bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Measures of Trunk Recovery 5 to 10 Weeks Postpartum and Pelvic Floor Support and Symptoms 1 Year Postpartum in Primiparas Delivered Vaginally
Authors: Hitchcock Robert , Shaw Janet M. , Niederauer Stefan , Zhou Jing , Sheng Xiaoming , Yang Meng , Nygaard Ingrid E. 
Published: September 2020

Objective
To determine whether 2 aspects of trunk recovery after childbirth, intraabdominal pressure (IAP) generation and trunk flexor endurance (TFE), predict measures of pelvic floor health 1 year postpartum.

Methods
In this prospective cohort study, we enrolled nulliparas in their third trimester and followed up those delivered vaginally for 1 year. We measured IAP while lifting a weighted car seat (IAPLIFT), IAP during TFE testing (IAPTFE), and TFE duration 5 to 10 weeks postpartum and assessed pelvic floor support and symptoms 1 year postpartum.

Results
Mean age of the 624 participants was 28.7 years. At 5 to 10 weeks postpartum, mean (SD) maximal IAPLIFT and IAPTFE were 47.67 (11.13) and 51.57 (12.34) cm H2O, respectively. Median TFE duration was 126 seconds (Interquartile range, 74–211). At 1 year postpartum, 9.3% demonstrated worse support (maximal vaginal descent at or below hymen) and 54% met criteria for symptom burden (bothersome symptoms in ≥2 domains of Epidemiology of Prolapse and Incontinence Questionnaire). In multivariable models, neither IAPLIFT nor IAPTFE were associated with worse support or symptom burden (P = 0.54–1.00). Trunk flexor endurance duration increased prevalence of worse support (prevalence ratio, 1.05; 95% confidence interval, 1.01–1.08) per 60-second increase, P = 0.005) but not symptom burden (prevalence ratio, 1.00; 95% confidence interval, 0.98–1.03; P = 0.92).

Conclusions
These results provide some reassurance to early postpartum women, who are unlikely to perform routine activities that generate IAP far outside the range tested. Further research is needed to understand why women with long TFE durations have increased prevalence of worse support.
Put PEP in your step with a Podiatric Enhanced Recovery After Surgery Protocol in the outpatient adult population: a best practice implementation project
Authors: Noble Kim A. 
Published: September 2020

ABSTRACT

Objective:
The goal of this implementation project was to improve postoperative outcomes in the Day Surgery Podiatric patient population with the implementation of an enhanced recovery after surgery (ERAS) protocol at a large urban health system in the northeastern United States. We aimed to improve postoperative patient pain scores and reduce patient length of stay (LOS) with the implementation of the podiatric ERAS protocol (PEP).

Introduction:
ERAS provides an evidence-based interdisciplinary approach to the preparation and care of surgical patients. The core goals of ERAS promote accelerated patient recovery after surgery by incorporating broad patient education with strategies to reduce the physiologic stress associated with surgery and anesthesia. This strategy has been applied to many major surgical specialties but has not been established in podiatric patients.

Methods:
The PEP evidence implementation initiative integrates two Joanna Briggs Institute tools: the Getting Research into Practice audit and feedback tool, and Practical Application of Clinical Evidence System, by incorporating proactive planning and data analyses. Baseline electronic health record data were collected in July 2019, followed by interdisciplinary PEP review, revision, implementation, and three data collection cycles. Strategic education was provided to stakeholders throughout data collection cycles.

Results:
This use of ERAS in the outpatient podiatric surgery population demonstrated excellence in compliance with best practice recommendations. The proactive multimodal approach of PEP revealed improvement in four measures of patient pain, with improvement from 83 to 100% of patients having a pain goal higher than their admission postoperative pain score. Patient pain goal greater than discharge pain score was also found but not sustained. Baseline data collection established that 29% of podiatric patients had a LOS less than 90 min, which improved to 42% with PEP. This finding was also not sustained in the third cycle of audit data. Missing data may have influenced these results, reinforcing the need for further study.

Conclusion:
The use of ERAS in orthopedic patients has an established empirical basis for use, demonstrating a reduction in both postoperative pain and LOS. This novel use of ERAS in a podiatric surgery outpatient population has similar findings but was not sustained in all audit criteria. PEP demonstrated promising reductions in postoperative pain and LOS; however, further implementation replication is needed to confirm this expansion of ERAS and the promising results.
Successful Emergency Treatment of Refractory Neuroleptic Malignant Syndrome With Electroconvulsive Therapy and a Novel Use of Dexmedetomidine
Authors: Rajan Rajani , Sage Mary 
Published: September 2020

Abstract
We describe the case of a patient, hospitalized in a California community medical ICU for over a month, with severe neuroleptic malignant syndrome (NMS), unresponsive to medical management, but responsive to electroconvulsive therapy (ECT). We discuss the medical, logistical, and legal challenges in providing ECT in this setting. We also describe a previously unpublished use of dexmedetomidine, which aided in the safe and rapid reduction of benzodiazepines and permitted a successful ECT course. The rapid delivery and efficacy of ECT were essential because of the burgeoning coronavirus pandemic. The patient's treatment required exemplary efforts by providers across multiple disciplines, ongoing medicolegal consultation with the county mental health medical director, as well as consultation with expert members of the International Society for ECT and Neurostimulation. We conclude with a discussion of the unique challenges of providing emergency ECT to patients in California, including during a serious pandemic, when courts are closed. This case illustrates the importance of cultivating and maintaining high-quality ECT expertise in community hospitals and keeping ECT services available even during pandemics. Also, this case demonstrates that ECT is not “merely an elective procedure” but a vital, life-saving treatment, even during the era of COVID-19. To our knowledge, this is the first such published case of emergency ECT performed in California.
Travel-time, bikes, and HIV elimination in Malawi: a geospatial modeling analysis
Authors: Palk Laurence , Okano Justin T. , Dullie Luckson , Blower Sally 
Published: September 2020

AbstractBackgroundUNAIDS has prioritized Malawi and 21 other countries in sub-Saharan Africa (SSA) for “fast-tracking” the end of their HIV epidemics. To achieve elimination requires treating 90% of people living with HIV (PLHIV); coverage is already fairly high (70–75%). However, many individuals in SSA have to walk to access healthcare. We use data-based geospatial modeling to determine whether the need to travel long distances to access treatment and limited transportation in rural areas are barriers to HIV elimination in Malawi. Additionally, we evaluate the effect on treatment coverage of increasing the availability of bicycles in rural areas.MethodsWe build a geospatial model that we use to estimate, for every PLHIV, their travel-time to access HIV treatment if driving, bicycling, or walking. We estimate the travel-times needed to achieve 70% or 90% coverage. Our model includes a spatial map of healthcare facilities (HCFs), the geographic coordinates of residencies for all PLHIV, and an “impedance” map. We quantify impedance using data on road/river networks, land cover, and topography.FindingsTo cross an area of one km2in Malawi takes from ~60 seconds (driving on main roads) to ~60 minutes (walking in mountainous areas); ~80% of PLHIV live in rural areas. At ~70% coverage, HCFs can be reached within: ~45 minutes if driving, ~65 minutes if bicycling, and ~85 minutes if walking. Increasing coverage above ~70% will become progressively more difficult. To achieve 90% coverage, the travel-time for many PLHIV (who have yet to initiate treatment) will be almost twice as long as those currently on treatment. Increasing bicycle availability in rural areas reduces round-trip travel-times by almost one hour (in comparison with walking), and could substantially increase coverage levels.InterpretationGeographic inaccessibility to treatment coupled with limited transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV.FundingNational Institute of Allergy and Infectious Diseases
Mortality and risk factors among US Black, Hispanic, and White patients with COVID-19
Authors: Jun Tomi , Nirenberg Sharon , Kovatch Patricia , Huang Kuan-lin 
Published: September 2020

SummaryBackgroundLittle is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States.MethodsIn this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity.FindingsA total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09).InterpretationIn this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.FundingIcahn School of Medicine at Mount Sinai, New York, NY.
Estimating the Risk of Outbreaks of COVID-19 Associated with Shore Leave by Merchant Ship Crews: Simulation Studies for a Case Country
Authors: Wilson Nick , Blakely Tony , Baker Michael , Eichner Martin 
Published: September 2020

AbstractAimWe aimed to estimate the risk of COVID-19 outbreaks in a case study COVID-free destination country, associated with shore leave for merchant ship crews.MethodsA stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilised. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics, and plausible control measures.ResultsWhen no control interventions were in place, an outbreak of COVID-19 in our case study destination country (New Zealand; NZ) was estimated to occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1000 population per week, a crew of 20, a voyage length of 10 days, 1 day of shore leave both in NZ and abroad, and 108 port visits by international merchant ships per week). For this example the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combined use of a PCR test on arrival, self-reporting of symptoms with contact tracing, and mask use during shore leave, increased this median time to 1.0 year (14 days to 5.4 years). Scenario analyses found that onboard infection chains could persist for well over 4 weeks even with crews of only 5 members.ConclusionIntroduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. The risk can be substantially mitigated by control measures such as PCR testing and mask use.
Identification of Blood Glucose Patterns through Continuous Glucose Monitoring Sensors and Decision Trees
Authors: Lozano F. José , Hidalgo J. Ignacio , Botella Marta , Contador Sergio , Lanchares Juan , Velasco J. Manuel , Garnica Oscar 
Published: September 2020

AbstractThe demand for Continuous Glucose Monitoring systems is increasing among type 1 diabetic patients. Some companies are trying to improve the monitoring and the usability of these systems. One example is Abbott FreeStyle Libre, which provides a new concept of glucose monitoring called Flash Glucose Monitoring which is more affordable and does not need calibration. The increasing demand for these devices means an opportunity for data and computer scientists, who can contribute to the development of decision-making support systems based on the data collected from the devices. Type 1 diabetic patients that use FreeStyle Libre may enter the number of insulin and carbohydrates units that they are going to take before a meal. Using both the entered data and the blood glucose values collected by the device automatically, the application presented in this paper generates a report of the patient’s glucose patterns. In addition, it provides a web application that allows the user to upload the data obtained from the device and download the report on his computer or smartphone. The application uses decision trees to detect the patterns and entails a starting point in the creation of ensemble models with more predictive power, also based on decision trees. Furthermore, the methodology makes a segmentation of the data set in blocks, determined by the different meals done throughout the day, adding more information to the set of variables used to train the model. As a result, the application can discover repetitive patterns in the daily life of the patient, which can help to take early preventive measures for risk situations in a period close to the next meal.
How to Make COVID-19 Contact Tracing Apps work: Insights From Behavioral Economics
Authors: Ayres Ian , Romano Alessandro , Sotis Chiara 
Published: September 2020

AbstractDue to network effects, Contact Tracing Apps (CTAs) are only effective if many people download them. However, the response to CTAs has been tepid. For example, in France less than 2 million people (roughly 3% of the population) downloaded the CTA. Against this background, we carry out an online experiment to show that CTAs can still play a key role in containing the spread of COVID-19, provided that they are re-conceptualized to account for insights from behavioral science. We start by showing that carefully devised in-app notifications are effective in inducing prudent behavior like wearing a mask or staying home. In particular, people that are notified that they are taking too much risk and could become a superspreader engage in more prudent behavior. Building on this result, we suggest that CTAs should be re-framed as Behavioral Feedback Apps (BFAs). The main function of BFAs would be providing users with information on how to minimize the risk of contracting COVID-19, like how crowded a store is likely to be. Moreover, the BFA could have a rating system that allows users to flag stores that do not respect safety norms like wearing masks. These functions can inform the behavior of app users, thus playing a key role in containing the spread of the virus even if a small percentage of people download the BFA. While effective contact tracing is impossible when only 3% of the population downloads the app, less risk taking by small portions of the population can produce large benefits. BFAs can be programmed so that users can also activate a tracing function akin to the one currently carried out by CTAs. Making contact tracing an ancillary, opt-in function might facilitate a wider acceptance of BFAs.
Self-reported sleep duration and timing: A methodological review of event definitions, context, and timeframe of related questions
Authors: Robbins Rebecca , Quan Stuart F. , Barger Laura K. , Czeisler Charles A. , Frazy-Witzer Maya , Weaver Matthew D. , Zhang Ying , Redline Susan , Klerman Elizabeth B. 
Published: September 2020

AbstractBackgroundClinical practice guidelines and population health recommendations are derived from studies that include self-reported data. Small semantic differences in question wording and response scales, may significantly affect the response. We conducted a methodological review to assess the variation in event definition(s), context (i.e., work-versus free-day), and timeframe of sleep timing and duration questions.MethodsWe queried multiple databases of sleep, medicine, public health, and psychology for survey-based studies and/or publications with sleep duration and/or timing questions. The text of these questions was extracted and thematically analyzed by two trained coders.ResultsWe identified 49 surveys that included sleep duration and/or timing questions. Sample sizes of participants in the reviewed publications using these surveys ranged from 93 to 1,185,106. For sleep duration questions, participants were asked to report nocturnal sleep (22/43), sleep in the past 24-hours (15/43), their major sleep episode (3/43), or no event definition was given (3/43). Among bedtime questions, participants were asked to report the time into bed (17/40), fall asleep time (10/40), or first attempt to sleep (13/40). For wake time questions, participants were asked to report their out of bed time (3/36), the time they get up (6/36), or their wake up time (27/36). Context (e.g., work versus free day) guidance was provided in 18/43 major sleep duration questions, 31/40 bedtime questions, and 30/36 wake time questions. Timeframe (e.g., the past 4 weeks) was provided in 6/43 major sleep episode duration questions, 9/40 bedtime questions, and 3/36 wake time questions. Among the surveys analyzed, only one question asked about the method of awakening (e.g., spontaneously or by alarm clock), 15 questions assessed sleep latency, and eight measured napping.ConclusionThere is large variability in the event definition(s), context, and timeframe of questions relating to duration, bed/wake times, latency, and napping. This work may inform future efforts at data harmonization for meta-analyses, provide options for question wording for researchers and clinicians, and be used to identify candidate questions for future surveys.
Increased prolonged sitting in rheumatoid arthritis patients during the COVID-19 pandemic: a within-subjects, accelerometer-based study
Authors: Pinto Ana J. , Rezende Diego , Sieczkowska Sofia M. , Meireles Kamila , Bonfiglioli Karina , Ribeiro Ana C. M. , Bonfá Eloisa , Owen Neville , Dunstan David W. , Roschel Hamilton , Gualano Bruno 
Published: September 2020

AbstractBackgroundSocial distancing measures designed to contain the COVID-19 pandemic can explicitly and implicitly restrict physical activity, a particular concern for high-risk patient groups. Using a within-subjects design with objective measurement (via validated accelerometers), we assessed rheumatoid arthritis patients’ physical activity and sedentary behavior levels prior to and during the social distancing measures implemented in Sao Paulo, Brazil.MethodsPost-menopausal women diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24th May to 7th July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using postural-based accelerometry (ActivPAL micro™).FindingsMean age was 60.9 years (95%CI: 58.0, 63.7) and BMI was 29.5 Kg/m2 (95%CI: 27.2, 31.9). Disease activity ranged from remission to moderate activity. Most of the patients were using disease-modifying anti-rheumatic drugs and prednisone. Hypertension and dyslipidemia were the most frequent comorbidities During social distancing, there were reductions in total stepping time (15.7% [−0.3 h/day, 95%CI: −0.4, −0.1; p = 0.004]), in light-intensity activity (13.0% [−0.2 h/day, 95%CI: −0.4, −0.04; p = 0.016]) and in moderate-to-vigorous physical activity (38.8% [−4.5 min/day, 95%CI: −8.1, −0.9; p = 0.015]), but no changes in total standing time or total sedentary time. However, time spent in prolonged bouts of sitting ≥ 30 min increased by 34% 1.0 h/day, 95%CI: 0.3, 1.7; p=0.006) and sitting bouts ≥60 min increased by 85% (1.0 h/day, 95%CI: 0.5, 1.6) Sit-stand transitions were reduced by 10% (−5.1/day, 95%CI: −10.3, 0.0; p = 0.051)ConclusionImposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sitting among rheumatoid arthritis patients. Since this has the potential to increase the burden of cardiovascular disease in such high-risk patients, attention to maintaining physical activity is an urgent consideration during the pandemic.
Quantitative Evaluation of apparent diffusion coefficient in a large multi-unit institution using the QIBA diffusion phantom
Authors: Yung Joshua P , Ding Yao , Hwang Ken-Pin , Cardenas Carlos E. , Ai Hua , Fuller Clifton David , Stafford R. Jason 
Published: September 2020

AbstractPurposeThe purpose of this study was to determine the quantitative variability of diffusion weighted imaging and apparent diffusion coefficient values across a large fleet of MR systems. Using a NIST traceable magnetic resonance imaging diffusion phantom, imaging was reproducible and the measurements were quantitatively compared to known values.MethodsA fleet of 23 clinical MRI scanners was investigated in this study. A NIST/QIBA DWI phantom was imaged with protocols provided with the phantom. The resulting images were analyzed and ADC maps were generated. User-directed region-of-interests on each of the different vials provided ADC measurements among a wide range of known ADC values.ResultsThree diffusion phantoms were used in this study and compared to one another. From the one-way analysis of the variance, the mean and standard deviation of the percent errors from each phantom were not significantly different from one another. The low ADC vials showed larger errors and variation and appear directly related to SNR. Across all the MR systems and data, the coefficient of variation was calculated and Bland-Altman analysis was performed. ADC measurements were similar to one another except for the vials with the lower ADC values, which had a higher coefficient of variation.ConclusionADC values among the three phantoms showed good agreement and were not significantly different from one another. The large percent errors seen primarily at the low ADC values were shown to be a consequence of the SNR dependence and very little bias was observed between magnetic strengths and manufacturers. ADC values between diffusion phantoms were not statistically significant. Future investigations will be performed to study differences in magnetic field strength, vendor, MR system models, gradients, and bore size. More data across different MR platforms would facilitate quantitative measurements for multi-platform and multi-site imaging studies. With the increasing usage of diffusion weighted imaging in the clinic, the characterization of ADC variability for MR systems provides an improved quality control over the MR systems.