bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a Diagnostic OSCE to Discern Deficit From Disability in Struggling Students
Authors: Patwari Rahul , Ferro-Lusk Marie , Finley Ellenkate , Meeks Lisa M. 
Published: April 2020

Problem
When medical students with disabilities fail, identifying the underlying cause is challenging. Faculty unfamiliar with disability-related barriers or accommodations may falsely attribute academic struggles to disability. Fear of legal action may prompt inappropriate promotion of students with disabilities who are struggling to meet competencies. Therefore, a clear understanding of the origin of difficulty is critical to determining an appropriate response to the student’s failure, including revision of accommodations, academic remediation, probation, and dismissal.

Approach
A large Midwestern medical college created an innovative approach to differentiate between disability-related barriers and academic deficits by creating a diagnostic objective structured clinical examination (OSCE). The goal of this OSCE was to determine the need for additional or refined accommodations versus clinical remediation, and to guide future decision making about a student on academic probation. Using 3 simulated cases that drew on a cross section of clinical knowledge, a team of clinical and disability specialists observed a disabled student to determine the origin of that student’s difficulties in a clinical rotation.

Outcomes
Using the diagnostic OSCE, the team quickly identified clinical reasoning and fund of knowledge deficits, and need for further accommodations. As a result, the team was able to remediate the clinical deficits, augment the current accommodations in vivo, and determine the potential impact on performance. The team approach was documented and facilitated the legally required interactive process for determining additional barriers, efficacy of existing accommodations, and need for additional reasonable accommodations. All parties reported a positive experience. The collective knowledge and expertise of the team helped confirm the origin of the deficit: a fundamental lack of knowledge and reasoning skills versus a disability-related barrier.

Next Steps
The next step is to formalize this process to ensure appropriate evaluation of students with disabilities.
The Change to Pass/Fail Scoring for Step 1 in the Context of COVID-19: Implications for the Transition to Residency Process
Authors: Whelan Alison J. 
Published: April 2020

In this Invited Commentary, the author considers the February 2020 announcement that scoring on the United States Medical Licensing Examination (USMLE) Step 1 will change to pass/fail no sooner than January 2022 and its effects on the transition to residency process in the context of both the recommendations of the Invitational Conference on USMLE Scoring (InCUS) held in March 2019 and the disruptions caused by the COVID-19 pandemic in the spring of 2020. The author suggests that the medical education community must embrace any positive changes that come about as a result of the pandemic while continuing to systematically review the strengths and areas for improvement in the current transition to residency process.
In its recommendations, InCUS provided a thoughtful set of action priorities and an effective process to work together, which can inform and guide the work ahead. The COVID-19 pandemic is dominating the educational and clinical environments and is now the biggest disruptor in all aspects of life, not just medical education. It is the responsibility of leaders in medical education to have a vision for and then implement an improved continuum of education that maintains the core values of the field and fits the health care delivery needs of today and the future.
Effect of Gaze Angle During the Vertical Video Head Impulse Test Across Two Devices in Healthy Adults and Subjects With Vestibular Loss
Authors: Patterson Jessie , Rodriguez Amanda , Barin Kamran , Janky Kristen L. 
Published: April 2020

Objective:
To evaluate the effect of gaze angle on vertical vestibulo-ocular reflex (VOR) gain using two different video head impulse (vHIT) devices in healthy adults and subjects with bilateral vestibular loss (BVL).

Study Design:
Prospective study.

Setting:
Hospital research laboratory.

Subjects:
Twenty-four healthy adults (mean [standard deviation {SD}] age = 32 [4.8]; 23–42; 8 men) and four subjects with previously diagnosed BVL (mean age [SD] = 32 [8.2]; 21–40; 3 men) participated.

Intervention:
Vertical canal vHIT was administered with two different devices using three gaze angles (–45 degrees, 0 degree, +45 degrees). These devices have different gain calculation algorithms and different head and gaze angle protocols.

Main Outcome Measures:
Vertical canal gain and presence or absence of reset saccades.

Results:
A significant stepwise reduction in vHIT gain was noted as gaze moved away from the plane of the canals stimulated (from –45 degrees to 0 degree, to +45 degrees) for both healthy adults and subjects with BVL. vHIT gain was able to separate the two groups using gaze angles –45 degrees and 0 degree.

Conclusions:
In spite of their differences in gain algorithm and recommended head position and gaze angle, each device was able to appropriately separate healthy adults from subjects with BVL with high sensitivity/specificity.
Intraparotid Superficial Temporal Artery Arteriovenous Malformation Causing Persistent Pulsatile Tinnitus
Authors: Selleck Anne Morgan , O’Connell Brendan , Patel Samip , Clark Joseph Madison 
Published: April 2020

Objectives:This article discusses the diagnosis, imaging workup, and management of a rare cause of pulsatile tinnitus: intraparotid arteriovenous malformation.Patient:A single patient with a superficial temporal arteriovenous malformation diagnosed by carotid duplex causing pulsatile tinnitus that failed initial surgical management. Repeat imaging failed to identify a cause for the persistent tinnitus.Intervention:Reoperation with a parotid approach based on physical exam findings.Results:Removal of a more proximal arteriovenous malformation in the parotid gland resulted in long-term resolution of the patient's pulsatile tinnitus.Conclusions:Physical examination is essential in the workup and management of pulsatile tinnitus. Imaging is a useful adjunct in the diagnosis of pulsatile tinnitus but should not be solely relied upon.
Cost-effectiveness of Universal Hepatitis C Screening in Pregnant Women
Authors: Saab Sammy , Kullar Ravina , Khalil Haydar , Gounder Prabhu 
Published: April 2020

Background:
Hepatitis C virus (HCV) epidemiology has shifted from the baby-boomer generation to young women of childbearing age. The health benefits and cost-effectiveness (CE) of screening pregnant women remain controversial.

Aim:
To systematically review published studies evaluating the CE of screening pregnant women for HCV in the era of direct-acting antivirals (DAAs).

Materials and Methods:
We conducted a systematic literature search of CE studies evaluating the costs and benefits of screening pregnant women for HCV. Pertinent information including antiviral agent, drug costs, incremental cost-effective ratio (ICER), and infant care was collected. The authors’ definition of the threshold price at which screening was deemed CE was also recorded. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reports Standards (CHEERS) checklist.

Results:
We identified 5 studies that evaluated the ICER of screening pregnant women for HCV. Of these, 2 utilized all oral DAAs, with universal screening CE. The ICER of these 2 studies was $3000 and $41,000 per quality of life-years gained. The remaining studies were interferon-based regimens. Most studies did not include screening of infants.

Conclusions:
Universally screening pregnant women for HCV was CE in studies that utilized oral DAAs. Most pharmacoeconomic studies failed to incorporate the impact of vertical transmission on infants.
The Effect of Hopelessness and Perceived Group Compatibility on Treatment Outcome for Patients With Personality Dysfunction
Authors: Aafjes-van Doorn Katie , Kealy David , Ehrenthal Johannes C. , Ogrodniczuk John S. , Joyce Anthony S. , Weber Rainer 
Published: April 2020

AbstractImprovement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N= 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction.
Comparison of Census Tract–Level Chronic Disease Prevalence Estimates From 500 Cities and Local Health Claims Data
Authors: Monaghan Alyssa , Jones Lynda , Brink LuAnn , Hacker Karen 
Published: April 2020

Objectives:
To compare city and census tract–level diabetes and hypertension prevalence using 500 Cities Project modeled estimates from the Centers for Disease Control and Prevention (CDC) and insurance claims data.

Methods:
Insurance claims by census tract were collected from 3 local health plans for the city of Pittsburgh, Pennsylvania, for 2015-2016; conditions were defined using International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. Crude prevalence estimates with 95% confidence intervals were downloaded from the CDC 500 Cities Web site to obtain modeled estimates by census tract. Confidence intervals were calculated for claims and compared with modeled estimates; nonoverlapping intervals were considered significant. Pearson correlation coefficients were generated for census tract–level comparison.

Results:
City-level model-based and claims estimates were 9% versus 10% for diabetes and 31% versus 21% for hypertension. At the census tract level, model-based and insurance claims estimates were more concordant for diabetes (r = 0.366) than for hypertension (r = 0.220). Modeled estimates were significantly higher than claims estimates for 89% of census tracts for hypertension and 35% for diabetes.

Conclusions:
Modeled estimates from the 500 Cites Project were significantly higher than insurance claims estimates for hypertension but were more consistent for diabetes. Utilization of multiple data sources to understand local-level chronic disease burden requires consideration of the strengths and limitations of each.
Tuberculous meningitis: where to from here?
Authors: Donovan Joseph , Thwaites Guy E. , Huynh Julie 
Published: April 2020

Purpose of review
Tuberculous meningitis (TBM) is associated with significant mortality and morbidity yet is difficult to diagnose and treat. We reviewed original research published in the last 2 years, since 1 January 2018, which we considered to have a major impact in advancing diagnosis, treatment and understanding of the pathophysiology of TBM meningitis in children and adults.

Recent findings
Studies have sought to identify a high sensitivity diagnostic test for TBM, with new data on modified Ziehl--Neelsen staining, urinary and cerebrospinal fluid (CSF) lipoarabinomannan and GeneXpert Ultra. Recent studies on CSF biomarkers provide a better understanding of the detrimental inflammatory cascade and neuromarkers of brain damage and suggest potential for novel host-directed therapy. Tryptophan metabolism appears to affect outcome and requires further study. Increased clinical trials activity in TBM focuses on optimizing antituberculosis drug regimens and adjuvant therapy; however, there are few planned paediatric trials.

Summary
Tuberculous meningitis still kills or disables around half of sufferers. Although some progress has been made, there remains a need for more sensitive diagnostic tests, better drug therapy, improved management of complications and understanding of host-directed therapy if outcomes are to improve.
Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury
Authors: Anand Tanya , Hanna Kamil , Kulvatunyou Narong , Zeeshan Muhammad , Ditillo Michael , Castanon Lourdes , Tang Andrew , Gries Lynn , Joseph Bellal 
Published: April 2020

BACKGROUND
The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.

METHODS
We performed a 5-year (2010–2014) analysis of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age, ≥18 years) trauma patients who had traumatic CSCI and received tracheostomy. Patients were subdivided into two groups: early tracheostomy (ET) (≤4 days from initial intubation) and late tracheostomy (LT) (>4 days). Outcome measures included respiratory complications, ventilator-free days, intensive care unit–free days and hospital length of stay, and mortality. Multivariate logistic regression analysis was performed.

RESULTS
A total of 5,980 patients were included in the study, of which 1,010 (17%) patients received ET, while 4,970 (83%) patients received LT. Mean age was 46 years, and 73% were men. In terms of CSCI location, 48% of the patients had high CSCI (C1–C4), while 52% had low CSCI (C5–C7). Patients in the ET group had lower rates of respiratory complications (30% vs. 46%, p = 0.01), higher ventilator-free days (13 days vs. 9 days; p = 0.02), intensive care unit–free days (11 days vs. 8 days; p = 0.01), and a shorter hospital length of stay (22 days vs. 29 days; p = 0.01) compared with those in the LT group. On regression analysis, ET was associated with lower rates of respiratory complications in patients with high CSCI (odds ratio, 0.55 [0.41–0.81]) and low CSCI (odds ratio, 0.93 [0.72–0.95]). However, no association was found between time to tracheostomy and in-hospital mortality.

CONCLUSION
Early tracheostomy regardless of CSCI level may lead to improved outcomes. Quality improvement efforts should focus on defining the optimal time to tracheostomy and considering ET as a component of SCI management bundle.

LEVEL OF EVIDENCE
Therapeutic, level IV.
MATHEMATICAL MODELING FOR TRANSMISSIBILITY OF COVID-19 VIA MOTORCYCLES
Authors: Okelo Benard 
Published: April 2020

AbstractIn this paper, we present a mathematical model of trigonometric type for transmissibility and deaths as a result of COVID-19. In the model, we analyze the spread of COVID-19 by considering a new parameter, the motor-cycle as a means of public transport, which has not been considered in several other models for COVID-19. We use the mathematical model to predict the spread and deaths and we suggest strategies that can be put in place to prevent the spread caused by motorcycle as a means of public transport.
Higher mortality in men from COVID19 infection-understanding the factors that drive the differences between the biological sexes
Authors: Iyer Swaminathan P. , Ensor Joe , Anand Kartik , Hwu Patrick , Subbiah Vivek , Flowers Christopher , Channappanavar Rudragouda 
Published: April 2020

AbstractThe emergent global pandemic caused by the rapid spread of Severe Acute Respiratory syndrome-Coronavirus-2 (SARS-CoV-2) has led to increased mortality and negatively impacted day to day activities of humankind within a short period of time. As the data is rapidly emerging from earlier outbreak locations around the world, there are efforts to assimilate this with the knowledge from prior epidemics and find rapid solutions for this. One of the observations and a recurring theme is the disproportionate differences in the incidence of infection and the consequent mortality between males and females. We, therefore, analyzed retrospective datasets from the previous epidemics and the ongoing pandemic in order to address these differences in clinical outcomes. The data shows that even though the infection rates are similar, the odds ratio of male mortality remains high, indicating a divergence in the crosstalk between the three pathogenic human Coronavirus (hCoVs)-the SARS-CoV, MERS-CoV and the SARS-CoV-2 and immune effectors in the two sexes. One proximate cause is the sex-specific modulation of the X-linked genes that can influence susceptibility to infection. Future studies are needed to confirm these findings, which can form the basis for developing rational strategies for ending the current and preventing future pandemics.
Clonal chromosomal mosaicism and loss of chromosome Y in men are risk factors for SARS-CoV-2 vulnerability in the elderly
Authors: Pérez-Jurado Luis A. , Cáceres Alejandro , Esko Tonu , López de Heredia Miguel , Quintela Inés , Cruz Raquel , Lapunzina Pablo , Carracedo Ángel ,   SCOURGE Cohort Group, González Juan R. 
Published: April 2020

AbstractThe ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) has an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome events (CME) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (CME and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, CME and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people.
Clinical and Imaging Findings in COVID-19 Patients Complicated by Pulmonary Embolism
Authors: Li Ting , Kicska Gregory , Kinahan Paul E , Zhu Chengcheng , Oztek Murat Alp , Wu Wei 
Published: April 2020

AbstractObjectiveTo describe clinical, and imaging findings including the evolution pattern in COVID-19 pneumonia complicated by pulmonary embolism (PE).MethodsEleven of 1453 patients with a probable diagnosis of COVID-19 pneumonia were retrospectively selected for the presence of PE. Clinical and laboratory data were recorded. All cross-sectional CT imaging was qualitatively scored for the first 28 days after onset of symptoms.ResultsOf 24 patients underwent CTA-PE, 11 were confirmed with PE. All 11 patients developed acute respiratory distress syndrome (ARDS). The pulmonary emboli were most common in segmental and subsegmental pulmonary arteries. We observed an evolution pattern of predominant findings with ground-glass opacities (GGO) to GGO with crazy paving in 3 patients, then to consolidation with linear densities, or to reticulation in 9 patients. Lung cysts or traction bronchiectasis could be seen from day 5 to 9 after symptoms and reticulation, subpleural curvilinear lines were more common from day 20. The pulmonary opacities were predominantly peripheral in distribution with relative sparing of nondependent lungs. The severity of lung involvement was high with an average score of 9.7 in the first phase, 18 in the second phase plateauing in the next two phases, with a slight decrease to 16.9 in the late phase.ConclusionThe incidence of PE among suspected patients in COVID-19 was high. The pulmonary emboli were most common in segmental and subsegmental pulmonary arteries. Our study suggests PE may occur with increased frequency in the ARDS subgroup. The evolution of radiographic abnormalities showed a general pattern, but are also unique with more extensive lung injury and specific imaging features, which may due to the exist of ARDS in these patients.
Liver transplantation without graft ischemia in humans
Authors: Guo Zhiyong , Zhao Qiang , Huang Shanzhou , Huang Changjun , Zhang Jian , Wang Dongping , Yang Lu , Chen Maogen , Wu Linwei , Zhang Zhiheng , Zhu Zebin , Wang Linhe , Zhu Caihui , Zhang Yixi , Tang Yunhua , Sun Chengjun , Xiong Wei , Shen Yuekun , Chen Xiaoxiang , Xu Jinghong , Wang Tielong , Ma Yi , Hu Anbin , Chen Yinghua , Zhu Xiaofeng , Rong Jian , Cai Changjie , Gong Fengqiu , Guan Xiangdong , Huang Wenqi , Ko Dicken Shiu-Chung , Li Xianchang , Huang Jiefu , Ju Weiqiang , He Xiaoshun 
Published: April 2020

ABSTRACTBACKGROUNDIschemia-reperfusion injury is considered an inevitable event that compromises posttransplant outcomes. Numerous treatments have been proposed to reduce its impact. However, most of them have had limited success, as none of them can completely avoid graft ischemia.METHODSIschemia-free liver transplantation (IFLT) comprises surgical techniques to enable continuous oxygenated blood supply to brain-dead donor livers during procurement, preservation and implantation using normothermic machine perfusion technology. In this nonrandomized study, 38 donor livers were transplanted using IFLT and were compared to 130 livers procured and transplanted using a conventional procedure (CLT).RESULTSOne patient (2.6%) suffered early allograft dysfunction in the IFLT group, compared with 43.8% of patients in the CLT group (absolute risk difference, 41.2 percentage points; 95% confidence interval, −31.3, −51.1). The median (range) peak aspartate aminotransferase levels within the first week (336, 149-4112 vs. 1445, 149-25083 U/L, P<0.001), and the median (range) total bilirubin levels on day 7 (2.11, 0.68-12.47 vs. 5.11, 0.56-51.97 mg/dL, P<0.001) posttransplantation were much lower in the IFLT than in the CLT group. The IFLT recipients had less need for renal replacement therapy (2.6% vs. 16.9%, P=0.02), shorter median (range) intensive care unit stay (34, 12-235 vs. 43.5, 7-936 hours, P=0.003), and higher one-year recipient survival (97.4% vs. 84.6%, P=0.02) and graft survival (94.7% vs. 83.8%, P=0.04) rates than the CLT recipients. The extended criteria donor livers in IFLT yielded faster posttransplant recovery than the standard criteria donor livers in CLT.CONCLUSIONSIFLT provides a new approach to minimize ischemia-reperfusion injury and improve post-transplant outcomes.Clinical trial registryThis trial is registered with http://www.chictr.org.cn, number ChiCTR-OPN-17012090.