). At least 1 additional melanocytic marker was assessed in each case of CNT.

Results:
Both DFs and CNTs showed a female predilection and a wide age range. Immunostaining in CNTs for MITF was positive in the vast majority (focal 68%, diffuse 24%), as was NKI/C3 (focal 72%, diffuse 24%). All DFs were MITF positive (diffuse 74%, focal 26%), and most DFs were NKI/C3 positive (focal 57%, diffuse 3%).

Conclusion:
CNT and DF share demographic, histopathologic, and immunohistochemical features, including shared expression of MITF and NKI/C3, especially cellular DF.
NLRP3 and IL-1β Gene Expression Is Elevated in Monocytes From HIV-Treated Patients With Neurocognitive Disorders
Authors: Mazaheri-Tehrani Elham , Mohraz Minoo , Nasi Milena , Chester Johanna , De Gaetano Anna , Lo Tartaro Domenico , SeyedAlinaghi SeyedAhmad , Gholami Mohammad , De Biasi Sara , Gibellini Lara , Mattioli Anna Vittoria , Pinti Marcello , Mussini Cristina , Cossarizza Andrea 
Published: December 2020

Background:
Systemic immune activation and inflammation in chronic HIV infection are driving factors of non–AIDS-related events, including neurocognitive impairment. The role of inflammasome in monocytes from patients with HIV infection has been extensively studied, but its association with the extent of neurocognitive dysfunction has been poorly investigated.

Methods:
We enrolled 79 HIV-positive patients; 44 with varying levels of HIV-associated neurocognitive disorder (HAND) and 35 without and 8 healthy donors. HAND subtypes included asymptomatic neurocognitive impairment (asymptomatic neurocognitive impairment; n = 19), mild neurocognitive disorder (MND; n = 17), and HIV-associated dementia (n = 8). We quantified plasmatic concentrations of proinflammatory cytokines (TNF-α, IL-6, IL-17A, IL-1β, and IFN-γ) for all HIV patients, and the mRNA expression of genes involved in the inflammasome activity (NLRP3, PYCARD, NAIP, AIM2, IL-1β, and IL-18) in monocytes of a subgroup of 28 HIV patients and 8 healthy donors.

Results:
HIV patients' plasma concentrations of IFN-γ, IL-1β, and IL-17A were undetectable. Levels of TNF-α and IL-6 were similar among the HIV patient groups. A trend toward an increased expression of inflammasome genes according to neurocognitive disorder severity was observed. Of note, the NLRP3 mRNA relative expression was higher in MND compared with other groups, and IL-1β was lower in MND than HIV-associated dementia patients.

Conclusions:
Changes in inflammasome components in circulating monocytes according to different HAND severity suggest that NLRP3 may be a possible biomarker or target to better understand and treat the link between systemic inflammation and neurocognitive impairment in HIV infection.
Roadway features associated with elderly drivers in motor vehicle crashes
Authors: Presser Maxwell , Nwabuo Adaobi , Soltani Shamsi , Morris Devan , Wier Megan , Plevin Rebecca E. 
Published: December 2020

BACKGROUND
As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow.

METHODS
This is a retrospective observational study using 2015 to 2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥65 years) and younger drivers. χ2 and nonparametric tests were used to analyze 36,168 drivers involved in MVCs.

RESULTS
There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared with younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared with MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared with younger drivers. However, elderly drivers were more frequently the at-fault party, especially after the age of 75 years.

CONCLUSION
Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living.

LEVEL OF EVIDENCE
Prognostic/Epidemiological, level IV.
Occipital gamma-aminobutyric acid and glutamate-glutamine alterations in major depressive disorder: An MRS study and meta-analysis
Authors: Truong Vuong , Cheng Paul Z. , Lee Hsin-Chien , Lane Timothy J. , Hsu Tzu-Yu , Duncan Niall W. 
Published: December 2020

AbstractThe neurotransmitters GABA and glutamate have been suggested to play a role in Major Depressive Disorder (MDD) through an imbalance between cortical inhibition and excitation. This effect has been highlighted in higher brain areas, such as the prefrontal cortex, but has also been posited in basic sensory cortices. Based on this, magnetic resonance spectroscopy (MRS) was used to investigate potential changes to GABA+ and glutamate+glutamine (Glx) concentrations within the occipital cortex in MDD patients (n = 25) and healthy controls (n = 25). No difference in occipital GABA+ or Glx concentrations, nor in the GABA+/Glx ratio, was found between groups. An analysis of an extended MDD patient and unmatched control dataset (n = 90) found no correlation between metabolite concentrations and depressive symptoms. These results were integrated with prior studies through metabolite-specific meta-analyses, revealing no difference in occipital GABA and Glx concentrations between patients and controls. An effect of publication year on GABA group differences was found, suggesting that previously reported results may have been artifacts of measurement accuracy. Taken together, our results suggest that, contrary to some prior reports, MRS measurements of occipital GABA and Glx do not differ between MDD patients and controls.
Modeling MRSA decolonization: Interactions between body sites and the impact of site-specific clearance
Authors: Poyraz Onur , Sater Mohamad R. A. , Miller Loren G. , McKinnell James A. , Huang Susan S. , Grad Yonatan H. , Marttinen Pekka 
Published: December 2020

AbstractMethicillin-resistantStaphylococcus aureus(MRSA) can colonize multiple body sites, and carriage is a risk factor for infection. Successful decolonization protocols reduce disease incidence; however, multiple protocols exist, comprising diverse therapies targeting multiple body sites, and the optimal protocol is unclear. Standard methods are inadequate to infer the impact of site-specific components on successful decolonization. Here, we formulate a Bayesian coupled hidden Markov model (CHMM), which estimates interactions between body sites, quantifies the contribution of each therapy to successful decolonization, and enables predictions of the efficacy of therapy combinations. We applied the model to longitudinal data from a randomized controlled trial (RCT) of an MRSA decolonization protocol consisting of chlorhexidine body and mouthwash and nasal mupirocin. Our findings 1) confirmed nares as a central hub for MRSA colonization and nasal mupirocin as the most crucial therapy, and 2) demonstrated that all components contributed significantly to the efficacy of the protocol and the protocol reduced self-inoculation. Finally, we assessed the impact of hypothetical increases on the effectiveness of each therapyin silicoand found that enhancing MRSA clearance at the skin would yield the largest gains to the overall decolonization regimen. This study demonstrates the use of advanced modeling to go beyond what is typically achieved by RCTs, enabling evidence-based decision-making to streamline clinical protocols.