bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behind the Mask: An Exploratory Assessment of Female Surgeons’ Experiences of Gender Bias
Authors: Barnes K. Lauren , Dunivan Gena , Sussman Andrew L. , McGuire Lauren , McKee Rohini 
Published: July 2020

Though overt sexism is decreasing, women now experience subtle, often unconscious, gender bias as microaggressions. The authors sought to explore the prevalence and impact of the sexist microaggressions female surgeons experience, using a sequential exploratory mixed methods approach (January 2018–April 2018), to identify opportunities for education and prevention. First, all resident, fellow, and attending female surgeons at the University of New Mexico Health Sciences Center (UNM HSC) were invited to participate in focus groups conducted by experienced moderators using a semistructured interview guide based on the 7 Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) domains. Qualitative analysis was performed using line-by-line manual coding to identify themes aligned with the Sexist MESS domains as well as other gender bias experiences of female surgeons. Next, a survey was sent to all resident, fellow, and attending female surgeons at the UNM HSC, which included the Sexist MESS questionnaire and questions related to surgeon-specific experiences of gender bias that the authors developed based on major thematic categories from the focus groups.
Four focus groups of 23 female surgeons were conducted, revealing 4 themes: exclusion, increased effort, adaptation, and resilience to workplace slights. The survey response rate was 64% (65/101 surgeons). Across Sexist MESS domains, the frequency and severity of microaggressions was higher for trainees than attendings. The variables of non-White race/ethnicity, having children under 18, and fellowship training generally did not demonstrate statistical significance. This exploratory study adds to the growing body of evidence that gender bias in surgery continues and frequently manifests as microaggressions. Trainees reported the highest rates and severity of microaggressions and bias experiences. Further research should investigate how to address microaggressions, the experiences of male surgeons, the perspectives of medical students and groups who were reported as often perpetuating gender bias, and the efficacy of possible interventions.
Increased aortic augmentation index is associated with reduced exercise capacity after heart transplantation
Authors: Chun Kyeong-Hyeon , Lee Chan Joo , Oh Jaewon , Won Chihyeong , Lee Taeyoon , Park Sungha , Lee Sang-Hak , Kang Seok-Min 
Published: July 2020

Objective:
Exercise capacity is often reduced after heart transplantation. We aimed to investigate the association between aortic stiffness and exercise capacity after heart transplantation.

Methods:
We retrospectively analyzed the data of patients who underwent a cardiopulmonary exercise test and central hemodynamic measurements over 1 year following heart transplantation, from Janary 2011 to June 2018.

Results:
A total of 54 patients (mean age, 49 years; 72% men) were analyzed. The median peak oxygen uptake level was 21.1 ml/kg per min at a median time of 13 months after heart transplantation. In univariate linear regression, recipient age, pulmonary arterial pressure, pulmonary capillary wedge pressure, hemoglobin level, estimated glomerular filtration rate, aortic augmentation index, and pulse wave velocity were significant predictors for peak oxygen uptake level. After adjustment for other confounding variables, heart rate-corrected aortic augmentation index was a significant predictor for peak oxygen uptake (β = −0.141, 95% confidence interval, −0.263 to −0.058, P = 0.003).

Conclusion:
In the present study, increased aortic augmentation index was associated with reduced exercise capacity after heart transplantation. Therefore, this simple measurement of aortic stiffness should be periodically used for the evaluation of exercise capacity after heart transplantation.
Quality of life and satisfaction among physicians after wavefront-optimized vs topography-guided laser vision correction
Authors: Ma Jeffrey , Pillar Angelique , Krueger Ronald 
Published: July 2020

Purpose:
To assess satisfaction, quality of life, occupational impact, and clinical outcomes of physicians who have undergone laser vision correction (LVC) using either wavefront-optimized (WFO) or topography-guided (TG) excimer laser ablation profile with femtosecond laser flap creation.

Setting:
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Design:
Retrospective survey study.

Methods:
A 12-question survey was sent to all physicians who underwent laser in situ keratomileusis or photorefractive keratectomy at the Cole Eye Institute between 2011 and 2018 on the WaveLight Allegretto Wave Eye-Q Laser (Alcon Laboratories, Inc.). Visual outcomes were obtained from patient charts.

Results:
Two hundred thirty-five physicians (454 eyes) met the study's inclusion criteria, including 181 physicians (353 eyes) who underwent WFO LVC and 54 physicians (101 eyes) who underwent TG LVC. One hundred seventeen physicians (49.8%) responded to the survey and reported an overall satisfaction rate of 98.3% among all physicians receiving LVC with 96.6% reporting they would have the procedure again. Visual outcomes showed a high level of surgical predictability, efficacy, and safety among WFO and TG eyes, with a higher percentage of eyes that received TG ablation achieving 20/10 vision (22% vs 4%, P < .0001) and 20/15 vision (87% vs 69%, P < .01) when compared with WFO eyes.

Conclusions:
Physicians who had undergone LVC with either WFO or TG excimer laser ablation reported high satisfaction and quality-of-life improvements. Both groups achieved excellent visual outcomes, with a higher percentage of TG eyes achieving 20/10 and 20/15 vision.
Insomnia and Insomnia Symptoms in Persons With Heart Failure
Authors: Gharzeddine Rida , McCarthy Margaret M. , Yu Gary , Dickson Victoria Vaughan 
Published: July 2020

Background/Objective
Insomnia and insomnia symptoms are highly prevalent in persons with heart failure (HF), and they are associated with several untoward outcomes. The purpose of this integrative review is to describe the correlates, predictors, and outcomes of insomnia and insomnia symptoms in persons with HF.

Methods
Using integrative review methods, an extensive electronic search of 5 databases was conducted for the period of 2000–2019. Sixteen studies were identified that met the inclusion criteria for review and investigated insomnia or insomnia symptoms in HF.

Results
Various sociodemographic factors, chronic comorbidities, clinical factors, and cognitive-behavioral factors are correlates and predictors of insomnia and insomnia symptoms in persons with HF. Depression, fatigue, daytime sleepiness, poor self-reported physical functioning, decreased exercise capacity, cardiac events, and poor health-related quality of life are significant outcomes of insomnia and insomnia symptoms in persons with HF. The associations of insomnia and insomnia symptoms with age, sex, sleep-disordered breathing, and cognition were not consistent across all studies.

Conclusion
Larger studies with diverse age and race groups as well as longitudinal studies and designs that test mediation effects are needed to disentangle complex relationships between insomnia and insomnia symptoms and several of their potential predictors and correlates in HF.
Equity in Genomics
Authors: Scott Jewel , Cousin Lakeshia , Woo Jennifer , Gonzalez-Guarda Rosa , Simmons Leigh Ann 
Published: July 2020

Background
African Americans are more likely to die from cardiovascular disease (CVD) than all other populations in the United States. Although technological advances have supported rapid growth in applying genetics/genomics to address CVD, most research has been conducted among European Americans. The lack of African American representation in genomic samples has limited progress in equitably applying precision medicine tools, which will widen CVD disparities if not remedied.

Purpose
This report summarizes the genetic/genomic advances that inform precision health and the implications for cardiovascular disparities in African American adults. We provide nurse scientists recommendations for becoming leaders in developing precision health tools that promote population health equity.

Conclusions
Genomics will continue to drive advances in CVD prevention and management, and equitable progress is imperative. Nursing should leverage the public's trust and its widespread presence in clinical and community settings to prevent the worsening of CVD disparities among African Americans.
Neurogenic Orthostatic Hypotension: An Underrecognized Complication of Parkinson Disease
Authors: Sin Mo-Kyung , Khemani Pravin 
Published: July 2020

ABSTRACT

BACKGROUND: Neurogenic orthostatic hypotension (nOH) is a common source of disability but is an often untreated nonmotor symptom of Parkinson disease. The key manifestations of nOH include lightheadedness, dizziness, weakness, and fatigue when standing and engaging in activities in the upright position and result in falls, impaired activities of living, decreased quality of life, and short-term cognitive impairment. Early diagnosis and treatment of nOH are necessary to mitigate its adverse effects and reduce nOH-related symptom burden. CASE STUDY: The management of nOH is illustrated through a case study. MANAGEMENT CONSIDERATIONS: Alerting providers about the impact and treatment of nOH, accurate measurement of orthostatic blood pressure, and educating patients and caregivers about nonpharmacological treatment options are important strategies to manage nOH. The goal of nOH treatment is to mitigate symptoms and improve the patient's quality of life. CONCLUSIONS: Nurses can play a crucial role in the recognition and management of nOH. Nurses who are educated about nOH are well suited to partner with care providers to treat disabling motor and nonmotor symptoms of Parkinson disease.
What Can Social Media Tell Us About Patient Symptoms
Authors: Lee Young Ji , Park Albert , Roberge Mary , Donovan Heidi 
Published: July 2020

Background
Ovarian cancer (OvCa) patients suffer from symptoms that severely affect quality of life. To optimally manage these symptoms, their symptom experiences must be better understood. Social media have emerged as a data source to understand these experiences.

Objective
The objective of this study was to use topic modeling (ie, latent Dirichlet allocation [LDA]) to understand the symptom experience of OvCa patients through analysis of online forum posts from OvCa patients and their caregivers.

Interventions/Methods
Ovarian cancer patient/caregiver posts (n = 50 626) were collected from an online OvCa forum. We developed a symptom dictionary to identify symptoms described therein, selected the top 5 most frequently discussed symptoms, extracted posts that mentioned at least one of those symptoms, and conducted LDA on those extracted posts.

Results
Pain, nausea, anxiety, fatigue, and skin rash were the top 5 most frequently discussed symptoms (n = 4536, 1296, 967, 878, and 657, respectively). Using LDA, we identified 11 topic categories, which differed across symptoms. For example, chemotherapy-related adverse effects likely reflected fatigue, nausea, and rash; social and spiritual support likely reflected anxiety; and diagnosis and treatment often reflected pain.

Conclusion
The frequency of a symptom discussed on a social media platform may not include all symptom experience and their severity. Indeed, users, who are experiencing different symptoms, mentioned different topics on the forum. Subsequent studies should consider the influence of additional factors (eg, cancer stage) from discussions.

Implications for Practice
Social media have the potential to prioritize and answer the questions about clinical care that are frequently asked by cancer patients and their caregivers.
Small Cell Neuroendocrine Carcinoma of Paranasal Sinuses: Radiologic Features in 14 Cases
Authors: Lin Naier , Qi Meng , Wang Zhengyue , Luo Siqi , Pan Yucheng , Zhang Fang , Sha Yan 
Published: July 2020

Purpose
The purpose of this study was to explore the characteristic computed tomography (CT) and magnetic resonance (MR) features of small cell neuroendocrine carcinoma (SNEC) of paranasal sinuses.

Materials and Methods
Computed tomography (n = 8) and MR (n = 14) images and clinical findings from 14 patients with SNEC of paranasal sinuses were retrospectively reviewed.

Results
Eight lesions were located in the ethmoidal sinus, 4 in the maxillary sinus, and 2 in the sphenoid sinus. Small cell neuroendocrine carcinoma of the sphenoid sinus showed bilateral asymmetry patterns. On CT images, bony changes were visible in all 8 cases. On MR, 4 cases contained hemorrhage, and 10 cases contained cystic or necrotic areas. All cases demonstrated marked heterogeneous enhancement, with half showing a “cribriform-like” or “geographic” appearance. The nasal cavity was the most common site invaded by SNEC of paranasal sinuses, followed by the orbits. A time-signal intensity curve examination showed a washout-type pattern in all but 1 case. The mean ± SD apparent diffusion coefficient value was 0.702 ± 0.112 (×10−3 mm2/s). According to the Dulguerov staging system, 9 tumors were staged as N0 (1 T1, 1 T2, 5 T3, and 2 T4). The recurrence rate was 64.3%.

Conclusions
Some characteristics of radiological findings can provide important clues for preoperative diagnosis.
Well-Being, Burnout, and Resiliency Among Early-Career Rheumatologists
Authors: Kumar Bharat , Swee Melissa L. , Suneja Manish , Iyer Priyanka 
Published: July 2020

Background/Objective
Physician well-being is being increasingly recognized for its important role in high-quality patient care, integrity of the healthcare system, and vitality of the workforce. However, little is known about well-being, resiliency, and burnout among rheumatologists, particularly early-career rheumatologists. In this qualitative study, the investigators explore these concepts among early-career rheumatologists.

Methods
We performed a qualitative study using semistructured phone interviews of rheumatologists who completed fellowship in 2017. Participants were recruited through purposive sampling. Twenty questions were devised by the investigators, covering sample demographics, exploring definitions of well-being, resiliency, and burnout, and probing potential solutions.
Interviews were recorded and transcribed independently and verified for consistency. The investigators used grounded theory to code the transcripts and iteratively derive categories, subthemes, and themes until reaching theoretical sufficiency.

Results
Sixty-four rheumatologists were interviewed, accounting for 30.6 hours of material. Seven major themes were identified: (1) well-being as a holistic state where an individual is able to translate one's potential to maximal performance, (2) work-family balance as a dynamic equilibrium changing over time, (3) inadequacy of training in addressing self-doubt over autonomy, (4) uncertainty over career development and progression, (5) excessive administrative burdens, (6) protective nature of longitudinal relationships, and (7) addressing burnout requires a multifaceted approach at multiple levels.

Conclusions
New rheumatologists face a series of challenges as they enter the workforce. Investments into well-being can help reduce the risk of burnout and enlarge our community. Our results highlight drivers and potential solutions, as identified by recent fellowship graduates.
Contrast Saline Mixture DualFlow Injection Protocols for Low-Kilovolt Computed Tomography Angiography
Authors: Overhoff Daniel , Jost Gregor , McDermott Michael , Wichtmann Barbara , Schoenberg Stefan O. , Pietsch Hubertus , Attenberger Ulrike 
Published: July 2020

Objective
The aim of this study was to evaluate a contrast media (CM)–saline mixture administration with DualFlow (DF) to adapt injection protocols to low-kilovolt (kV) computed tomography angiography (CTA).

Materials and Methods
In both a circulation phantom and animal model (5 Goettingen minipigs), 3 injection protocols were compared in dynamic thoracic CTA: (a) DF injection protocol at 80 kV with a iodine delivery rate (IDR) of 0.9 gI/s, a flowrate of 5 mL/s injected with a 60%/40% ratio of iopromide (300 mgI/mL) and saline (dose contrast medium 180 mgI/kg body weight [BW]); (b) reference CTA was performed at 120 kV and a 40% higher iodine dose applied at higher IDR (1.5 gI/s, 5 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 300 mgI/kg BW); and (c) conventional single-flow (SF) protocol with identical IDR as the DF protocol at 80 kV (0.9 gI/s, 3 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 180 mgI/kg BW). All 3 injection protocols are followed by a saline chaser applied at the same flow rate as the corresponding CM injection. Time attenuation curves representing the vascular bolus shape were generated for pulmonary trunk and descending aorta.

Results
In the circulation phantom, pulmonary and aortic time attenuation curves for the 80 kV DF injection protocols do not significantly differ from the 80 kV SF and the 120 kV SF reference. In the animal model, the 80 kV DF protocol shows similar pulmonal and aortic peak enhancement when compared with the 120 kV SF and 80 kV SF protocols. Also, the bolus length above an attenuation level of 300 HU reveals no significant differences between injection protocols. However, the time to peak was significantly shorter for the 80 kV DF when compared with the 80 kV SF protocol (15.78 ± 1.9 seconds vs 18.24 ± 2.0 seconds; P = 0.008).

Conclusion
DualFlow injection protocols can be tailored for low-kV CTA by reducing the IDR while overall flow rate remains unchanged. Although no differences in attenuation were found, DF injections offer a shorter time to peak closer to the reference 120 kV protocol.
This allows the use of DF injection protocols to calibrate bolus density in low-kV CTA and yields the potential for a more individualized CM administration.
Two-Minute Quantitative Susceptibility Mapping From Three-Dimensional Echo-Planar Imaging
Authors: Wicaksono Krishna Pandu , Fushimi Yasutaka , Nakajima Satoshi , Yokota Yusuke , Oshima Sonoko , Otani Sayo , Sakurama Azusa , Shima Atsushi , Sawamoto Nobukatsu , Okada Tomohisa , Nakamoto Yuji 
Published: July 2020

Objectives
The aim of this study was to assess the accuracy, reliability, and cerebral microbleed (CMB) detection performance of 2-minute quantitative susceptibility mapping (QSM) from 3-dimensional echo-planar imaging (3D-EPI).

Materials and Methods
Gadolinium phantom study was conducted using 3D-EPI, single–echo time (TE), and multi-TE gradient-recalled echo (GRE) sequences on two 3-T magnetic resonance (MR) scanners to assess the accuracy between measured and theoretical susceptibility values. The institutional review board approved this prospective study, and 40 healthy volunteers were enrolled with written consent between April 2018 and October 2019. Each underwent 3D-EPI, single-TE, and multi-TE GRE sequences consecutively on one 3-T MR scanner, and QSMs were calculated to assess the reliability of 3D-EPI QSM. Intraclass correlation coefficient (ICC), linear regression, and Bland-Altman plots were calculated. Patients with CMB who underwent both 3D-EPI and GRE QSM scans were retrospectively enrolled. Two radiologists evaluated images independently, and Cohen κ coefficients were calculated to compare CMB detection performance.

Results
Phantom study showed excellent validity of 3D-EPI QSM on both MR scanners: Skyra, R
2 = 0.996, P < 0.001, ICC = 0.997, mean difference, −2 ppb (95% confidence interval [CI], −45 to 40 ppb); Prisma, R
2 = 0.992, P < 0.001, ICC = 0.988, mean difference, 15 ppb (95% CI, −67 to 97 ppb). A human study of 40 healthy volunteers (59 ± 13 years, 25 women) showed excellent reliability with 3D-EPI QSM for both single-TE and multi-TE GRE (R
2 = 0.981, P < 0.001, ICC = 0.988; R
2 = 0.983, P < 0.001, ICC = 0.990, respectively), supported by a Bland-Altman mean difference of 4 ppb (95% CI, −15 to 23 ppb) for single-TE GRE and 3 ppb (95% CI, −15 to 20 ppb) for multi-TE GRE. The CMB detection performance evaluation from 38 patients (51 ± 20 years, 20 women) showed almost perfect agreement between 3D-EPI and GRE QSM for both raters (κ = 0.923 and 0.942, P < 0.001).

Conclusions
Faster QSM from 3D-EPI demonstrated excellent accuracy, reliability, and CMB detection performance.
Association Between Compensatory Overaction of the Non-Injured Eye, Measured by HESS Chart and Postoperative Diplopia in Blow-Out Fracture
Authors: Nakajima Yuta , Iwasawa Motonao , Mishima Yoshito , Yuzuriha Shunsuke 
Published: July 2020

Abstract
In orbital floor fracture, diplopia often persists post-operatively. This study evaluated the association between pre-operative parameters concerning the extent of the injury and post-operative diplopia, using multivariate analysis. A retrospective computed tomography analysis and chart review was performed for patients with punched out orbital floor fracture, who underwent operations during the period from April 2011 to March 2018. Five parameters were evaluated: the number of upward arrows on the Hess chart (representing compensatory overaction of the non-injured eye), time interval to surgery, muscular subscores, fracture area, and swelling rate of the inferior rectus muscle. Of the 32 patients, 9 (28%) had post-operative diplopia; pre-operative diplopia was completely restored in 23 (72%) patients by 6 months after surgery. Univariate analysis found statistically significant differences in the number of upward arrows on the Hess chart, time interval to surgery, muscular subscores, and fracture area. Logistic regression analysis demonstrated that only the number of upward arrows displayed a significantly increased risk for post-operative diplopia (odds ratio, 15.3; 95% confidence interval, 2.0–117.0; P = 0.008). Excessive overaction of the non-injured eye predicted persistent diplopia by 6 months post-operatively. Surgical intervention may be insufficient to achieve full recovery from diplopia and disturbances of ocular motility in some patients.