bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent Systemic Microbial Translocation, Inflammation, and Intestinal Damage During Clostridioides difficile Infection
Authors: Oliva Alessandra , Aversano Lucia , De Angelis Massimiliano , Mascellino Maria Teresa , Miele Maria Claudia , Morelli Sergio , Battaglia Riccardo , Iera Jessica , Bruno Giovanni , Corazziari Enrico Stefano , Ciardi Maria Rosa , Venditti Mario , Mastroianni Claudio Maria , Vullo Vincenzo 
Published: December 2019

Abstract

Background
Clostridioides difficile infection (CDI) might be complicated by the development of nosocomial bloodstream infection (n-BSI). Based on the hypothesis that alteration of the normal gut integrity is present during CDI, we evaluated markers of microbial translocation, inflammation, and intestinal damage in patients with CDI.

Methods
Patients with documented CDI were enrolled in the study. For each subject, plasma samples were collected at T0 and T1 (before and after CDI therapy, respectively), and the following markers were evaluated: lipopolysaccharide-binding protein (LPB), EndoCab IgM, interleukin-6, intestinal fatty acid binding protein (I-FABP). Samples from nonhospitalized healthy controls were also included. The study population was divided into BSI+/BSI- and fecal microbiota transplantation (FMT) +/FMT- groups, according to the development of n-BSI and the receipt of FMT, respectively.

Results
Overall, 45 subjects were included; 8 (17.7%) developed primary n-BSI. Markers of microbial translocation and intestinal damage significantly decreased between T0 and T1, however, without reaching values similar to controls (P &lt; .0001). Compared with BSI-, a persistent high level of microbial translocation in the BSI+ group was observed. In the FMT+ group, markers of microbial translocation and inflammation at T1 tended to reach control values.

Conclusions
CDI is associated with high levels of microbial translocation, inflammation, and intestinal damage, which are still present at clinical resolution of CDI. The role of residual mucosal perturbation and persistence of intestinal cell damage in the development of n-BSI following CDI, as well as the possible effect of FMT in the restoration of mucosal integrity, should be further investigated.
Robotic Orthogonal Implantation of Responsive Neurostimulation (RNS) Depth Electrodes in the Mesial Temporal Lobe: Case Series
Authors: Chan Alvin Y , Tran Diem Kieu , Paff Michelle R , Urgun Kamran , Hsu Frank P K , Vadera Sumeet 
Published: December 2019

Abstract

BACKGROUND
Responsive neurostimulation (RNS) is a closed-loop neurostimulation modality for treating intractable epilepsy in patients who are not candidates for resection. In the past, implantation of depth electrodes was done through a transoccipital approach that transverses the hippocampus. There have been no descriptions of orthogonal approaches to RNS electrode placement.

OBJECTIVE
To describe our initial experience with placing RNS depth electrodes using an orthogonal approach to target the short axis of the mesial temporal lobe.

METHODS
Presurgical work-up included magnetic resonance imaging, video electroencephalography, and neuropsychological testing. During the procedure, patients were placed with their heads in a neutral position. Electrodes were placed via stereotactic robotic assistance using a unilateral orthogonal approach targeting the amygdala or hippocampus. Patients who underwent RNS electrode implantation via orthogonal approach were identified. Multiple variables were collected, including age, disease onset, complications, follow-up, semiology, and seizure reduction.

RESULTS
There were 8 patients who underwent RNS electrode placement with orthogonal approach. The mean age and follow-up were 44.8 and 1.2 yr, respectively. There were 4 patients with at least 1-yr follow-up. Of them, 1 was seizure free and 2 experienced over 50% reduction in seizures. There were no complications associated with electrode implantation.

CONCLUSION
The initial experience using an orthogonal approach for depth electrode placement for RNS implantation was described. The potential advantages may include better safety, accuracy, and positioning in comparison to a transoccipital approach.
Comparing Costs of Living across World Cities
Authors: Nakamura Shohei , Harati Rawaa , Lall Somik V , Dikhanov Yuri M , Hamadeh Nada , Oliver William Vigil , Rissanen Marko Olavi , Yamanaka Mizuki 
Published: December 2019

Abstract
This paper compares costs of living across world cities. The International Comparison Program (ICP) reports price levels across world economies in its calculation of purchasing power parity through an extensive scale of price data collection and rigorous methodology. While the price levels are reported only at the national level, some modification makes it possible to compare the cost of living across a group of world cities. In addition, various agencies report costs of living rankings for world cities on a regular basis, and some of them, such as the Economist Intelligence Unit (EIU)’s World Cost of Living Survey, systematically collect a wide variety of items from a host of cities, even covering low-income countries. This article's application of the ICP method to the EIU price data yields an overall reasonable result: richer cities have higher price levels, and the rankings of cities based on their price levels are similar when using the ICP and EIU data. Nevertheless, the results based on the EIU data differ from the ICP data relatively widely in some nonfood items and among cities with low price levels. This result highlights important issues regarding the data and methodology required to measure costs of living for development purposes.
Systemic estradiol levels with low-dose vaginal estrogens
Authors: Santen Richard J. , Mirkin Sebastian , Bernick Brian , Constantine Ginger D. 
Published: December 2019

Abstract

Objectives:
To critically evaluate published systemic estradiol levels during use of low-dose vaginal estrogens considering detection method and estrogen dose; describe challenges with accurately measuring estradiol; and determine the normal estradiol level range in postmenopausal women.

Methods:
PubMed was searched for studies reporting systemic estradiol levels with lower-dose vaginal estrogens (≤25 μg estradiol or 0.3 mg conjugated equine estrogens). Estradiol levels at baseline and during treatment, area under the curve, and maximum estradiol concentrations were summarized by dose within assay type. A proposed range of systemic estradiol in normal, untreated, postmenopausal women was estimated by conservatively pooling means and standard deviations from published studies.

Results:
Mean basal estradiol levels were 3.1 to 4.9 pg/mL using liquid or gas chromatography/mass spectroscopy (LC or GC/MS/MS) with a range of undetectable to 10.5 pg/mL using radioimmunoassay. Systemic estradiol levels with vaginal estrogens reflected their doses as measured with LC or GC/MS/MS in different studies: 7.1 to 9.1 pg/mL and 16.7 to 22.7 pg/mL with a 25-μg softgel capsule insert and a tablet insert, respectively; 4.6 to 7.4 pg/mL and 6.6 to 14.8 pg/mL with a 10-μg softgel capsule and a tablet insert, respectively; and 3.6 to 3.9 pg/mL with a 4-μg softgel capsule insert. A mean systemic estradiol concentration ranging from undetectable to 10.7 pg/mL is proposed as an estimate for basal estradiol levels in normal, untreated, postmenopausal women. Systemic estradiol absorption may be influenced by the placement of estradiol higher (as with an applicator) versus lower (as without an applicator) in the vagina, as estradiol transport to the uterus would be more likely further away than closer to the introitus.

Conclusion:
Serum estradiol concentrations were generally lower when measured with more specific and sensitive assays. Estradiol absorption was dose-dependent, and may be influenced by dose, formulation, and positioning in the vagina. Very low systemic estradiol absorption with low/ultralow-dose vaginal estrogens may potentially decrease any adverse events that may be associated with higher doses of vaginal estrogens used for treating moderate to severe VVA due to less estradiol exposure.
Effect of Eyelid Treatments on Bacterial Load and Lipase Activity in Relation to Contact Lens Discomfort
Authors: Siddireddy Jaya Sowjanya , Vijay Ajay K. , Tan Jacqueline , Willcox Mark 
Published: December 2019

Objectives:
To evaluate the effect of microblepharon exfoliation on the number of eyelid bacteria and their lipase activity and the relationship of these to contact lens discomfort.

Methods:
Thirty experienced contact lens wearers had their eyelid margin physiology, tear properties, and comfort scores assessed. The number, type, and frequency of lower eyelid margin bacteria, and their lipase activity, were measured. Eyelids were treated with a foam cleanser or microblepharon exfoliation. Clinical and microbiological tests were repeated at each visit. Changes and correlations were examined.

Results:
Symptomatic lens wearers had a higher ratio for the number and frequency of gram-positive rods and cocci. Microblepharon exfoliation reduced the number and ratio of gram-positive rods to cocci from baseline for symptomatic wearers that lasted 7 to 10 days after treatment (P<0.05). Numbers of bacteria, the ratio of rods to cocci, and lipase activity correlated with lash contamination (r≥0.385; P≤0.046) and anterior blepharitis (r≥0.359; P≤0.048). Bacterial lipase correlated with meibomian gland secretions (r=0.422; P=0.038) and the tear evaporation rate (r=0.479; P=0.022). Microblepharon exfoliation produced a significant reduction in CLDEQ-8 scores and converted 10 symptomatic into asymptomatic lens wearers.

Conclusions:
There was dysbiosis in the lid microbiome of symptomatic lens wearers. Microblepharon exfoliation reduced the number, frequency of isolation, and ratio of gram-positive rods and cocci. Bacterial numbers and their lipase production correlated with changes to clinical signs and symptoms. Symptomatic lens wearers could be converted to asymptomatic lens wearers after microblepharon exfoliation.
The Impact of Bilateral Subepithelial Corneal Infiltrates on Tear Film After Epidemic Keratoconjunctivitis
Authors: Arici Ceyhun , Sultan Pinar , Mergen Burak , Buttanri Bulent , Dogan Cezmi 
Published: December 2019

Objectives:
To evaluate the effect of corneal subepithelial infiltrates (SEIs) on tear film function and best-corrected visual acuity (BCVA) after persistent epidemic keratoconjunctivitis (EKC) and to compare the findings with controls.

Methods:
In this prospective, cross-sectional study, 38 patients with EKC and 42 healthy volunteers were enrolled. While patients with SEIs after EKC made up groups 1a (first involved eye) and 1b (second involved eye), healthy controls made up group 2. Best-corrected visual acuity, corneal subepithelial infiltrate scoring (CSIS), Fantes score, tear breakup time (TBUT), Schirmer test, and ocular surface disease index (OSDI) scores were measured. The Oxford grading system was used to score corneal staining.

Results:
The mean Fantes score was 1.8±0.8 for group 1a and 1.3±1.1 for group 1b (P=0.03). The mean CSIS was 2.9±1.3 for group 1a and 1.9±1.7 for group 1b (P=0.005). But there was no significant difference in terms of the mean BCVA, TBUT, Schirmer, OSDI, and Oxford grading (P=0.66, 0.9, 0.9, 0.9, and 1.0, respectively) between group 1a and group 1b. The mean BCVA, TBUT, Schirmer, and OSDI values were worse in group 1a and group 1b in comparison to group 2 (P=0.001).

Conclusions:
We showed that the first involved eyes of patients with SEIs may be affected more significantly, but this difference may not have a clinical reflection on the difference in tear film functions between two eyes. However, compared with the healthy eyes, tear film function and BCVA were equally compromised in both eyes of the patients with SEIs irrelevant to the involved eye.
Collaborative Care Across the Acute and Subacute Continuum Facilitated by Physical Therapy in the Emergency Department
Authors: Seip John , Drinkwine Peter 
Published: December 2019

Background:
Research has supported the use of physical therapy services within emergency departments (EDs) in relation to fall reduction, reduced readmissions, and positive patient satisfaction. While the evidence supports the use of physical therapy services in the ED, other authors fail to provide examples of what collaboration looks like at the personal, professional, and patient levels. This case report is unique in that it describes the effects of collaborative care across the acute and subacute continuum starting at the initial ED presentation.

Case Report:
A medically complex patient with multiple medical comorbidities and mobility deficits presenting from the home environment was evaluated by a physical therapist in the ED. The evaluation consisted of musculoskeletal and mobility assessments, as well as assistance with discharge planning. This early collaboration resulted in a streamlined workup of the patient's orthopedic problems, a positive patient experience, and a positive outcome without readmission. This patient's entire workup, rehabilitation, and safe home discharge with improved home access and quality of life occurred in the span of 6 days.

Conclusion:
This case describes a medically complex patient with high risk for readmission. A model of collaborative care was used by consulting a physical therapist in the ED to help address these problems, which resulted in a positive outcome. The patient reported satisfaction with his care and did not return to the hospital for mobility-related impairments. The patient and his wife/caregiver also reported improvements in quality of life because of his rehabilitation and improved mobility. All of this occurred over a short span of 6 days. The authors hope that this case will lead to further discussion and research concerning the potential positive effects of early collaborative care between providers and staff physical therapists in the ED setting.
Impact of Social Isolation on Subsequent Peptic Ulcer Recurrence in Older Adults With Mild Cognitive Impairment: The Role of Change in Severity of Depression
Authors: Fang Boye , Liu Huiying , Yang Shuyan , Xu Ruirui , Chen Gengzhen 
Published: December 2019

ABSTRACT

Objective
This study aimed to examine the association between social isolation, change in severity of depression, and subsequent recurrence of peptic ulcer disease (PUD) in older adults with mild cognitive impairment.

Methods
Older adults (≥55 years) with mild cognitive impairment and Helicobacter pylori–infected PUD (N = 2208) were recruited between 2010 and 2014 from 12 hospitals in the People’s Republic of China. H. pylori was eradicated and PUD was cleared in 2015 participants by the end of 2014; 1900 of these were followed up for up to 36 months. The Kaplan-Meier method was used to assess how PUD recurrence varied with social engagement levels and changes in depression severity. Multivariate Cox proportional hazard models were used to examine associations between social isolation, changes in depression severity, and PUD recurrence.

Results
PUD recurrence was more prevalent in socially isolated (10.8%) than in socially engaged participants (5.5%). However, the rates of PUD were lower in socially isolated individuals without (absence of) depression (7.2%) and those with decreased depression (8.2%), whereas socially isolated individuals with unchanged and increased depression had substantially higher rates of PUD (16.3% and 17.8%, respectively; the social isolation by depression group for PUD recurrence was significant (p < .001). Specifically, although social isolation was associated with PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 2.665 [1.602–4.518]), it did not increase PUD recurrence risk in participants without depression or with reduced depression. However, in participants with unchanged or increased depression, PUD recurrence was more likely to occur in socially isolated (HR = 1.587 [1.125–2.588]; HR = 1.886 [1.012, 3.522] respectively) than in socially engaged participants.

Conclusions
Social isolation is associated with a greater risk of PUD recurrence; however, the absence of or decreased severity of depression may alter this relationship.
The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities
Authors: Krebs Emanuel , Zang Xiao , Enns Benjamin , Min Jeong E. , Behrends Czarina N. , del Rio Carlos , Dombrowski Julia C. , Feaster Daniel J. , Gebo Kelly A. , Golden Matthew , Marshall Brandon D.L. , Metsch Lisa R. , Schackman Bruce R. , Shoptaw Steven , Strathdee Steffanie A. , Nosyk Bohdan 
Published: December 2019

Objective:
Effective interventions to reduce the public health burden of HIV/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness of HIV treatment and prevention interventions implemented at previously documented scales of delivery in six US cities with diverse HIV microepidemics.

Design:
Dynamic HIV transmission model-based cost-effectiveness analysis.

Methods:
We identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions from the US CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we estimated averted HIV infections, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratios (healthcare perspective; 3% discount rate, 2018$US), for each intervention and city (10-year implementation) compared with the status quo over a 20-year time horizon.

Results:
Increased HIV testing was cost-saving or cost-effective across cities. Targeted preexposure prophylaxis for high-risk MSM was cost-saving in Miami and cost-effective in Atlanta ($6123/QALY), Baltimore ($18 333/QALY) and Los Angeles ($86 117/QALY). Interventions designed to improve antiretroviral therapy initiation provided greater value than other treatment engagement interventions. No single intervention was projected to reduce HIV incidence by more than 10.1% in any city.

Conclusion:
Combination implementation strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV care will be necessary to meet targets for HIV elimination in the United States.
Implicit bias is strongest when assessing top candidates
Authors: Andersson Emma R , Hagberg Carolina , Hägg Sara 
Published: December 2019

ABSTRACTBackgroundAcademic life is highly competitive and expectations of fair competition underlie the assumption that academia is a meritocracy. However, implicit bias reinforces gender inequality in all peer review processes, unfairly eliminating outstanding individuals and depleting academia of diversity. Here, we ask whether applicant gender biases reviewer assessments of merit in Sweden, a country that is top ranked for gender equality.MethodsWe analyzed the peer review procedure for positions awarded at a Swedish medical University, Karolinska Institutet (KI), during four consecutive years (2014-2017) for Assistant Professor (n=207) and Senior Researcher (n=153). We derived a composite bibliometric score to compute productivity, and compared this to subjective external (non-KI) peer reviewer scores on applicants’ merits to test their association for men and women, separately.ResultsMen and women with equal merits are not scored equally by reviewers. Men generally have stronger associations (steeper slopes) between computed productivity and subjective external scores, meaning that peer reviewers suitably “reward” men’s productivity with increased merit scores. However, for each additional composite bibliometric score point, women applying for Assistant Professor positions only receive 58% (79% for Senior Researcher) of the external reviewer score that men received, confirming that implicit bias affects external reviewers’ assessments. As productivity increases, the difference in merit scores between men and women increases.ConclusionsAccumulating bias impacts most strongly in the highest tier of competition, the pool from which successful candidates are ultimately chosen. Gender bias is apparent in external peer review processes of applications for academic positions in Sweden, and is likely to reinforce the unbalanced numbers of professorships in Sweden.
Processing of the SARS-CoV pp1a/ab nsp7-10 region
Authors: Krichel Boris , Falke Sven , Hilgenfeld Rolf , Redecke Lars , Uetrecht Charlotte 
Published: December 2019

1.1.AbstractSevere acute respiratory syndrome coronavirus (SARS-CoV) is the causative agent of a respiratory disease with a high case fatality rate. During the formation of the coronaviral replication/transcription complex (RTC), essential steps include processing of the conserved polyprotein nsp7-10 region by the main protease Mproand subsequent complex formation of the released nsp’s. Here, we analyzed processing of the coronavirus nsp7-10 region using native mass spectrometry showing consumption of substrate, rise and fall of intermediate products and complexation. Importantly, there is a clear order of cleavage efficiencies, which is influenced by the polyprotein tertiary structure. Furthermore, the predominant product is an nsp7+8(2:2) hetero-tetramer with nsp8 scaffold. In conclusion, native MS, opposed to other methods, can expose the processing dynamics of viral polyproteins and the landscape of protein interactions in one set of experiments. Thereby, new insights into protein interactions, essential for generation of viral progeny, were provided, with relevance for development of antivirals.
Individual differences in dopamine function underlying the balance between model-based and model-free control
Authors: Lee Ying , Deserno Lorenz , Kroemer Nils B. , Pooseh Shakoor , Oehme Liane , Müller Dirk K. , Goschke Thomas , Huys Quentin J.M. , Smolka Michael N. 
Published: December 2019

AbstractReinforcement learning involves a balance between model-free (MF) and model-based (MB) systems. Recent studies suggest that individuals with either pharmacologically enhanced levels of dopamine (DA) or higher baseline levels of DA exhibit more MB control. However, it remains unknown whether such pharmacological effects depend on baseline DA.Here, we investigated whether effects of L-DOPA on the balance of MB/MF control depend on ventral striatal baseline DA. Sixty participants had two functional magnetic resonance imaging (fMRI) scans while performing a two-stage sequential decision-making task under 150 mg L-DOPA or placebo (counterbalanced), followed by a 4-hour18F-DOPA positron emission tomography (PET) scan (on a separate occasion).We found an interaction between baseline DA levels and L-DOPA induced changes in MB control. Individuals with higher baseline DA levels showed a greater L-DOPA induced enhancement in MB control. Surprisingly, we found a corresponding drug-by-baseline DA interaction on MF, but not MB learning signals in the ventromedial prefrontal cortex. We did not find a significant interaction between baseline DA levels and L-DOPA effects on MF control or MB/MF balance.In sum, our findings point to a baseline dependency of L-DOPA effects on differential aspects of MB and MF control. Individual differences in DA washout may be an important moderator of L-DOPA effects. Overall, our findings complement the general notion where higher DA levels is related to a greater reliance on MB control. Although the relationship between phasic DA firing and MF learning is conventionally assumed in the animal literature, the relationship between DA and MF control is not as straightforward and requires further clarification.