bluuebunny/crossref_metadata_2025_split huggingface dataset:
“If They Do Not Fulfill What They Have Promised, I Will Accuse Them”: Locating Indigenous Women and Their Influence in the California Missions
Authors: Rizzo Martin 
Published: May 2020

Abstract
In Indigenous California, women often held important roles of political and spiritual leadership. Spanish Franciscan colonialism imposed a patriarchal framework through the California missions. Through a close look of the lives of two Indigenous women who lived at Mission Santa Cruz, this article examines how Native women maintained power and influence within the mission communities. The stories of these two women, Yaquenonsat and Yuñan, intersect with difficult issues of rape and sexual violence, infanticide, sterility, abortion, and the impact of sexually transmitted disease. And yet, the article focuses on resistance and expressions of power—the two women played key roles in organizing and planning the assassination of the abusive Padre Quintana in 1812. This article proposes new methodological approaches to the chancery archives to trace the lives of these women and suggests new ways of analyzing stories of individuals and families within the missions to find the subtle ways of resistance and rebellion by Indigenous men and women.
Public Health Is Essential: COVID-19’s Learnable Moment for Medical Education
Authors: Maeshiro Rika , Carney Jan K. 
Published: May 2020

The COVID-19 pandemic, an unprecedented challenge for this generation of physicians and for the health care system, has reawakened calls to strengthen the United States’ public health systems. This global event is also a “learnable moment” for medical education—an opportunity to decisively incorporate public health, including public health systems, through the continuum of medical education. Although medical educators have made progress in integrating public health content into medical curricula, “public health” is not a phrase that is consistently used in curricular standards, and public health colleagues are not identified as unique and critical partners to improve and protect health. The COVID-19 crisis has demonstrated how a strong public health system is necessary to support the health of patients and populations, as well as the practice of medicine. Partnerships between medical and public health communities, through individual- and population-based interventions, can also more effectively combat more common threats to health, such as chronic diseases, health inequities, and substance abuse.
To achieve a more effective medicine–public health relationship in practice, curricula across the continuum of medical education must include explanations of public health systems, the responsibilities of physicians to their local and state governmental public health agencies, and opportunities for collaboration. Medical education should also prepare physicians to advocate for public health policies, programs, and funding in order to improve and protect the health of their patients and communities. Pandemic COVID-19 demonstrates with laser focus that all physicians are part of public health systems and that public health content has a distinct and essential place across the continuum of medical education to prepare physicians to participate in, collaborate with, and advocate for public health systems.
Exercise-induced Hypoalgesia Is Impaired in Chronic Whiplash-associated Disorders (WAD) With Both Aerobic and Isometric Exercise
Authors: Smith Ashley , Ritchie Carrie , Warren Jacelle , Sterling Michele 
Published: May 2020

Objectives:
Exercise-induced hypoalgesia (EIH) can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of EIH are not known. This study aimed to: (1) compare EIH in participants with chronic whiplash-associated disorders (WAD) to asymptomatic controls, (2) determine if EIH differs between aerobic and isometric exercise, (3) determine predictors of EIH.

Materials and Methods:
A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on EIH in 40 participants with chronic WAD and 30 controls. Pressure pain thresholds were measured at the hand, cervical spine, and tibialis anterior. Pain intensity, reported previous week physical activity, temporal summation, and conditioned pain modulation (CPM) were measured at baseline.

Results:
Participants with WAD demonstrated impaired EIH. Although, the WAD participants demonstrated a partial EIH response (EIH induced at the hand during exercise), no EIH response was found immediately after exercise. There was no difference in EIH between exercise types. In the WAD group, moderate physical activity levels predicted EIH at the hand and high physical activity levels predicted impaired EIH at the neck. More efficient CPM predicted EIH at the hand and less efficient CPM predicted impaired EIH at the neck. These associations were found for isometric exercise only.

Discussion:
Individuals with chronic WAD have impaired EIH with both aerobic and isometric exercise. Higher levels of physical activity and less efficient CPM may be associated with impaired EIH. This may have implications for exercise prescription in this patient group.
Systemic Hyperthermia in Traumatic Brain Injury—Relation to Intracranial Pressure Dynamics, Cerebral Energy Metabolism, and Clinical Outcome
Authors: Svedung Wettervik Teodor M. , Engquist Henrik , Lenell Samuel , Howells Timothy , Hillered Lars , Rostami Elham , Lewén Anders , Enblad Per 
Published: May 2020

Background:
Systemic hyperthermia is common after traumatic brain injury (TBI) and may induce secondary brain injury, although the pathophysiology is not fully understood. In this study, our aim was to determine the incidence and temporal course of hyperthermia after TBI and its relation to intracranial pressure dynamics, cerebral metabolism, and clinical outcomes.

Materials and Methods:
This retrospective study included 115 TBI patients. Data from systemic physiology (body temperature, blood pressure, and arterial glucose), intracranial pressure dynamics (intracranial pressure, cerebral perfusion pressure, compliance, and pressure reactivity), and cerebral microdialysis (glucose, pyruvate, lactate, glycerol, glutamate, and urea) were analyzed during the first 10 days after injury.

Results:
Overall, 6% of patients did not have hyperthermia (T>38°C) during the first 10 days after injury, whereas 20% had hyperthermia for >50% of the time. Hyperthermia increased from 21% (±27%) of monitoring time on day 1 to 36% (±29%) on days 6 to 10 after injury. In univariate analyses, higher body temperature was not associated with higher intracranial pressure nor lower cerebral perfusion pressure, but was associated with lower cerebral glucose concentration (P=0.001) and higher percentage of lactate-pyruvate ratio>25 (P=0.02) on days 6 to 10 after injury. Higher body temperature and lower arterial glucose concentration were associated with lower cerebral glucose in a multiple linear regression analysis (P=0.02 for both). There was no association between hyperthermia and worse clinical outcomes.

Conclusion:
Hyperthermia was most common between days 6 and 10 following TBI, and associated with disturbances in cerebral energy metabolism but not worse clinical outcome.
Immediate Improvement in Physical Function After Symptomatic Syndesmotic Screw Removal
Authors: Kohring Jessica M. , Greenstein Alexander , Gorczyca John T. , Judd Kyle T. , Soles Gillian , Ketz John P. 
Published: May 2020

Objective:
To investigate the immediate impact of removing symptomatic syndesmotic screws on PROMIS outcomes and ankle range of motion (ROM) in patients who had previously undergone ankle fracture open reduction and internal fixation (ORIF) and syndesmotic fixation and later experienced functional limitations.

Design:
Prospective cohort study.

Setting:
Level 1—trauma center.

Patients/Participants:
Fifty-eight patients with ankle fractures with syndesmotic instability that required ORIF with syndesmotic fixation who underwent syndesmotic screw removal (SSR) and 71 patients who underwent ankle ORIF with syndesmotic fixation, but without screw removal during the same study period.

Intervention:
Symptomatic SSR for patients with functional limitations and decreased ankle ROM.

Main Outcome Measurements:
PROMIS physical function (PF) and pain interference T-scores and ankle ROM before and after screw removal.

Results:
Patients who underwent SSR had a statistically significant improvement in the PF T-score to 44.5 (P < 0.01) in the early postoperative period (mean 48 days) after screw removal. The screw removal occurred an average of 184 days after initial ORIF. This PF T-score change also met the minimally clinically important difference. There was a trend toward a significant improvement in PF T-scores for the SSR group as compared to the cohort group (44.5 vs. 41.6; P = 0.06) after screw removal. Removal of symptomatic implants resulted in an early mean improvement of total arc ankle ROM by 17 degrees (P < 0.01).

Conclusions:
Patients experienced an immediate and significant improvement in PF outcomes and ankle ROM after symptomatic SSR for ankle fracture ORIF with syndesmotic fixation.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mibefradil Alleviates High-Glucose–induced Cardiac Hypertrophy by Inhibiting PI3K/Akt/mTOR-mediated Autophagy
Authors: Zhao Ling-Gong , Li Pei-Lin , Dai Ying , Deng Ji-Li , Shan Meng-Ya , Chen Bin , Zhang Ke-Bin , Guo Shao-Dong , Xu Zi-Hui 
Published: May 2020

Abstract:
Cardiac hypertrophy causes heart failure and is associated with hyperglycemia in patients with diabetes mellitus. Mibefradil, which acts as a T-type calcium channel blocker, exerts beneficial effects in patients with heart failure. In this study, we explored the effects and mechanism of mibefradil on high-glucose–induced cardiac hypertrophy in H9c2 cells. H9c2 cells were incubated in a high-glucose medium and then treated with different concentrations of mibefradil in the presence or absence of the Akt inhibitor MK2206 or mTOR inhibitor rapamycin. Cell size was evaluated through immunofluorescence, and mRNA expression of cardiac hypertrophy markers (atrial natriuretic peptide, brain natriuretic peptide, and β-myosin heavy chain) was assessed by using quantitative real-time polymerase chain reaction. Changes in the expression of p-PI3K, p-Akt, and p-mTOR were evaluated using Western blotting, and autophagosome formation was detected using transmission electron microscopy. Our results indicate that mibefradil reduced the size of H9c2 cells, decreased mRNA expression of atrial natriuretic peptide, brain natriuretic peptide, and β-myosin heavy chain, and decreased the level of autophagic flux. However, MK2206 and rapamycin induced autophagy and reversed the effects of mibefradil on high-glucose–induced H9c2 cells. In conclusion, mibefradil ameliorated high-glucose–induced cardiac hypertrophy by activating the PI3K/Akt/mTOR pathway and inhibiting excessive autophagy. Our study shows that mibefradil can be used therapeutically to ameliorate cardiac hypertrophy in patients with diabetes mellitus.
Use of antidepressants with pharmacogenetic prescribing guidelines in a 10-year depression cohort of adult primary care patients
Authors: Jessel Chaten D. , Mostafa Sam , Potiriadis Maria , Everall Ian P. , Gunn Jane M. , Bousman Chad A. 
Published: May 2020

Objective
To describe the usage patterns of antidepressants with published CYP2D6- and CYP2C19-based prescribing guidelines among depressed primary care patients and estimate the proportion of patients taking antidepressants not recommended for them based on their CYP2C19 and CYP2D6 genotype-predicted metabolizer status.

Methods
Medication use and pharmacogenetic testing results were collected on 128 primary care patients enrolled in a 10-year depression cohort study. At each 12-month interval, we calculated the proportion of patients that: (1) reported use of one or more of the 13 antidepressant medications (i.e. amitriptyline, citalopram, escitalopram, clomipramine, desipramine, doxepin, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline, trimipramine, venlafaxine) with published CYP2D6- and CYP2C19-based prescribing guidelines, (2) were taking an antidepressant that was not recommended for them based on their CYP2C19 and CYP2D6 genotype-predicted metabolizer phenotype, and (3) switched medications from the previous 12-month interval.

Results
The annual proportion of individuals taking an antidepressant with a CYP2D6- and CYP2C19-based prescribing guidelines ranged from 45 to 84%. The proportion of participants that used an antidepressant that was not recommended for them, based on available CYP2D6 and CYP2C19 metabolizer phenotype, ranged from 18 to 29% and these individuals tended to switch medications more frequently (10%) compared to their counterparts taking medication aligned with their metabolizer phenotype (6%).

Conclusion
One-quarter of primary care patients used an antidepressant that was not recommended for them based on CYP2D6- and CYP2C19-based prescribing guidelines and switching medications tended to be more common in this group. Studies to determine the impact of CYP2D6 and CYP2C19 genotyping on reducing gene-antidepressant mismatches are warranted.
Doripenem Pharmacokinetics in Hemodialysis
Authors: Phenphinan Sirin , Chaiyakum Aporanee , Subongkot Suphat , Aromdee Chantana , Rotjanapan Porpon , Assanatham Montira , Jaisue Siriluk 
Published: May 2020

Background
Doripenem is a broad spectrum carbapenem with activity against gram-positive, gram-negative, and anaerobic bacteria. The drug concentration in target sites is an important determinant of carbapenem efficacy. Doripenem is primarily eliminated by kidneys and can be removed by hemodialysis. The purpose of this study was to determine the pharmacokinetics of doripenem in hemodialysis patients with moderate to severe infections.

Methods
This prospective, single-center study was conducted in end-stage renal disease patients undergoing hemodialysis and receiving doripenem. Low-flux hemodialysis was performed for 4 hours. Blood and dialysate samples were collected during hemodialysis and nonhemodialysis periods. The doripenem concentrations in plasma and dialysate were measured by reverse phase high performance liquid chromatography. The total amount of drug removed during hemodialysis was determined and the hemodialysis clearance of doripenem was calculated using PKSolver, the add-in program for Microsoft Excel. The appropriate dose of doripenem was estimated using Monte Carlo simulation.

Results
Six patients were eligible for the study. The fraction of doripenem eliminated via hemodialysis was 51.31%. The mean total amount of doripenem removed by 4 hours of hemodialysis was 1472.06 ± 861 mg at a removal rate of 6.13 ± 3.59 mg/min. Hemodialysis drug clearance volume was 26.06 ± 14.59 L/h. The recommended doripenem dose estimated from the simulation was 250 mg infused every 12 hours during hemodialysis and 250 mg infused every 48 hours for nonhemodialysis periods.

Conclusions
A low-flux dialyzer removes about half of the total amount of doripenem in blood circulation for 4 hours. Therefore, drug dosage adjustment is required for end-stage renal disease patients undergoing hemodialysis.
The Risk of Vitamin D Deficiency, Osteoporosis, and Fractures in Acute Pancreatitis
Authors: Abou Saleh Mohannad , Alkhayyat Motasem , Mansoor Emad , Khoudari George , Simons-Linares C. Roberto , Vargo John , Chahal Prabhleen , Stevens Tyler 
Published: May 2020

Objectives
A few past studies have found increased utilization of 25-hydroxyvitamin D and prevalence of osteoporosis in acute pancreatitis (AP). Our aim was to obtain a survey of bone diseases after a sentinel episode of AP.

Methods
A database (Explorys), an aggregate of electronic health record from 26 integrated United States healthcare systems, was queried. A cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms diagnosis of AP between 2014 and 2019, after excluding patients with selected medical conditions and medications that are associated with poor bone health, was identified. The prevalence of new diagnoses of vitamin D deficiency (VDD), osteoporosis, and fractures in the study cohort was evaluated. Age-, race-, and sex-based distributions and risk factors were determined through univariate and multivariate analyses.

Results
Of the 36,087,380 individuals in the database, we identified 256,580 (0.71%) with AP. In multivariate analysis, patients with AP were more likely to develop VDD (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.24–1.26; P < 0.0001), osteoporosis (OR, 1.89; CI, 1.81–1.85; P < 0.0001), and fractures (OR, 1.58; 95% CI, 1.57–1.59; P < 0.0001).

Conclusions
Acute pancreatitis was associated with increased risk of VDD, osteoporosis, and fractures.
Diazoxide Preconditioning of Nonhuman Primate Pancreas Improves Islet Isolation Outcomes by Mitochondrial Protection
Authors: Wang Yong , Qi Meirigeng , McGarrigle James J. , Xing Yuan , Mendoza-Elias Joshua E. , Bochenek Matt , Marchese Enza , He Yi , Oberholzer Jose 
Published: May 2020

Objectives
Previously, we showed that diazoxide (DZ), an effective ischemic preconditioning agent, protected rodent pancreas against ischemia-reperfusion injury. Here, we further investigate whether DZ supplementation to University of Wisconsin (UW) solution during pancreas procurement and islet isolation has similar cytoprotection in a preclinical nonhuman primate model.

Methods
Cynomolgus monkey pancreata were flushed with UW or UW + 150 μM DZ during procurement and preserved for 8 hours before islet isolation.

Results
First, a significantly higher islet yield was observed in UW + DZ than in UW (57,887 vs 23,574 IEq/pancreas and 5396 vs 1646 IEq/g). Second, the DZ treated islets had significantly lower apoptotic cells per islet (1.64% vs 9.85%). Third, DZ significantly inhibited ROS surge during reperfusion with a dose-response manner. Fourth, DZ improved in vitro function of isolated islets determined by mitochondrial potentials and calcium influx in responses to glucose and KCI. Fifth, the DZ treated islets had much higher cure rate and better glycemia control in diabetic mice transplant model.

Conclusions
This study showed a strong mitochondrial protection of DZ on nonhuman primate islets against ischemia-reperfusion injury that provides strong evidence for its clinical application in islet and pancreas transplantation.
Improving Quality With Emergency Department Throughput in a Critical Access Hospital
Authors: Probus Kimberly A. , Smith Todd B. 
Published: May 2020

OBJECTIVE
The study objective was to determine the impact of specific measures to reduce the length of stay (LOS) in an emergency department (ED) in a critical access hospital (CAH).

BACKGROUND
Despite mandates to reduce bottlenecks by increasing throughput, many EDs are not successful. Strategies available to larger hospitals may not be feasible for resource-limited CAHs.

METHODS
Interventions were implemented to decrease ED LOS in a rural CAH. Through retrospective chart reviews from time periods both preimplementation and postimplementation, the LOS was determined and compared using 2-sample t tests.

RESULTS
Significant decreases were found between the groups in mean LOS times, as well as specific time intervals within the overall LOS time for nursing-centric activities and incidence of patients leaving prior to treatment completion.

CONCLUSIONS
A significant decrease in LOS resulted from numerous actions taken to improve patient flow. Results may be used to enhance patient flow and decrease LOS in other CAHs, improving quality and access to care.
A Combination of Self-debriefing and Instructor-led Debriefing Improves Team Effectiveness in Health Science Students
Authors: Rueda-Medina Blanca , Gómez-Urquiza Jose Luis , Molina-Rivas Esther , Tapia-Haro Rosa , Aguilar-Ferrándiz María Encarnación , Correa-Rodríguez María 
Published: May 2020

Background
Debriefing is considered a critical component of simulation-based learning, but the differences between different debriefing methods remain unclear.

Purpose
The purpose of the study was to investigate the effectiveness of the debriefing assessment, problem-solving process, and team effectiveness among students who received instructor-led debriefing, self-debriefing, and combined debriefing.

Methods
An experimental design was conducted with 250 students (nursing, physiotherapy, and occupational therapy). Differences in the Debriefing Experience Scale (DES), Problem Solving Inventory (PSI), and Communication and Teamwork Skills (CATS) assessment between the groups were measured.

Results
In nursing students, the combined debriefing group had the highest scores for the CATS assessment (P < .001) and for the coordination (P < .001), cooperation (P = .012), and communication (P = .002) categories. No significant differences were observed between debriefing groups for DES or PSI.

Conclusions
Combined debriefing improves communication and team skills in students. Educators might promote combined debriefing after simulation sessions as it seems to improve team effectiveness.
Pediatric Emergency Medicine Training in Procedural Sedation
Authors: Sims Morgan J. , Robinson Lauren C. , Titus M. Olivia , Jackson Benjamin F. 
Published: May 2020

Objectives
Pediatric procedural sedation (PS) has been performed with increasing frequency by pediatric emergency physicians for recent years. Accreditation Council for Graduate Medical Education Pediatric Emergency Medicine fellowship core competency requirements do not specify the manner in which fellows should become proficient in pediatric PS. We surveyed the variety of training experience provided during fellowship and whether those surveyed felt that their training was sufficient.

Methods
A 35-question survey offered to pediatric emergency fellows and recent (within 10 years) graduates collected data on pediatric PS training during fellowship. A follow-up questionnaire was sent to fellowship directors at programs where fellow or graduate respondents stated that a sedation curriculum that existed asked details of their program.

Results
There were 95 respondents to the survey, 62% of which had completed pediatric emergency medicine fellowship training. Of respondents, 65% reported having a formal sedation curriculum during fellowship. Of those who participated in a formal curriculum, 82% of respondents felt comfortable performing sedation, whereas the remaining 18% required additional preceptorship and/or more formal training to feel proficient. Fifty-six percent of respondents reported having to complete a set number of sedations before being allowed to sedate independently. Of 17 programs contacted, 9 fellowship directors responded. All 9 included didactics, 6 (66.6%) of 9 included evidence-based medicine literature review, and 6 (66.6%) of 9 included simulation. Other modalities used included supervised clinical experience in a pediatric sedation unit, a 2-week rotation with a hospital sedation team, online sedation modules, and precepted sedations using each pharmacologic agent including nitrous oxide, ketamine, propofol, and ketamine-propofol combination. Ketamine was the most frequently used agent for sedation (87%).

Conclusions
Pediatric emergency medicine fellowship requirements lack a clearly defined pathway for training in PS. Data collected from both current and former fellows depict inconsistency in training experience and suboptimal comfort level in performing these procedures. We suggest that fellows receive a more comprehensive and varied experience with multiple teaching modalities to improve proficiency with this critical and complex aspect of emergency pediatric care.