bluuebunny/crossref_metadata_2025_split huggingface dataset:
Red Cell Distribution Width, Unlike Neutrophil Lymphocyte Ratio Is Unable to Accurately Gauge Enhanced Systemic Inflammation Associated With Panoramic Imaged Carotid Plaque
Authors: Chang Tina I , Wu Xiuju , Boström Kristina I , Tran Hoang-Anh , Friedlander Arthur H 
Published: October 2020

ABSTRACTIntroductionWe have previously shown that panoramic X-rays (PXs) demonstrating calcified carotid artery atheromas (CCAA) are associated with increased systemic inflammation demonstrating increased neutrophil lymphocyte ratios (NLRs), a validated risk indicator of fatal myocardial infarctions arising from coronary artery atherosclerosis. Using this same cohort of patients (with minor adjustments because of missing data), we sought to determine if a like association existed between PXs evidencing CCAA and elevated red blood cell distribution width (RDW) given conflicting data as its reliability relative to NLR as a biologic marker of system inflammation. We hypothesized that CCAAs on PXs would simultaneously be associated with both increased NLR and RDW.Materials and MethodsInvestigators implemented a cross-sectional study design. Study sample consisted of patient medical records and PXs of white men ≥ 55 years. Two groups (N = 50 each) were constituted, one with atheromas (CCAA+) and without atheromas (CCAA–). The predictor variable was CCAA+ and outcome variables were NLR and RDW. Bootstrapping analysis was employed to analyze the differences in mean NLRs and RDWs between groups since the data was not normally distributed. Statistical significance determined to be ≤ 0.05 for all tests. The Medical Center’s Institutional Review Board approved the research protocol.ResultsA study group of 50 CCAA+ men (mean age 71; range 58-89 years) demonstrated a mean NLR of 2.98 ± 1.38 and an RDW of 13.21 ± 0.85. A control group of 50 CCAA– males (mean age 70 range; 55-91 years) evidenced a mean NLR of 2.38 ± 0.77 and an RDW of 13.16 ± 0.77. Bootstrapping comparison of NLR values evidenced significant (P = 0.008) difference (95% confidence interval of difference of mean: − 0.4272, 0.4384; observed effect size: 0.579) between groups; however, there was no significant difference in RDW values between the groups. Furthermore, logistic regression modeling demonstrated that for a one unit increase in NLR the odds of being CCAA+ (vs. CCAA–) increases by a factor of 1.659.ConclusionThe existence of CCAA seen on PXs of elderly white men is associated with significantly (P = 0.008) elevated NLR values but is not associated with increases in RDW.
Smoking and Physical Activity Patterns of U.S. Military Veterans With Chronic Obstructive Pulmonary Disease: An Analysis of 2017 Behavioral Risk Factor Surveillance System
Authors: Greiner Benjamin , Ottwell Ryan , Corcoran Adam , Hartwell Micah 
Published: October 2020

ABSTRACT

Introduction
The prevalence of chronic obstructive pulmonary disease (COPD) in U.S. military veterans is higher than that of non-veterans. Smoking and physical activity behaviors of veterans with COPD have not been studied. Therefore, our objective was to determine whether smoking and physical activity behaviors of veterans with COPD differ from non-veterans with COPD. Our secondary objective was to describe lifestyle behaviors of veterans after being diagnosed with COPD.

Materials and Methods
A cross-sectional analysis of lifestyle behaviors in veterans and non-veterans with COPD from the 2017 BRFSS was conducted. Logistic regression models were constructed to obtain adjusted risk ratios (ARRs). All confidence intervals (CIs) were reported at 95%.

Results
The prevalence of COPD among veterans was 14.2% (13.45–14.99) and 11.1% (10.82–11.41) among the non-veteran population (X2: F(1, 250,985) = 62.71, P &lt; 0.01) (n = 37,532, N = 16,587,340). Veterans with COPD were significantly less likely to have a quit attempt in the past 12 months (ARR = 0.89, CI 0.81–0.97). Female veterans were significantly more likely to be current smokers (ARR = 1.28, CI 1.06–1.55) and less likely to meet aerobic physical activity recommendations (ARR = 0.71, CI 0.54–0.93) compared with male veterans.

Conclusions
Veterans were significantly more likely to have COPD compared with non-veterans. Additionally, female veterans were significantly more likely to be current smokers following a diagnosis of COPD, which was not significant in male veterans, and both sexes were less likely to have a quit attempt compared with non-veterans. Finally, both male and female veterans were less likely to meet aerobic physical activity recommendations compared with non-veterans. Our findings suggest that further efforts should be made to increase the frequency of quit attempts and improve smoking rates and physical activity in veterans with COPD.
Characterization and mitigation of fragmentation enzyme-induced dual stranded artifacts
Authors: Gregory Thomas , Ngankeu Apollinaire , Orwick Shelley , Kautto Esko A , Woyach Jennifer A , Byrd John C , Blachly James S 
Published: October 2020

Abstract
High-throughput short-read sequencing relies on fragmented DNA for optimal sampling of input nucleic acid. Several vendors now offer proprietary enzyme cocktails as a cheaper and more streamlined method of fragmentation when compared to acoustic shearing. We have discovered that these enzymes induce the formation of library molecules containing regions of nearby DNA from opposite strands. Sequencing reads derived from these molecules can lead to artifact-derived variant calls appearing at variant allele frequencies &lt;5%. We present Fragmentation Artifact Detection and Elimination (FADE), software to remove these artifacts from mapped reads and mitigate artifact-related effects on downstream analysis. We find that the artifacts principally affect downstream analyses that are sensitive to a 1–3% artifact bias in the sequencing reads, such as targeted resequencing and rare variant discovery.
Personal perspectives: having a series of cardiac events
Authors: Taylor-Robinson S D 
Published: October 2020

Abstract
It has never been clear to me whether being a medically qualified patient has positive or negative associations. In 2019, after a prostatectomy, where I had extended bleeding per urethra, I suffered two myocardial infarctions, underwent three coronary angiograms and eventually coronary stenting. Junior doctors never examined me at any point, while senior ones worried over the risk of stent placement in an actively bleeding patient. I report my views on how this seemed as a largely passive, but still actively thinking patient.
The Design and Validation of Three Interprofessional Simulations: A Feasibility Study
Authors: Klenke-Borgmann Laura , Cantrell Mary Ann 
Published: October 2020

Abstract
This article provides pragmatic guidance on how to operationalize the INACSL Standards of Best Practice: SimulationSM. The purpose of this feasibility study was to determine content validity and intervention fidelity of three interprofessional simulations where clinical judgment is required to provide care to simulated patients. The process met all 11 criteria of the INACSL standards. The mean item-content validity indices for the scenarios ranged from .98 to 1. The scale-content validity indices ranged from .86 to 1. These findings advance the science of simulation design as an exemplar of the integration of best practices in simulation.
Are asymmetric tibial baseplates superior in primary total knee arthroplasty? A systematic review of clinical studies
Authors: Gouveia Kyle , Gyemi Lauren , Ekhtiari Seper , Bhandari Mohit , Sancheti Parag , Tapasvi Sachin 
Published: October 2020

Background:
Despite the asymmetric nature of the native tibial condyles, traditional primary total knee arthroplasty (TKA) has overwhelmingly employed the use of symmetric tibial baseplates. However, designs exist utilizing an asymmetric tibial baseplate that mimics normal tibial anatomy. The purpose of this review was to assess the functional and radiographic outcomes of asymmetric tibial base plates.

Methods:
Embase, MEDLINE, and Web of Science were searched for relevant literature from database inception until September 2019, and after screening by two reviewers, studies investigating the use of asymmetric tibial baseplates in primary TKA were included. Demographic data as well as data on revision rates, functional and radiographic outcomes, and complications were recorded. A risk of bias assessment was performed for all studies.

Results:
Overall, 24 studies were identified with a total of 4776 patients (4937 knees). Seventeen studies (1895 knees) reported a pooled revision rate of 2.4% (45/1845) at a mean follow-up of 72.9 mo. TKA with an asymmetric baseplate resulted in improvement of range of motion and functional outcome scores postoperatively, as well as radiographic evidence of good tibial component positioning and bone coverage. Lastly, the overall pooled complication rate of reporting studies was 12.7%.

Conclusions:
The use of an asymmetric tibial baseplate in primary TKA is a safe and effective option, with the potential for improved component alignment and tibial coverage. However, more evidence is needed to determine if there are significant differences in failure rates and postoperative functional outcomes before justifying the implementation of a new and potentially more costly technology.

Level of Evidence:
Level IV.
The Older Adults With Rectal Cancer—Does Age Matter?
Authors: Shulman Katerina , Musallam Samar , Epelbaum Ron , Haim Nissim , Ben-Yosef Rahamim , Kaidar-Person Orit 
Published: October 2020

Objectives:
Oncological treatments of older patients have many unresolved questions mainly because of the fact that these patients were not eligible to be included in most clinical trials. The aim of this study was to evaluate the treatment approach to localized rectal cancer in the older population, including complication rates and overall survival in patients treated with curative intent.

Materials and Methods:
A retrospective review of patients older than 80 years old (group A) who were treated for clinical stages II to III rectal cancer. The data collection included demographics, comorbidities, treatment protocols, adverse events, time of death, and a comparison with a group of patients aged 65 to 75 years (group B).

Results:
A total of 88 patients were included in the analysis (group A, 35; group B, 53). The groups were balanced with regards to sex, comorbidities, pretreatment albumin, and hemoglobin levels (for all categories P>0.05). More patients in group A (25%) received preoperative treatment as in-patients (P=0.022) and were treated with radiation only (P<0.0001) as the initial treatment approach. In group A, in 82% of patients the initial chemotherapy dose was reduced to 75% or less of the calculated dose compared with 7% in group B (P<0.001). Discontinuation of chemotherapy was needed in 55% in group A and 31% in group B (P=0.07). Median overall survival was 33 months in group A and 55 months in group B (P=0.06), 5-year overall survival was 27% and 60%, respectively (P=0.004).

Conclusions:
The age has a significant implication on preoperative treatment, chemotherapy dose, hospitalization rates, and survival.
Effect of bevel direction on the tracheal tube pathway during nasotracheal intubation
Authors: Won Dongwook , Kim Hyerim , Chang Jee-Eun , Lee Jung-Man , Min Seong-Won , Jung Jiyun , Yang Hyo Jun , Hwang Jin-Young , Kim Tae Kyong 
Published: October 2020

BACKGROUND
For nasotracheal intubation, the nasal pathway between the inferior turbinate and hard palate (lower pathway) is preferred for patient safety. However, selecting the lower pathway can be challenging because passage of the tube through the nasal pathway is usually performed blindly.

OBJECTIVES
We investigated whether facing the bevel of the tracheal tube in the cephalad direction of the patient could help in advancing the tracheal tube through the lower pathway during nasotracheal intubation.

DESIGN
A randomised, blinded trial.

SETTING
SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea from January 2019 to March 2020.

PATIENTS
Sixty-eight adult patients undergoing oromaxillary surgeries were enrolled in this study.

INTERVENTIONS
Patients were randomly allocated to undergo nasotracheal intubation with the bevel of the tube facing the cephalad direction (intervention group) or to the left (conventional group).

MAIN OUTCOME MEASURES
The effects of bevel direction on the pathway of the tube in the nasal cavity, and the incidence of epistaxis were evaluated by fibreoptic bronchoscopy.

RESULTS
The success rate of the tracheal tube passing through the lower pathway was significantly higher in the intervention group than the conventional group (79.4 vs. 55.9%, relative risk 1.421, 95% CI 1.007 to 2.005, P = 0.038). The incidence of epistaxis was also lower in the intervention group than in the conventional group (41.2 vs. 73.5%, relative risk 0.560, 95% CI 0.357 to 0.878, P = 0.007).

CONCLUSIONS
Facing the bevel of the tracheal tube in the cephalad direction of the patient facilitated selection of the lower pathway and reduced the incidence of epistaxis during nasotracheal intubation in patients undergoing oromaxillary surgery.

TRIAL REGISTRATION
ClinicalTrial.gov, NCT03740620.
VITREOUS SEEDING OF CHOROIDAL MELANOMA
Authors: Raval Vishal , Bowen Randy C. , Soto Hansell , Biscotti Charles , Yeaney Gabrielle , Sears Jonathan , Singh Arun 
Published: October 2020

Purpose:
To report a case of vitreous seeding in a medium-sized choroidal melanoma and review the literature.

Methods:
Observational case report and review of literature for pathogenesis, role of vitreous biopsy, and treatment outcomes.

Results:
A case of 57-year-old man diagnosed with vitreous seeding in the left eye 1 year after episcleral brachytherapy for medium-sized choroidal melanoma. The patient was initially diagnosed to have subretinal and vitreous hemorrhage due to rupture of a retinal artery macroaneurysm for which focal laser and intravitreal antivascular endothelial growth factor injections were administered. Over the next 9 months, the vitreous hemorrhage cleared and choroidal melanoma with retinal invasion became evident. One year after brachytherapy, the primary tumor regressed with resolution of surrounding subretinal fluid and hemorrhage. However, gradual decline in the visual acuity from 20/50 to 20/500 with increase of pigmented debris over the retinal surface and in the vitreous cavity was noted. A vitreous biopsy confirmed the presence of viable melanoma cells (epithelioid type), and the eye was enucleated. Histopathology showed microscopic persistence of primary tumor with diffuse vitreous seeding.

Conclusion:
Vitreous seeding of choroidal melanoma poses a diagnostic and management challenge.
Work-Sampling Study of an Innovative Care Coordination Program Aimed at Children With Chronic Health Conditions
Authors: Talon Brian , Gerges Michael , Perry-Bell Kenita , Caskey Rachel N. , Van Voorhees Benjamin , Martin Molly A. , Touchette Daniel R. 
Published: October 2020

Purpose of Study:
To estimate time allocation and labor cost for care coordinators (CCs), community health workers (CHWs), and mental health workers (MHWs) to conduct care coordination tasks in a pediatric care coordination program.

Primary Practice Setting:
A public tertiary academic medical center in Chicago, IL.

Methodology and Sample:
A work-sampling study was conducted using a text message-based survey on 5 CCs, 20 CHWs, and 4 MHWs who volunteered to participate. Workers were randomly sampled within working hours to collect information on who was the subject of interaction and what service was being delivered over a 6-month period. Time allocation of workers to different subjects and services was summarized using descriptive statistics.

Results:
Care coordinators allocated 41% of their time to managing CHW teams. Community health workers allocated 37% of time providing services directly to children and 26% to the parent/caregiver. Mental health workers allocated 16% of time providing services to children and 29% to the parent/caregiver. The care coordination program serviced 5,965 patients, with a total annual labor cost of $1,455,353.

Implications for Case Management Practice:
Community health workers spent the majority of time working with patients and their families to conduct assessments. Mental health workers primarily addressed children's needs through their caregivers. Care coordinators primarily supported CHWs in coordinating care. Results may be used to inform development of such programs by determining services most often utilized, and labor cost may be used to inform program implementation and reimbursement.
Effect of Pudendal Blockade on Bladder Emptying After Midurethral Sling: A Randomized Controlled Trial
Authors: Maheshwari Deepali , Sierra Tania , Leung Katherine , Hall Cynthia , Flynn Michael 
Published: October 2020

Objectives
To evaluate the effect of bilateral pudendal nerve blockade on immediate postoperative bladder emptying after midurethral sling.

Methods
We performed a double-blinded, randomized, placebo-controlled trial of women undergoing a midurethral sling procedure between October 2017 and February of 2019. Women older than 18 years were eligible if they were undergoing a midurethral sling with no concomitant procedures and had no preoperative urinary retention. Participant demographics and medical conditions that may affect bladder emptying were recorded preoperatively. Participants were randomized to a bilateral pudendal injection of either bupivacaine or normal saline. After induction of anesthesia, the pudendal injection was administered before any incisions. No other local anesthesia was used. The primary outcome was the rate of passing a standardized void trial. Secondary outcomes included perioperative pain scores, analgesia use, and complications.

Results
Ninety-one participants were enrolled in the study. One patient had a delayed void trial on postoperative day 1, leaving 90 participants for the final analysis. Demographic and perioperative characteristics were similar between the groups. Adjusted logistic regression showed that the administration of a bupivacaine pudendal block led to a higher rate of void trial failure (43% vs 20%, odds ratio = 0.32, P = 0.02 adjusted for age, body mass index, and comorbidities). Postoperative pain scores and analgesia use were similar between the groups. Postoperative complications, including urinary tract infection, mesh erosion, pelvic hematoma, or urinary retention within 6 weeks were similar between the groups.

Conclusions
Our prospective trial demonstrates that a bilateral pudendal blockade before midurethral sling procedure worsens postoperative bladder emptying.
QSM Reconstruction Challenge 2.0: a realistic in silico head phantom for MRI data simulation and evaluation of susceptibility mapping procedures
Authors: Marques José P. , Meineke Jakob , Milovic Carlos , Bilgic Berkin , Chan Kwok-Shing , Hedouin Renaud , van der Zwaag Wietske , Langkammer Christian , Schweser Ferdinand 
Published: October 2020

AbstractPurposeTo create a realisticin-silicohead phantom for the second Quantitative Susceptibility Mapping (QSM) Reconstruction Challenge and for future evaluations of processing algorithms for QSM.MethodsWe created a digital whole-head tissue property phantom by segmenting and post-processing high-resolution (0.64mm isotropic), multi-parametric MRI data acquired at 7T from a healthy volunteer. We simulated the steady-state magnetization at 7T using a Bloch simulator and mimicked a Cartesian sampling scheme through Fourier-based processing. Computer code for generating the phantom and performing the MR simulation was designed to facilitate flexible modifications of the phantom in the future, such as the inclusion of pathologies, as well as the simulation of a wide range of acquisition protocols. Specifically, the following parameters and effects were implemented: repetition time and echo time, voxel size, background fields, and RF phase biases. Diffusion weighted imaging phantom data is provided allowing future investigations of tissue microstructure effects in phase and QSM algorithms.ResultsThe brain-part of the phantom featured realistic morphology with spatial variations in relaxation and susceptibility values similar to the in vivo setting. We demonstrated some of the phantom’s properties, including the possibility of generating phase data with non-linear evolution over echo time due to partial volume effects or complex distributions of frequency shifts within the voxel.ConclusionThe presented phantom and computer programs are publicly available and may serve as a ground truth in future assessments of the faithfulness of quantitative susceptibility reconstruction algorithms.
Adaptive conformational restraints for interactive model rebuilding in Cartesian and torsion space
Authors: Croll Tristan I , Read Randy J 
Published: October 2020

AbstractWhen building atomic models into weak and/or low-resolution density, a common strategy is to restrain its conformation to that of a higher-resolution model of the same or similar sequence. When doing so, it is important to avoid over-restraining to the reference model in the face of disagreement with the experimental data. The most common strategy for this is the use of “top-out” potentials. These act like simple harmonic restraints within a defined range, but gradually weaken when the deviation between the model and reference grows larger than a defined transition point. In each current implementation, the rate at which the potential flattens beyond the transition region follows a fixed form – although the form chosen varies between implementations. A restraint potential with a tuneable rate of flattening would provide greater flexibility to encode the confidence in any given restraint. Here we describe two new such potentials: a Cartesian distance restraint derived from a recent generalisation of common loss functions, and a periodic torsion restraint based on a renormalisation of the von Mises distribution. Further, we describe their implementation as user-adjustable/switchable restraints in ISOLDE, and demonstrate their use in some real-world examples.SynopsisNew forms of adaptive or top-out distance and torsion restraints are described, suitable for restraining a model to match a reference structure during interactive rebuilding. In addition, their implementation in ISOLDE is described along with some illustrative example applications.