bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chromium propionate supplementation alters animal growth performance, carcass characteristics, and skeletal muscle properties in feedlot steers
Authors: Baggerman Jessica O , Smith Zachary K , Thompson Alex J , Kim Jongkyoo , Hergenreder Jerilyn E , Rounds Whitney , Johnson Bradley J 
Published: July 2020

Abstract
The objective of this study was to evaluate the effects of increasing concentrations of Cr propionate (CrP) on feedlot performance, blood parameters, carcass characteristics, and skeletal muscle fiber properties in feedlot steers. Crossbred steers (n = 32; 367 ± 2.5 kg; 16 pens; 2 hd/pen) were blocked by body weight (BW), and treatment was randomly assigned to pen: (1) 0 mg added Cr/kg diet dry matter (DM) (control), (2) 0.15 mg added Cr/kg diet DM (CrP; KemTRACE Chromium 0.04%, Kemin Industries, Des Moines, IA), (3) 0.30 mg added Cr/kg diet DM, and (4) 0.45 mg added Cr/kg diet DM. Steers were fed ad libitum, and the treatment was top-dressed at the time of feeding. Body weights, blood samples, and longissimus biopsies were collected before feeding on days 0, 28, 56, 91, 119, and 147. Blood sera were harvested for analysis of glucose, insulin, sera urea nitrogen, and non-esterified fatty acid concentrations. Longissimus biopsies were collected for gene expression, protein expression, and immunohistochemical (IHC) analysis. Pen was the experimental unit for live and carcass data, and steer was the experimental unit with day as a repeated measure for sera and IHC analyses. For the entire duration of the trial, a linear increase in average daily gain (ADG) (P = 0.01) and improvement in G:F was observed (P = 0.01) with no change in DMI (P = 0.11) with increasing CrP. A linear increase in hot carcass weight (HCW) (P ≤ 0.01) with no other changes in carcass composition were noted (P ≥ 0.38) as the level of dietary CrP increased. There was no effect of treatment on any sera parameters measured (P ≥ 0.10). No difference was detected for gene or protein expression of glucose transporter type 4 (GLUT4) due to CrP supplementation (P ≥ 0.10). For skeletal muscle fiber distribution and cross-sectional area, there was no effect of treatment (P ≥ 0.10). Density of total GLUT4 did not change due to CrP (P ≥ 0.10). Internalization of GLUT4 was increased in the 0.30 and 0.45 mg/kg treatments (P &lt; 0.01). For total nuclei density and myonuclei density, there were treatment × day interaction tendencies (P ≤ 0.08). Supplementation of CrP did not alter density of satellite cells (P ≥ 0.10). The number of transporters located in the sarcolemma of skeletal muscle fibers did decrease, implying fewer proteins were needed to transport extracellular glucose into the muscle fiber. Therefore, CrP may augment cellular function and growth via increased efficiency of GLUT4 function. These results indicated CrP increases BW, ADG, and HCW, without changes in circulating sera parameters or total GLUT4 expression.
What is the current significance of low birthweight pigs on commercial farms in Northern Ireland in terms of impaired growth and mortality?
Authors: Hawe Samuel J , Scollan Nigel , Gordon Alan , Magowan Elizabeth 
Published: July 2020

Abstract
There is little modern data addressing the differential lifetime growth of commercially reared low and average birthweight pigs born into large litters (&gt;14 piglets). As such, the main aim of this study was to quantify the lifetime growth and mortality rate of low and average birthweight pigs on commercial farms in Northern Ireland. It was also aimed to analyze the level, stage and cause of mortality within each birthweight category. A total of 328 low birthweight (low BW; &lt;1 kg) and 292 average birthweight (Av BW; 1.3 to 1.7 kg) pigs were individually identified across four commercial farms and one research farm. Animal growth and mortality were monitored on an individual basis from birth until slaughter age. Av BW pigs were heavier than low BW pigs throughout the trial (P &lt; 0.001), with a weight advantage of 1.16 kg at weaning increasing to over 9 kg at slaughter age. Av BW pigs recorded a superior average daily gain (ADG) to low BW pigs throughout the trial (P &lt; 0.05), with the greatest difference recorded immediately postweaning between weeks 4 and 8 and weeks 8 and 12 when a 77 and 85 g/d difference was recorded, respectively. AV BW pigs which were cross-fostered were significantly lighter than those remaining with their birth mother at weaning (0.9 kg), week 8 (1.7 kg), and week 12 (3.1 kg) (P &lt; 0.05, respectively). The variance of weight was significantly greater for the AV BW pig population than the low BW pig population at week 4 (P &lt; 0.001) and 8 (P &lt; 0.05). Preweaning mortality of low BW pigs was over three times greater than that of Av BW pigs (21% vs. 6%; P &lt; 0.001), with low BW deaths occurring earlier (9.2 d vs. 15.4 d; P &lt; 0.001) and at a lighter weight (1.2 vs. 2.4 kg; P &lt; 0.001) than Av BW pigs. There was a clear association between birthweight and cause of preweaning death (P &lt; 0.05), with starvation (49%) and overlying (28%) accounting for the majority of low BW mortalities. Birthweight had no effect on rate, age, or weight of postweaning mortalities (P &gt; 0.05). The alimentary tract (27%) and respiratory tract (27%) were the most commonly implicated body systems following postmortem examination of postweaning deaths. In conclusion, this study quantified the inferior weight, growth rate, and mortality of low BW pigs, identifying the lactation and immediate postweaning periods as having the greatest potential in reducing this birthweight associated growth differential.
Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention
Authors: Mueller Raquel Aitken Soares , Frota Ana Cristina Cisne , Menna Barreto Daniela Durão , Vivacqua Daniela Pires Ferreira , Loria Gabriela Bueno , Lebreiro Giuliana Pucarelli , Martins Mariana Guerreiro , Potsch Mariana Vigo , Maia Paula Dias , Coutinho Raquel Lara Melo , Abreu Thalita Fernandes , Hofer Cristina Barroso 
Published: July 2020

AbstractObjectivesIdentify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016.MethodsDescriptive study including infants with CT, diagnosis established based on Brazil’s Ministry of Health’s criteria. All data regarding the infants and their mother’s prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)—a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded.ResultsThe obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth.ConclusionDespite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.
Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis
Authors: Panda Prateek Kumar , Sharawat Indar Kumar , Panda Pragnya , Natarajan Vivekanand , Bhakat Rahul , Dawman Lesa 
Published: July 2020

AbstractBackgroundKnowledge about neurological complications of COVID-19 in children is limited due to the paucity of data in the existing literature. Some systematic reviews are available describing overall clinical features of COVID-19 in children and neurological complications of COVID-19 in adults. But to the best of our knowledge, no systematic review has been performed to determine neurological manifestations of COVID-19.MethodsSix different electronic databases (MEDLINE, EMBASE, Web of Science, CENTRAL, medRxiv and bioRxiv) were searched for articles related to COVID-19 and neurological complications in children. Studies/case series reporting neurological manifestations of COVID-19 in patients aged ≤18 years, as well as case reports, as neurological complications appear to be rare. The pooled estimate of various non-specific and specific neurological manifestations was performed using a random effect meta-analysis.ResultsTwenty-one studies/case series and five case reports (3707 patients) fulfilled the eligibility criteria and were included in this systematic review, from a total of 460 records. Headache, myalgia and fatigue were predominant non-specific neurological manifestations, presenting altogether in 16.7% cases. Total of 42 children (1%) were found to have been reported with definite neurological complications, more in those suffering from a severe illness (encephalopathy—25, seizure—12, meningeal signs—17). Rare neurological complications were intracranial hemorrhage, cranial nerve palsy, Guillain–Barré syndrome and vision problems. All children with acute symptomatic seizures survived suggesting a favorable short-term prognosis.ConclusionNeurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.
Identifying Entrustable Professional Activities for Shared Decision Making in Postgraduate Medical Education: A National Delphi Study
Authors: Baghus Anouk , Giroldi Esther , Muris Jean , Stiggelbout Anne , van de Pol Marjolein , Timmerman Angelique , van der Weijden Trudy 
Published: July 2020

Purpose
Although shared decision making (SDM) is considered the preferred approach in medical decision making, it is currently not routinely used in clinical practice. To bridge the transfer gap between SDM training and application, the authors aimed to reach consensus on entrustable professional activities (EPAs) for SDM and associated behavioral indicators as a framework to support self-directed learning during postgraduate medical education.

Method
Using existing literature on SDM frameworks and competencies; input from an interview study with 17 Dutch experts in SDM, doctor–patient communication, and medical education; and a national SDM expert meeting as a starting point, in 2017, the authors conducted a modified online Delphi study with a multidisciplinary Dutch panel of 32 experts in SDM and medical education.

Results
After 3 Delphi rounds, consensus was reached on 4 EPAs—(1) the resident discusses the desirability of SDM with the patient, (2) the resident discusses the options for management with the patient, (3) the resident explores the patient’s preferences and deliberations, and (4) the resident takes a well-argued decision together with the patient. Consensus was also reached on 18 associated behavioral indicators. Of the 32 experts, 30 (94%) agreed on this list of SDM EPAs and behavioral indicators.

Conclusions
The authors succeeded in developing EPAs and associated behavioral indicators for SDM for postgraduate medical education to improve the quality of SDM training and the application of SDM in clinical practice. These EPAs are characterized as process EPAs for SDM in contrast with content EPAs related to diverse medical complaints. A next step is the implementation of the SDM EPAs in existing competency-based workplace curricula.
An Incentive to Innovate: Improving Health Care Value and Restoring Physician Autonomy Through Physician-Directed Reinvestment
Authors: Vilendrer Stacie M. , Asch Steven M. , Anzai Yoshimi , Maggio Paul 
Published: July 2020

Problem
Many health care systems in the United States are shifting from a fee-for-service reimbursement model to a value-based payment model. To remain competitive, health care administrators must engage frontline clinicians in their efforts to reduce costs and improve patient outcomes. Engaging physicians and other clinicians is challenging, however, as many feel overwhelmed with clinical responsibilities and do not view cost reduction as in their purview. Even if they are willing, providing a direct financial incentive to clinicians to control costs poses ethical and legal challenges. An effective incentive in the current system must motivate clinicians to engage in creative problem solving and mitigate ethical and legal risk.

Approach
Evidence suggests the most successful behavior change interventions in physicians are multifaceted and combine intrinsic motivators, such as increased autonomy, with extrinsic motivators, such as access to funding or social recognition. Two academic health centers—the University of Utah Health and Stanford Health Care—have begun experimenting with an alternative value-sharing arrangement. Physician-directed reinvestment is an explicit agreement in which a health care system reinvests a portion of savings attributed to physician-led cost reduction initiatives back into areas of the physician’s choosing, such as capital investment, research, or education.

Outcomes
Both organizations reported similar positive outcomes, including increased engagement from clinicians and administrators, sustained or improved quality of care, reduced costs of care, and benefits from reinvested funds. Many savings opportunities were previously unknown to administrators.

Next Steps
Physician-directed reinvestment appears to effectively engage physicians in ongoing efforts to improve value in health care, although formal evaluation is still needed. This incentive structure may hold promise in other configurations, such as inviting nonphysicians to apply as project leaders (clinician-directed reinvestment) and expanding the program to nonacademic and ambulatory settings.
Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation
Authors: Schwenk Eric S. , Kasper Vincent P. , Smoker Jordan D. , Mendelson Andrew M. , Austin Matthew S. , Brown Scot A. , Hozack William J. , Cohen Alexa J. , Li Jonathan J. , Wahal Christopher S. , Baratta Jaime L. , Torjman Marc C. , Nemeth Alyson C. , Czerwinski Eric E. 
Published: July 2020

Background
Early ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.

Methods
This randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, or 12.5 mg of isobaric bupivacaine for spinal anesthesia. The primary outcome was ambulation between 3 and 3.5 h. Secondary outcomes included return of motor and sensory function, postoperative pain, opioid consumption, transient neurologic symptoms, urinary retention, intraoperative hypotension, intraoperative muscle tension, same-day discharge, length of stay, and 30-day readmissions.

Results
Of 154 patients, 50 received mepivacaine, 53 received hyperbaric bupivacaine, and 51 received isobaric bupivacaine. Patient characteristics were similar among groups. For ambulation at 3 to 3.5 h, 35 of 50 (70.0%) of patients met this endpoint in the mepivacaine group, followed by 20 of 53 (37.7%) in the hyperbaric bupivacaine group, and 9 of 51 (17.6%) in the isobaric bupivacaine group (P < 0.001). Return of motor function occurred earlier with mepivacaine. Pain and opioid consumption were higher for mepivacaine patients in the early postoperative period only. For ambulatory status, 23 of 50 (46.0%) of mepivacaine, 13 of 53 (24.5%) of hyperbaric bupivacaine, and 11 of 51 (21.5%) of isobaric bupivacaine patients had same-day discharge (P = 0.014). Length of stay was shortest in mepivacaine patients. There were no differences in transient neurologic symptoms, urinary retention, hypotension, muscle tension, or dizziness.

Conclusions
Mepivacaine patients ambulated earlier and were more likely to be discharged the same day than both hyperbaric bupivacaine and isobaric bupivacaine patients. Mepivacaine could be beneficial for outpatient total hip arthroplasty candidates if spinal is the preferred anesthesia type.

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What This Article Tells Us That Is New
Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice Among Jordanian Nurses in Critical Care Units
Authors: Salah Ma'moun A. , Abu-Moghli Fathieh A. 
Published: July 2020

Background
Evidence-based practice (EBP) has become of great interest to policymakers, health care practitioners, and researchers.

Objective
This study aimed at assessing knowledge associated with, attitudes toward, and implementation of EBP among Jordanian registered nurses (RNs) in critical care units.

Method
A descriptive, correlational, and cross-sectional study was conducted in 5 hospitals: 3 public and 2 private. A convenience sample of 200 RNs was invited. Data were collected using a paper-based and self-administered questionnaire, in 2 sections; the first section was the demographic and contextual characteristics and the second was the Evidence-Based Practice Questionnaire (J Adv Nurs. 2006;53(4):454-458) to measure RNs' knowledge, attitudes, and EBP.

Results
A total of 187 RNs were included in this study. Findings revealed that Jordanian RNs in critical care units perceived themselves as having a satisfactory level of knowledge and practice of evidence-based interventions. In addition, RNs strongly recognized the value of EBP. There were significant positive associations between EBP and knowledge associated with EBP (r = 0.708, P < .001) and attitude toward EBP (r = 0.490, P < .001).

Conclusion
Knowledge associated with EBP, a positive attitude toward EBP, higher educational qualifications, and training in EBP all increased the implementation of EBP. It is recommended that continuing education programs on EBP for nurses be conducted. Nursing educators in clinical settings have to consider a number of strategies to improve EBP. A qualitative research design and/or including open-ended questions are encouraged to gain more in-depth views about EBP.
How We Manage Patients With Chronic Lymphocytic Leukemia During the SARS‐CoV‐2 Pandemic
Authors: Rossi Davide , Shadman Mazyar , Condoluci Adalgisa , Brown Jennifer R. , Byrd John C. , Gaidano Gianluca , Hallek Michael , Hillmen Peter , Mato Anthony , Montserrat Emili , Ghia Paolo 
Published: July 2020

AbstractInfections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). These can be exacerbated by anti‐leukemic treatments. In addition, the typical patients with CLL already have fragilities and background risk factors that apply to the general population for severe COVID‐19. On these bases, patients with CLL may experience COVID‐19 morbidity and mortality. Recurrent seasonal epidemics of SARS‐CoV‐2 are expected, and doctors taking care of patients with CLL must be prepared for the possibility of substantial resurgences of infection and adapt their approach to CLL management accordingly. In this Guideline Article, we aim at providing clinicians with a literature‐informed expert opinion on the management of patients with CLL during SARS‐CoV‐2 epidemic.
Pediatric Cardiac Intensive Care Distribution, Service Delivery, and Staffing in the United States in 2018*
Authors: Horak Robin V. , Alexander Peta M. , Amirnovin Rambod , Klein Margaret J. , Bronicki Ronald A. , Markovitz Barry P. , McBride Mary E. , Randolph Adrienne G. , Thiagarajan Ravi R. 
Published: July 2020

Objectives:
To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States.

Design:
Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders.

Setting:
Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate units, specifically for the treatment of children with life-threatening conditions, including primary cardiac disease.

Participants:
Cardiac ICU or mixed ICU physician medical directors or designees.

Measurements and Main Results:
One-hundred twenty ICUs were identified: 61 (51%) were mixed ICUs and 59 (49%) were cardiac ICUs. Seventy five percent of institutions at least sometimes used a neonatal ICU prior to surgery. The most common temporary cardiac support beyond extracorporeal membrane oxygenation was a centrifugal pump such as Centrimag. Durable cardiac support devices were far more common in separate cardiac ICUs (84% vs 20%; p < 0.0001). Significantly less availability of electrophysiology, heart failure, and cardiac anesthesia consultation was available in mixed ICUs (p = 0.0003, p < 0.0001, p = 0.042 respectively). ICU attending physicians were in-house day and night 98% of the time in mixed ICUs and 87% of the time in cardiac ICUs. Nurse practitioners were consistent front-line providers in the ICUs caring for children with primary cardiac disease staffing 88% of cardiac ICUs and 56% of mixed ICUs. Mixed ICUs were more commonly staffed with pediatric residents, and critical care fellows were found in more cardiac ICUs (83% vs 77%; p < 0.0001).

Conclusions:
Mixed ICUs and cardiac ICUs have statistically different staffing models and available services. More evaluation is needed to understand how this may impact patient outcomes and training programs of physicians and nurses.