bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute kidney injury demographics and outcomes: changes following introduction of electronic acute kidney injury alerts—an analysis of a national dataset
Authors: Holmes Jennifer , Donovan Kieron , Geen John , Williams John , Phillips Aled O 
Published: March 2020

Abstract

Background
Electronic alerts for acute kidney injury (AKI) have been widely advocated. Our aim was to describe the changes in AKI demographics and outcomes following implementation of a national electronic AKI alert programme.

Methods
A prospective national cohort study was undertaken to collect data on all cases of AKI in adult patients (≥18 years of age) between 1 April 2015 and 31 March 2019.

Results
Over the period of data collection, there were 193 838 AKI episodes in a total of 132 599 patients. The lowest incidence of AKI was seen in the first year after implementation of electronic alerts. A 30-day mortality was highest in Year 1 and significantly lower in all subsequent years. A direct comparison of mortality in Years 1 and 4 demonstrated a significantly increased relative risk (RR) of death in Year 1: RR = 1.08 [95% confidence interval (CI) 1.054–1.114 P &lt; 0.001]. This translates into a number needed to treat in Year 4 for one additional patient to survive of 69.5 (95% CI 51.7–106.2) when directly comparing the outcomes across the 2 years. The increase in the number of cases and improved outcomes was more pronounced in community-acquired AKI, and was associated with a significant increase in patient hospitalization.

Conclusions
This study represents the first large-scale dataset to clearly demonstrate that a national AKI alerting system which highlights AKI is associated with a change in both AKI demographics and patient outcomes.
Community economic factors influence outcomes for patients with primary malignant glioma
Authors: Bower Aaron , Hsu Fang-Chi , Weaver Kathryn E , Yelton Caleb , Merrill Rebecca , Wicks Robert , Soike Mike , Hutchinson Angelica , McTyre Emory , Laxton Adrian , Tatter Stephen , Cramer Christina , Chan Michael , Lesser Glenn , Strowd Roy E 
Published: March 2020

AbstractBackgroundCommunity economics and other social health determinants influence outcomes in oncologic patient populations. We sought to explore their impact on presentation, treatment, and survival in glioma patients.MethodsA retrospective cohort of patients with glioma (World Health Organization grades III–IV) diagnosed between 1999 and 2017 was assembled with data abstracted from medical record review. Patient factors included race, primary care provider (PCP) identified, marital status, insurance status, and employment status. Median household income based on zip code was used to classify patients as residing in high-income communities (HICs; ie, above the median state income) or low-income communities (LICs; ie, below the median state income). The Kaplan–Meier method was used to assess overall survival (OS); Cox proportional hazards regression was used to explore associations with OS.ResultsIncluded were 312 patients, 73% from LICs. Survivors residing in LICs and HICs did not differ by age, sex, race, tumor grade, having a PCP, employment status, insurance, time to presentation, or baseline performance status. Median OS was 4.1 months shorter for LIC patients (19.7 vs 15.6 mo; hazard ratio [HR], 0.75; 95% CI: 0.56–0.98, P = 0.04); this difference persisted with 1-year survival of 66% for HICs versus 61% for LICs at 1 year, 34% versus 24% at 3 years, and 29% versus 17% at 5 years. Multivariable analysis controlling for age, grade, and chemotherapy treatment showed a 25% lower risk of death for HIC patients (HR, 0.75; 95% CI: 0.57–0.99, P &lt; 0.05).ConclusionsThe economic status of a glioma patient’s community may influence survival. Future efforts should investigate potential mechanisms such as health care access, stress, treatment adherence, and social support.
Less Invasive Cervical Decompression via Unilateral Tubular Laminotomy Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video
Authors: Kirnaz Sertac , Wipplinger Christoph , Wong Taylor , Schmidt Franziska Anna , Nangunoori Raj , Härtl Roger 
Published: March 2020

Abstract
This video demonstrates the step-by-step surgical technique for a less invasive cervical unilateral laminotomy for bilateral decompression (cervical ULBD). This technique allows surgeons to address bilateral cervical pathology while minimizing approach-related complications.
1
In the video, we present the case of a 72-yr-old female patient with a past medical history of C3-C4 anterior cervical discectomy and fusion who presented in clinic with persistent posterior spinal cord compression and signal change. The patient had bilateral hand numbness, weakness, poor dexterity, and a positive Hoffman's sign. The patient was treated via a C3-C4 less invasive cervical ULBD using a mobile 3-dimensional (3D) C-arm (Ziehm Vision RFD 3D®, Nürnberg, Germany) combined with 3D computer navigation. Patient consent was obtained prior to performing the procedure. Contrary to anterior techniques, posterior cervical approaches avoid potential dysphasia, recurrent laryngeal nerve injury, and adjacent segment degeneration. Furthermore, the less invasive cervical ULBD results in decreased pain and postoperative narcotic usage, shorter hospital stays and fewer infections compared to open approaches, as well as a lower risk for postlaminectomy kyphosis and deformity, since it requires less muscle disruption and bony removal. Additionally, the use of total 3D navigation facilitates the workflow and minimizes radiation exposure.
High-pressure Cu–Fe–S Phase Equilibria: some Experimental and Thermodynamic Constraints on Sulfides in Subduction Zones and the Lithospheric Mantle
Authors: Brown Julie L , Dyer Sabastien C , Mungall James E , Christy Andrew G , Ellis David J 
Published: March 2020

Abstract
High-pressure phase relations for much of the Cu–Fe–S system have not previously been determined experimentally. Experimental studies have concentrated on low-pressure phase relations and cannot explain high-pressure sulfide mineral inclusion assemblages in some natural blueschists and eclogites. In particular, the coexistence of pyrite + covellite at 1·0 GPa, and pyrite + bornite at 1·9 GPa, observed in New Caledonian rocks, is precluded by tie-lines between S and bornite, and S and the intermediate solid solution (iss), in the published low-pressure experimental topologies at corresponding temperatures. In addition, the Cu content (up to ∼10 at%) of pyrrhotite in eclogite exceeds the experimentally determined maximum for Cu in solid solution with pyrrhotite at low pressures and at corresponding temperatures. We have performed six experiments in which natural chalcopyrite starting material was equilibrated at conditions ranging from 1·0 to 1·7 GPa and 500 to 650 °C. At 1 GPa chalcopyrite is replaced by iss. The iss phase undergoes a terminal breakdown reaction between 1·0 and 1·7 GPa, being replaced by a new assemblage of bornite, pyrite, and pyrrhotite. Our experimental results confirm predictions from the SUPCRT thermodynamic database (Johnson et al., 1992; Computers & Geosciences 18, 899–947) but not that of Robie & Hemingway (1995; US Geological Survey Bulletin 2131). The former database is therefore recommended for calculation of high-pressure sulfide phase relations. Chalcopyrite and its high-temperature, low-fS2 equivalent, iss are not stable at pressures corresponding to much of blueschist–eclogite-facies metamorphism. These results are also applicable to sulfide assemblages in the lithospheric mantle along both oceanic and continental geotherms; the subsolidus Cu-rich mineral in the lithosphere at depths of 30 to &gt;65 km must be bornite–digenite solid solution (bn-ss) rather than iss as is commonly assumed.
To split or to lump? Classifying the central disorders of hypersomnolence
Authors: Fronczek Rolf , Arnulf Isabelle , Baumann Christian R , Maski Kiran , Pizza Fabio , Trotti Lynn Marie 
Published: March 2020

Abstract
The classification of the central disorders of hypersomnolence has undergone multiple iterations in an attempt to capture biologically meaningful disease entities in the absence of known pathophysiology. Accumulating data suggests that further refinements may be necessary. At the 7th International Symposium on Narcolepsy, a group of clinician-scientists evaluated data in support of keeping or changing classifications, and as a result suggest several changes. First, idiopathic hypersomnia with long sleep durations appears to be an identifiable and meaningful disease subtype. Second, idiopathic hypersomnia without long sleep time and narcolepsy without cataplexy share substantial phenotypic overlap and cannot reliably be distinguished with current testing, and so combining them into a single disease entity seems warranted at present. Moving forward, it is critical to phenotype patients across a wide variety of clinical and biological features, to aid in future refinements of disease classification.
Evaluation of biomarkers for in vitro prediction of drug-induced nephrotoxicity in RPTEC/TERT1 cells
Authors: Qiu Xuan , Miao Yufa , Geng Xingchao , Zhou Xiaobing , Li Bo 
Published: March 2020

Abstract
There have been intensive efforts to identify in vivo biomarkers that can be used to monitor drug-induced kidney damage before significant impairment occurs. Kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, clusterin, β2-microglobulin and cystatin C (CysC) have been validated as clinical or preclinical biomarkers in urinary and plasma predictive of acute and chronic kidney injuries and diseases. A high-throughput in vitro assay predictive of nephrotoxicity could potentially be implemented in early drug discovery stage to reduce attrition at later stages of drug development. To assess the potential of these known in vivo biomarkers for in vitro evaluation of drug-induced nephrotoxicity, we selected four nephrotoxic agents (cisplatin, cyclosporin, aristolochic acid I and gentamicin) and detected their effects on the protein levels of nephrotoxic biomarkers in RPTEC/TERT1 cells. The protein levels of clusterin, CysC, GSTπ and TIMP-1 significantly increased in the conditioned media of RPTEC/TERT1 cells treated with cisplatin, cyclosporin, aristolochic acid I and gentamicin. The messenger RNA levels of clusterin, CysC, GSTπ and TIMP-1 also increased in RPTEC/TERT1 cells treated with cisplatin, cyclosporin, aristolochic acid I and gentamicin, indicating that drug-induced upregulation involves transcriptional activation. Taken together, the results clearly demonstrate that among the known in vivo nephrotoxic biomarkers, clusterin, CysC, GSTπ and TIMP-1 can be effectively used as in vitro biomarkers for drug-induced nephrotoxicity in RPTEC/TERT1 cells.
Late Protective Effect of Netrin-1 in the Murine Acetaminophen Hepatotoxicity Model
Authors: Duan Luqi , Woolbright Benjamin L , Jaeschke Hartmut , Ramachandran Anup 
Published: March 2020

AbstractAcetaminophen (APAP) overdose-induced acute liver failure is an important clinical problem in the United States and the current antidote N-acetylcysteine, has a short early therapeutic window. Since most patients present late to the clinic, there is need for novel late-acting therapeutic options. Though the neuronal guidance cue netrin-1, has been shown to promote hepatic repair and regeneration during liver ischemia/reperfusion injury, its effect in APAP-induced hepatotoxicity is unknown. In the quest for a late-acting therapeutic intervention in APAP-induced liver injury, we examined the role of netrin-1 in a mouse model of APAP overdose. Male C57BL/6J mice were cotreated with exogenous netrin-1 or vehicle control, along with 300 mg/kg APAP and euthanized at 6, 12, and 24 h. Significant elevations in alanine aminotransferase indicative of liver injury were seen in control mice at 6 h and this was not affected by netrin-1 administration. Also, netrin-1 treatment did not influence mitochondrial translocation of phospho-JNK, or peroxynitrite formation indicating that there was no interference with APAP-induced injury processes. Interestingly however, netrin-1 administration attenuated liver injury at 24 h, as seen by alanine aminotransferase levels and histology, at which time significant elevations in the netrin-1 receptor, adenosine A2B receptor (A2BAR) as well as macrophage infiltration was evident. Removal of resident macrophages with clodronate liposomes or treatment with the A2BAR antagonist PSB1115 blocked the protective effects of netrin-1. Thus, our data indicate a previously unrecognized role for netrin-1 in attenuation of APAP hepatotoxicity by enhancing recovery and regeneration, which is mediated through the A2BAR and involves resident liver macrophages.
Development of a Transformative Standardized Approach for Written Communication Skills in an Online RN-BS Program
Authors: Lockett Leslie , Katz Kathi S. , Czerwinski Sandra , Gore Teresa , Gwartney Tiffany 
Published: March 2020

Abstract
The perceived quality of health care received is highly dependent upon the quality of communication between patients and their health care providers and between members of the health care team (Institute of Medicine, 2003). A comprehensive, standardized module for developing effective writing skills was established and integrated in a research-intensive university in the southeastern United States. One year after integration, more than 60 percent of students and 50 percent of targeted courses accessed and adopted the module. The impact of the module upon student outcomes is being measured.
Evaluating Nursing Students’ Perceptions of Using Quick Response Codes to Enhance Learning During Nursing Health Assessment
Authors: Marcus Jessica , Adebayo Modupeola , Cranwell-Bruce Lisa , Faulkner Melissa Spezia 
Published: March 2020

Abstract
Providing engaging activities to supplement classroom learning can be a challenge for today’s nurse educator. Quick response (QR) code technology provides hands-on clinical experiences without the use of high-fidelity simulators. The purpose of this article is to evaluate how QR codes during a health assessment simulation activity enhanced learning for first-semester baccalaureate nursing students. The use of QR codes increased student confidence during health assessment with a form of technology they found engaging.
Classroom Concepts in the Clinical Setting: Student Perceptions of Concept Cards
Authors: Gay Jessica E. , Phillips Christina J. 
Published: March 2020

Abstract
Concept-based curricula have been widely implemented to combat content oversaturation in undergraduate nursing education. While nursing programs have focused on changing the classroom environment, only a few have integrated conceptual learning into clinical education. This qualitative descriptive study measured student perceptions of the effectiveness of concept cards, a concept-based clinical learning activity, in maternity and medical-surgical clinical sites. Two phases of the study indicated that the use of concept cards in clinical practicum deepened and reinforced understanding of concepts and enhanced student learning in the clinical setting.
Binaural Pitch Fusion: Binaural Pitch Averaging in Cochlear Implant Users With Broad Binaural Fusion
Authors: Oh Yonghee , Reiss Lina A. J. 
Published: March 2020

Objectives:
Individuals who use hearing aids (HAs) or cochlear implants (CIs) can experience broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are perceptually integrated across ears. Previously, it was shown in HA users that the fused pitch is a weighted average of the two monaural pitches, ranging from equal weighting to dominance by the lower pitch. The goal of this study was to systematically measure the fused pitches in adult CI users, and determine whether CI users experience similar pitch averaging effects as observed in HA users.

Design:
Twelve adult CI users (Cochlear Ltd, Sydney, Australia) participated in this study: six bimodal CI users, who wear a CI with a contralateral HA, and six bilateral CI users. Stimuli to HA ears were acoustic pure tones, and stimuli to CI ears were biphasic pulse trains delivered to individual electrodes. Fusion ranges, the ranges of frequencies/electrodes in the comparison ear that were fused with a single electrode (electrode 22, 18, 12, or 6) in the reference ear, were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus. Once the fusion ranges were measured, the fused binaural pitch of a reference-pair stimulus combination was measured by finding a pitch match to monaural comparison stimuli presented to the paired stimulus ear.

Results:
Fusion pitch weighting in CI users varied depending on the pitch difference of the reference-pair stimulus combination, with equal pitch averaging occurring for stimuli closer in pitch and lower pitch dominance occurring for stimuli farther apart in pitch. The averaging region was typically 0.5 to 2.3 octaves around the reference for bimodal CI users and 0.4 to 1.5 octaves for bilateral CI users. In some cases, a bias in the averaging region was observed toward the ear with greater stimulus variability.

Conclusions:
Fusion pitch weighting effects in CI users were similar to those observed previously in HA users. However, CI users showed greater inter-subject variability in both pitch averaging ranges and bias effects. These findings suggest that binaural pitch averaging could be a common underlying mechanism in hearing-impaired listeners.
Change in Bone CT Attenuation and C-reactive Protein Are Predictors of Bone Biopsy Culture Positivity in Patients With Vertebral Discitis/Osteomyelitis
Authors: Lee Harrison T. , Pukenas Bryan A. , Sebro Ronnie 
Published: March 2020

Study Design.
Case-control study.

Objective.
The objective of this study was to identify the best laboratory and imaging factors to predict bone biopsy culture positivity in the setting of vertebral discitis/osteomyelitis (VDO).

Summary of Background Data.
Good predictors of bone biopsy culture positivity in the setting of VDO are unknown.

Methods.
Retrospective review was performed for 46 patients who underwent CT-guided bone biopsy for the evaluation of clinically confirmed VDO. Erythrocyte sedimentation rate, C-reactive protein (CRP), mean CT attenuation of the biopsied bone, and the change in the CT attenuation of the bone compared to unaffected vertebral bone (delta CT attenuation) were measured. Receiver-operator characteristic curve analyses were performed to identify the optimal threshold value for each variable. A multivariable logistic regression model was used to predict the probability of a positive bone culture using delta CT attenuation and CRPx100% fold above normal.

Results.
For one of the 46 VDO patients, bone cultures were not obtained. Approximately 35.6% (16/45) of bone cultures were positive. The most significant predictors of bone culture positivity were CRP x100% fold above normal (P = 0.011) and delta CT attenuation (P = <0.001). Optimized predictive thresholds were calculated to be CRP 4-fold above normal reference value (90.9% sensitivity, 73.7% specificity), or if the CT attenuation of the affected vertebral body was >25.9 HU lower relative to unaffected bone (93.8% sensitivity, 75.0% specificity).

Conclusion.
Delta CT attenuation, as well as CRP level over four times the upper limits of normal, were the strongest predictors for bone culture positivity in patients with VDO.

Level of Evidence: 3
Association Between Metabolic Syndrome and Endometrial Cancer Survival in a SEER-Medicare Linked Database
Authors: Jin Jingxiao , Dalwadi Shraddha M. , Masand Ramya P. , Hall Tracilyn R. , Anderson Matthew L. , Ludwig Michelle S. 
Published: March 2020

Background:
Metabolic syndrome has previously been linked to increased risk of endometrial cancer. This study examines the association between metabolic syndrome and cancer-specific survival (CSS) in early stage and locoregionally advanced endometrial cancer.

Methods:
The SEER-Medicare linked database was used to identify a cohort of patients with endometrial cancer between 1992 and 2011 who underwent hysterectomy. Patients with incomplete stage or grade information were excluded. Patients were stratified into early stage (stage I to II) or locoregionally advanced (stage III to IVa) disease. Metabolic syndrome status was determined through Medicare claims 1 year before diagnosis. The relationship between metabolic syndrome and CSS was evaluated using univariable and multivariable Cox proportional hazards regression analyses.

Results:
A total of 10,090 patients with endometrial cancer were identified. The mean age was 75 and the majority (91.5%) were white. At diagnosis, 86.6% of patients were early stage and 13.4% were locoregionally advanced. Sixteen percent of patients had metabolic syndrome. On stage stratified multivariable analysis, race, income quartile, year of diagnosis, histopathology, and adjuvant treatment were associated with CSS in early stage disease. Presence of metabolic syndrome was associated with worse CSS in early stage disease (hazard ratio=1.28, 95% confidence interval: 1.09-1.53); this difference did not exist for locoregionally advanced disease (hazard ratio=1.18, 95% confidence interval: 0.93-1.49).

Conclusions:
In elderly early stage endometrial cancer patients, metabolic syndrome is associated with worse CSS. Control of metabolic syndrome through lifestyle and pharmacologic therapies may improve cancer prognosis in this population.
Peripheral Palisading in Melanoma Mimicking Basal Cell Carcinoma: A Case Report
Authors: Wang Yanqing , Guo Ying 
Published: March 2020

Abstract:
The incidence of melanoma has been increasing over the past few decades. Because of its phenotypic diversity, melanoma may present in various clinical and histopathological manifestations, and it can mimic varieties of skin lesions from benign to malignant and from epithelial to nonepithelial. Accurate diagnosis of melanoma is crucial because delayed treatment leads to worse prognoses. Here, we describe a case of melanoma in an 82-year-old man with an unusual histopathologic presentation, namely, the presence of neoplastic aggregates with a palisaded periphery resembling basal cell carcinoma.
OnabotulinumtoxinA Treatment for Moderate to Severe Forehead Lines: A Review
Authors: De Boulle Koenraad , Carruthers Alastair , Solish Nowell , Carruthers Jean , Philipp-Dormston Wolfgang G. , Fagien Steven , Sangha Sara , Silberberg Michael , Mao Cheri 
Published: March 2020

Background:
With onabotulinumtoxinA approved for the treatment of glabellar and crow’s feet lines and, most recently, for forehead lines (FHL), it is possible to simultaneously treat multiple areas of the upper face that are of high concern and treatment priority for aesthetically oriented individuals. This review aims to present key insights on the use of onabotulinumtoxinA for the treatment of moderate to severe FHL.

Methods:
Double-blind, placebo-controlled registration trials of onabotulinumtoxinA for the treatment of FHL were included. Using findings from 3 such published studies, we discuss key concepts and clinical experience for the treatment of moderate to severe FHL with onabotulinumtoxinA (20 U in the frontalis and 20 U in the glabellar complex, with/without 24 U in crow’s feet lines), including injection pattern, dose selection, efficacy and safety data, and considerations for patient selection.

Results:
Across the 2 pivotal phase 3 studies, responder rates on investigator- and subject-assessed measures of appearance of FHL severity were significantly higher with onabotulinumtoxinA versus placebo for the treatment of FHL at day 30 (P < 0.0001), and results were maintained through 3 cycles of onabotulinumtoxinA.

Conclusions:
OnabotulinumtoxinA treatment also resulted in high patient satisfaction rates. The incidence of eyebrow and of eyelid ptosis was low, and no new safety signals were detected. OnabotulinumtoxinA is safe and effective and an appropriate option for patients with moderate to severe FHL encountered in clinical practice.