bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peak Oxygen Uptake Recovery Delay After Maximal Exercise in Patients With Heart Failure
Authors: Kadariya Dinesh , Canada Justin M. , Del Buono Marco Giuseppe , van Wezenbeek Jessie , Tchoukina Inna , Arena Ross , Van Tassell Benjamin , Abbate Antonio 
Published: April 2020

Purpose:
Peak oxygen uptake recovery delay (V˙o2peakRD), measured as the time until post-exercise oxygen uptake (V˙o2) decreases below V˙o2peak following maximal cardiopulmonary exercise testing (CPX), has been recognized as an abnormal response, associated with reduced cardiac output reserve during exercise in patients with heart failure (HF). In the current study we examined the association of V˙o2peakRD during routine CPX testing of patients with symptomatic HF across a wide range of left ventricular ejection fraction (LVEF) values with clinical biomarkers.

Methods:
In this retrospective study, 80 clinically stable symptomatic HF patients across a wide range of LVEF at our institution were evaluated that put forth a minimally acceptable effort during CPX testing (respiratory exchange ratio ≥ 1.00). The V˙o2peakRD was measured in 10-sec intervals following maximal CPX testing. Markers of elevated cardiac filling pressures (N-terminal pro-brain natriuretic peptide [NTproBNP] and echocardio-Doppler E/e') and other key CPX parameters were explored for their association with V˙o2peakRD.

Results:
The mean V˙o2peakRD and V˙o2peak were 10 (interquartile range 10, 40) sec and 13.9 (11.6, 16.4) mL· kg−1 · min−1, respectively. V˙o2peakRD demonstrated a positive linear trend with serum NTproBNP levels and E/e' (T
JT = 1239.500, z = 2.634, P < .01; T
JT = 1081.000, z = 2.046, P = .04, respectively).

Conclusion:
Prolonged V˙o2peakRD following exercise is associated with markers of greater disease severity in patients with HF.
Design and Characterization of an Extremely-Sensitive, Large-Volume Gamma-Ray Spectrometer for Environmental Samples
Authors: Seekamp James M. , Noey Jordan D. , Kwapis Emily H. , Chung Long Kiu , Shubayr Nasser A. , Smith Travis , Trimas David J. , Kearfott Kimberlee J. 
Published: April 2020

Abstract
A large volume gamma spectrometer was designed and constructed to analyze foodstuffs and environmental samples having low radionuclide concentrations. This system uses eight 11-cm × 42.5-cm × 5.5-cm NaI(Tl) detectors, chosen due to their relatively high sensitivity and availability and arranged in an octagonal configuration. The sensitive volume of the system is ~28 cm in diameter and ~42 cm deep. Shielding consists of an 86-cm × 86-cm square, 64-cm-tall lead brick enclosure with 18-cm-thick lead walls lined by 0.3-cm-thick copper plates. An aluminum top was machined to suspend the detectors within this shield. The shielding reduces background counts by 72% at 100 keV and 42% at 1,000 keV. The positional variability in sensitivity of the well was determined by both simulation and experiment. A 2.1-L volume of nearly uniform sensitivity, varying less than 10%, exists in the well's center. Energy resolutions of 14.6% and 7.8% were measured for 241Am and 137Cs, respectively. Energy resolution shows a 0.2% variation for both 241Am and 137Cs as a function of position within all regions of the well’s central sensitive volume. Dead time was also determined to be less than 35% for all sources measured in the system, the largest of which had an activity of 1,760 kBq. Simulated results for various source geometries show higher counts for smaller samples, especially at lower energies due to less attenuation of low energy photons. Minimum detectable activities were determined for all source energies used, less than 5.1 Bq kg−1 for reasonable background and sample counting times.
The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients
Authors: Hirabayashi Kyle J. , Pomerantz Madison , Radell Jake E. , Chadha Nisha , Thomas Stephanie , Serle Janet B. 
Published: April 2020

Précis:
To assess the after-visit summary (AVS) as a tool for glaucoma medication recall. Medication recall was associated with level of education and complexity of medication regimen. Receiving an AVS was not associated with better medication recall.

Purpose:
The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall.

Materials and Methods:
Observational clinical study. Adults on ≥1 glaucoma medications examined between June 30, 2017 and August 2, 2017. Data collection: in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen. Data analysis: 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression.

Results:
A total of 118 patients enrolled: age 69.7±12.9 years (mean±SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4±1.0 vs. 2.7±0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate’s degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002).

Conclusions:
AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.
Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005–2015
Authors: Delahoy Miranda J. , Cárcamo César , Ordoñez Luis , Vasquez Vanessa , Lopman Benjamin , Clasen Thomas , Gonzales Gustavo F. , Steenland Kyle , Levy Karen 
Published: April 2020

Background:
We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors.

Methods:
We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the “pre-vaccine” (2005–2009) and “post-vaccine” (2010–2015) eras.

Results:
The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%–10%] lower in the post-vaccine era compared with the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%–12%), 13% (95% CI: 7%–19%) and 15% (95% CI: 10%–20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared with the pre-vaccine era); results for sewerage access were similar.

Conclusion:
Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru.
Premonitory symptoms in glyceryl trinitrate triggered migraine attacks: a case-control study
Authors: Onderwater Gerrit L.J. , Dool Jitze , Ferrari Michel D. , Terwindt Gisela M. 
Published: April 2020

AbstractSpontaneous and pharmacologically provoked migraine attacks are frequently preceded by nonheadache symptoms called premonitory symptoms. Here, we systematically evaluated premonitory symptoms in migraine patients and healthy controls after glyceryl trinitrate (GTN) infusion. In women with migraine without aura (n = 34) and age-matched female controls (n = 24), we conducted systematically a semistructured interview assessing 21 possible premonitory symptoms every 15 minutes in the 5 hours after GTN infusion (0.5 µg/kg/min over 20 minutes). Migraine-like headaches occurred in 28/34 (82.4%) migraineurs (GTN responders). After GTN, 26/28 (92.9%) responders, 6/6 (100%) nonresponders, and 13/24 (54.2%) controls reported at least one possible premonitory symptom. Concentration difficulties (P= 0.011), yawning (P= 0.009), nausea (P= 0.028), and photophobia (P= 0.001) were more frequently reported by those migraineurs who developed a migraine-like attack vs healthy controls. Importantly, concentration difficulties were exclusively reported by those who developed a migraine-like attack. Thus, our findings support the view that GTN is able to provoke the naturally occurring premonitory symptoms and show that yawning, nausea, photophobia, and concentration difficulties are most specific for an impending GTN-induced migraine-like headache. We suggest that these symptoms may also be helpful as early warning signals in clinical practice with concentration difficulties exclusively reported by those who develop a migraine-like attack.
Prolonged Ketamine and Norketamine Excretion Profiles in Urine After Chronic Use
Authors: de Jong Lutea A.A. , Qurishi Rouhollah , Stams Marieke P.J. , Böttcher Michael , de Jong Cornelis A.J. 
Published: April 2020

Abstract

Purpose/Background
Ketamine (K) is used as a party drug with hallucinogenic properties with a half-life of about 2.5 hours. Data are available with respect to the detection window (ie, when a person is still tested positive for the drug and/or metabolite after use) of K after single use. Nevertheless, no data are available with respect to the detection window of K in urine after chronic use.

Methods/Procedures
This retrospective case series describes 7 patients with K dependency as their main addiction who have been admitted to an addiction center for K detoxification. Their abstinence-oriented care involved routine urinary screening of K and its metabolites, as well as traditional drugs of abuse, such as cocaine and cannabinoids.

Findings/Results
Urine samples remained positive for all the cases identified after 22 to 96 days. A peak detection period of 61, 40, and 96 days for K, norketamine, and dehydronorketamine, respectively, measured using liquid chromatography–tandem mass spectrometry at a cutoff concentration of 1.0 ng/mL, is defined. The K/norketamine and K/dehydronorketamine ratios varied over time between 0.33 and 3.06, and 0.01 and 0.36 for all patients, respectively, implying a large interindividual variation in K metabolism.

Implications/Conclusions
Ketamine and its metabolites have a prolonged excretion profile in urine, which requires frequent measurements (at least weekly) to guide abstinence treatment. Further research is needed to develop an algorithm that can differentiate new K use from residual urinary K excretion in urine of chronic daily users.
An Alzheimer Disease Challenge Model: 24-Hour Sleep Deprivation in Healthy Volunteers, Impact on Working Memory, and Reversal Effect of Pharmacological Intervention
Authors: Chan Kwong Anna , Cassé-Perrot Catherine , Costes-Salon Marie-Claude , Jouve Elisabeth , Lanteaume Laura , Audebert Christine , Rouby Franck , Lefebvre Marie-Noëlle , Ranjeva Jean-Philippe , Beck Arnaud , Deplanque Dominique , Ponchel Amélie , Vervueren Céline , Truillet Romain , Babilon Claudio , Auffret Alexandra , Richardson Jill C. , Payoux Pierre , Bartrés-Faz David , Blin Olivier , Bordet Régis , Micallef Joëlle 
Published: April 2020

Abstract

Purpose/Background
Alzheimer disease (AD) is a public health issue because of the low number of symptomatic drugs and the difficulty to diagnose it at the prodromal stage. The need to develop new treatments and to validate sensitive tests for early diagnosis could be met by developing a challenge model reproducing cognitive impairments of AD. Therefore, we implemented a 24-hour sleep deprivation (SD) design on healthy volunteers in a randomized, double-blind, placebo-controlled, crossover study on 36 healthy volunteers.

Methods/Procedure
To validate the SD model, cognitive tests were chosen to assess a transient worsening of cognitive functions after SD and a restoration under modafinil as positive control (one dose of 200 mg). Then, the same evaluations were replicated after 15 days of donepezil (5 mg/d) or memantine (10 mg/d). The working memory (WM) function was assessed by the N-back task and the rapid visual processing (RVP) task.

Findings/Results
The accuracy of the N-back task and the reaction time of the RVP revealed the alteration of the WM with SD and its restoration with modafinil (changes in score after SD compared with baseline before SD), respectively, in the placebo group and in the modafinil group (−0.2% and +1.0% of satisfactory answers, P = 0.022; +21.3 and +1.9 milliseconds of reaction time, P = 0.025). Alzheimer disease drugs also tended to reverse this deterioration: the accuracy of the N-back task was more stable through SD (compared with −3.0% in the placebo group, respectively, in the memantine group and in the donepezil group: −1.4% and −1.6%, P = 0.027 and P = 0.092) and RVP reaction time was less impacted (compared with +41.3 milliseconds in the placebo group, respectively, in the memantine group and in the donepezil group: +16.1 and +29.3 milliseconds, P = 0.034 and P = 0.459).

Implications/Conclusions
Our SD challenge model actually led to a worsening of WM that was moderated by both modafinil and AD drugs. To use this approach, the cognitive battery, the vulnerability of the subjects to SD, and the expected drug effect should be carefully considered.
Lurasidone Improves Psychopathology and Cognition in Treatment-Resistant Schizophrenia
Authors: Meltzer Herbert Y. , Share Daniel B. , Jayathilake Karu , Salomon Ronald M. , Lee Myung A. 
Published: April 2020

Abstract

Purpose/Background
In addition to clozapine, other atypical antipsychotic drugs pharmacologically similar to clozapine, for example, olanzapine, risperidone, and melperone, are also effective in a similar proportion of treatment-resistant schizophrenia (TRS) patients, ~40%. The major goal of this study was to compare 2 doses of lurasidone, another atypical antipsychotic drug, and time to improvement in psychopathology and cognition during a 6-month trial in TRS patients.

Methods/Procedures
The diagnosis of TRS was based on clinical history and lack of improvement in psychopathology during a 6-week open trial of lurasidone 80 mg/d (phase 1). This was followed by a randomized, double-blind, 24-week trial of lurasidone, comparing 80- and 240-mg/d doses (phase 2).

Findings/Results
Significant non–dose-related improvement in the Positive and Negative Syndrome Scale—Total and subscales and in 2 of 7 cognitive domains, speed of processing and executive function, were noted. Twenty-eight (41.8%) of 67 patients in the combined sample improved ≥20% in the Positive and Negative Syndrome Scale—Total. Of the 28 responders, 19 (67.9%) first reached ≥20% improvement between weeks 6 and 24 during phase 2, including some who had previously failed to respond to clozapine.

Implications/Conclusions
Improvement with lurasidone is comparable with those previously reported for clozapine, melperone, olanzapine, and risperidone in TRS patients. In addition, this study demonstrated that 80 mg/d lurasidone, an effective and tolerable dose for non-TRS patients, was also effective in TRS patients but required longer duration of treatment. Direct comparison of lurasidone with clozapine in TRS patients is indicated.
Body Mass Index as a Moderator of Treatment Response to Ketamine for Major Depressive Disorder
Authors: Freeman Marlene P. , Hock Rebecca S. , Papakostas George I. , Judge Heidi , Cusin Cristina , Mathew Sanjay J. , Sanacora Gerard , Iosifescu Dan V. , DeBattista Charles , Trivedi Madhukar H. , Fava Maurizio 
Published: April 2020

AbstractPurpose/BackgroundMajor depressive disorder (MDD) and obesity commonly co-occur. We sought to assess the impact of body mass index (BMI) on the acute antidepressant effects of ketamine in patients with treatment-resistant depression.Methods/ProceduresPost hoc analyses were conducted from a multisite, randomized, double-blind, placebo-controlled trial designed to assess the rapid-onset effects of intravenous ketamine. Patients (n = 99) were randomized to a single dose administration of ketamine 0.1 mg/kg (n = 18), ketamine 0.2 mg/kg (n = 20), ketamine 0.5 mg/kg (n = 22), ketamine 1.0 mg/kg (n = 20), or active placebo, midazolam 0.045 mg/kg (n = 19). Patients were stratified for BMI. For patients randomized to ketamine (n = 80), BMI was assessed as a continuous variable and also categorically (obese, overweight, not obese/overweight [reference]). The primary outcome measure was the change on the 6-item Hamilton Depression Rating Scale 24 hours after treatment. Outcomes at day 3 were also assessed.Findings/ResultsThe 6-item Hamilton Depression Rating Scale change scores at 24 hours were inversely associated with BMI (−0.28 ± 0.12,P= 0.02). With BMI operationalized categorically, both obese (−4.15 ± 1.41,P= 0.004) and overweight (−1.99 ± 1.14,P= 0.08) categories were inversely related to the 6-item Hamilton Depression Rating Scale change score at 24 hours, statistically significant for the obese category, as compared with the reference group. Similar but weaker findings were observed at 72 hours after infusion.Implications/ConclusionsHigher BMI and obesity were associated with a more robust acute antidepressant response to ketamine. This may have clinical relevance for a great number of patients who have both MDD and obesity.Clinical Trial Registration: NCT01920555.
Scholarly Productivity and Occupational Stress Among Physician Assistant Educators
Authors: Hegmann Theresa E. 
Published: April 2020

Purpose
Academic scholarship continues to challenge physician assistant (PA) educators in the United States, who typically enter academia with little experience in research or publication. Consequently, difficulty with navigating the promotion process might be expected to impact both job satisfaction and retention of PA faculty. Providing reasonable benchmarks for scholarship is one focus of this project, along with exploration of relationships among publication success, gender, job stressors, program support, and intent to leave academia.

Methods
Deidentified data from the online 2017 Faculty & Directors Survey was obtained from the Physician Assistant Education Association (PAEA), including gender, academic rank, program role, degree, publication numbers, and variables measuring program support, stressors, and intent to leave the institution or academia. Individual response rate was 60.3%, N = 1009. SPSS-v25 was used for data analysis.

Results
Respondents were 65% female. The mean number of total publications was 2.7 (down from 4.2 in 2010); the median was zero with 50.6% reporting no publications during their career. Almost half (45.5%) of PA faculty were stressed by research or publishing demands; 53.6% were stressed by the promotion process. Physician assistant educators stressed by promotion were more likely to consider leaving their institution or academia as a whole (Fisher's exact, P < .001 for both).

Conclusion
This study updates publication benchmarks for PA educators. Scholarship levels have dropped since 2010, likely related to the recent influx of junior faculty. Navigating the promotions process is a significant occupational stressor for PA educators and is associated with faculty intent to leave academia.
Association of gender with clinical outcomes of patients with acute ST-segment elevation myocardial infarction presenting with acute heart failure
Authors: Dharma Surya , Dakota Iwan , Andriantoro Hananto , Firdaus Isman , Rahma Salsabila , Budi Siswanto Bambang 
Published: April 2020

Background
There is limited data evaluating the sex differences in outcomes of patients with ST-segment elevation myocardial infarction presenting with acute heart failure. We compared the outcomes between women and men with ST-segment elevation myocardial infarction presenting with acute heart failure (Killip classification ≥II).

Method
All ST-segment elevation myocardial infarction patients presenting to the emergency department of a cardiovascular center in Jakarta, Indonesia, from 1 February 2011 to 30 August 2019 were retrospectively analyzed.

Results
Of 6557 patients recorded, 929 were women, and 276 (4.2%) presented with acute heart failure. Compared with men with acute heart failure (N = 1540), women who presented with acute heart failure were older (63 ± 10 vs. 57 ± 10 years, P < 0.001), had a greater proportion of thrombolysis in myocardial infarction risk score >4 (85% vs. 73%, P < 0.001), received fewer primary angioplasty and in-hospital fibrinolytic therapy (40% vs. 48%, P = 0.004 and 1.1% versus 3.5%, P = 0.03, respectively), and had longer median door-to-device and total ischemia times (96 vs. 83 minutes, P = 0.001, and 516 versus 464 minutes, P = 0.02, respectively). Multivariate analysis showed that women and men with acute heart failure were each associated with increased risk of in-hospital mortality (odds ratio: 4.70; 95% confidence interval: 3.28–6.73 and odds ratio: 4.75; 95% confidence interval: 3.84–5.88, respectively), and this remained relatively unchanged even among patients with acute heart failure who had undergone reperfusion therapy (odds ratio: 5.35; 95% confidence interval: 3.01–9.47 and odds ratio: 5.19; 95% confidence interval: 3.80–7.08, respectively).

Conclusion
In our population, women with ST-segment elevation myocardial infarction presenting with acute heart failure had relatively similar risk of early mortality with their male counterpart (≈5-fold), thus should receive evidence-based treatment.
The impact of intra-arrest hypothermia
Authors: Nordberg Per , Annoni Filippo , Taccone Fabio S. 
Published: April 2020

Purpose of review
To address the impact of therapeutic hypothermia induced already during cardiopulmonary resuscitation (i.e. intra-arrest cooling) and its association with neurologic functional outcome.

Recent findings
Intra-arrest cooling is superior than post-ROSC cooling to mitigate brain injuries in experimental models of cardiac arrest. The delayed initiation of hypothermia in human studies may not have adequately addressed the underlying pathophysiology of ischemia and reperfusion. The assessment of early initiation of cooling has been complicated by increased rate of hemodynamic adverse events caused by infusion of cold intravenous fluids. These adverse events have been more deleterious in patients with initial shockable rhythms. A recent randomized study shows that an alternative intra-arrest cooling method using trans-nasal evaporative cooling was well tolerated and effective to shorten time to target temperature. However, the neurologic outcomes (CPC 1–2 at 90 days) in favor of intra-arrest cooling compared to hospital cooling (34.8% vs 25.9%, P = 0.11) in patients with initial shockable rhythms did not reach statistical significance.

Summary
Therapeutic intra-arrest hypothermia can be initiated safely at the scene of the arrest using transnasal evaporative cooling. The potential beneficial effect of intra-arrest cooling on neurologic recovery in patients with initial shockable rhythms should be explored further.