bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coinfection of H1N1 Influenza and Scrub Typhus-A Review
Authors: Jhuria L , Muthu V , Gupta S , Singh M P , Biswal M , Goyal K , Pannu A K , Kumari S , Bhalla A , Mohindra R , Suri V 
Published: January 2020

Abstract
The H1N1 influenza infection usually coincides with the typical scrub typhus season in North India. This leads to diagnostic difficulties due to their similar and non-specific symptoms. We describe three patients with confirmed co-infection of pandemic (H1N1) influenza and scrub typhus who had presented with acute respiratory distress syndrome. A systematic review of database yielded one case of scrub typhus and H1N1 influenza co-infection reported from South Korea. Co-infection of influenza with tropical infections may not be uncommon in endemic countries and hence a high index of suspicion on the part of physicians coupled with appropriate investigations are needed. The true burden of co-infections needs to be evaluated during outbreaks of influenza in a systematic manner.
AN ARTIFICIAL NEURAL NETWORK-BASED MODEL FOR PREDICTING ANNUAL DOSE IN HEALTHCARE WORKERS OCCUPATIONALLY EXPOSED TO DIFFERENT LEVELS OF IONIZING RADIATION
Authors: Mortazavi S M J , Aminiazad Fatemeh , Parsaei Hossein , Mosleh-Shirazi Mohammad Amin 
Published: January 2020

Abstract
We presented an artificial intelligence-based model to predict annual effective dose (AED) value of health workers. Potential factors affecting AED and the results of annual blood tests were collected from 91 radiation workers. Filter-based feature selection strategy revealed that the eight factors plate, red cell distribution width (RDW), educational degree, nonacademic course in radiation protection (hour), working hours per month, department and the number of procedures done per year and work in radiology department or not (0,1) were the most important predictors for AED. The prediction model was developed using a multilayer perceptron neural network and these prediction parameters as inputs. The model provided favorable accuracy in predicting AED value while a regression model did not. There was a strong linear relationship between the predicted AED values and the measured doses (R-value =0.89 for training samples and 0.86 for testing samples). These results are promising and show that artificial neural networks can be used to improve/facilitate dose estimation process.
Assessing Effects of BHV-0223 40 mg Zydis Sublingual Formulation and Riluzole 50 mg Oral Tablet on Liver Function Test Parameters Utilizing DILIsym
Authors: Longo Diane M , Shoda Lisl K M , Howell Brett A , Coric Vladimir , Berman Robert M , Qureshi Irfan A 
Published: January 2020

Abstract
For patients with amyotrophic lateral sclerosis who take oral riluzole tablets, approximately 50% experience alanine transaminase (ALT) levels above upper limit of normal (ULN), 8% above 3× ULN, and 2% above 5× ULN. BHV-0223 is a novel 40 mg rapidly sublingually disintegrating (Zydis) formulation of riluzole, bioequivalent to conventional riluzole 50 mg oral tablets, that averts the need for swallowing tablets and mitigates first-pass hepatic metabolism, thereby potentially reducing risk of liver toxicity. DILIsym is a validated multiscale computational model that supports evaluation of liver toxicity risks. DILIsym was used to compare the hepatotoxicity potential of oral riluzole tablets (50 mg BID) versus BHV-0223 (40 mg BID) by integrating clinical data and in vitro toxicity data. In a simulated population (SimPops), ALT levels &gt; 3× ULN were predicted in 3.9% (11/285) versus 1.4% (4/285) of individuals with oral riluzole tablets and sublingual BHV-0223, respectively. This represents a relative risk reduction of 64% associated with BHV-0223 versus conventional riluzole tablets. Mechanistic investigations revealed that oxidative stress was responsible for the predicted ALT elevations. The validity of the DILIsym representation of riluzole and assumptions is supported by its ability to predict rates of ALT elevations for riluzole oral tablets comparable with that observed in clinical data. Combining a mechanistic, quantitative representation of hepatotoxicity with interindividual variability in both susceptibility and liver exposure suggests that sublingual BHV-0223 confers diminished rates of liver toxicity compared with oral tablets of riluzole, consistent with having a lower overall dose of riluzole and bypassing first-pass liver metabolism.
Burden of baseline resistance of Mycobacterium tuberculosis to fluoroquinolones and second-line injectables in central India
Authors: Desikan Prabha , Panwalkar Nikita , Chaudhuri Shreya , Khan Zeba , Punde Ram Prakash , Pauranik Ankur , Mirza Shaina Beg , Ranjan Rajeev , Anand Sridhar , Sachdeva K S 
Published: January 2020

Abstract

Background
Drug-resistant TB is a serious public health problem in India. Pre-existing resistance to fluoroquinolones (FQs) and second-line injectable drugs (SLIDs) in strains of Mycobacterium tuberculosis (MTB) resistant to rifampicin (RIF) and/or isoniazid (INH) contributes to treatment failures and consequent transmission of drug-resistant TB. A baseline assessment of resistance of MTB to FQs and SLIDs may help guide policies to further improve management of drug-resistant TB in India. This study aims to determine the prevalence of resistance to FQs and SLIDs among MTB strains having RIF and/or INH resistance in central India.

Method
A total of 1032 smear positive sputum samples were subjected to line probe assay (GenoType MTBDRsl version 2) to test for resistance to FQs and SLIDs, according to the integrated diagnostic algorithm of the revised national TB control programme.

Results
Of 1032 samples, 92 (8.91%) were not interpretable and hence excluded, 295 (31.38%) were resistant to FQs alone, 13 (1.38%) were resistant to SLIDs alone, 15 (1.59%) were resistant to both FQs as well as SLIDs and 617 (65.63%) were sensitive to both FQs and SLIDs. The most common mutations in gyrA and gyrB genes were observed at codons D94G and E540V, respectively. Mutations at codon A1401G in rrs genes and in the C-14 T region of eis genes were most frequently observed.

Conclusion
High levels of FQ resistance points towards indiscriminate use of this class of drugs. Regulation for judicial use of FQs is an urgent requirement.
New drug treatment options for HIV antiretroviral therapy
Authors: Kwong Jeffrey 
Published: January 2020

Abstract:
Current treatments for patients with HIV are not only effective at controlling viral replication but are also associated with a more favorable adverse reaction profile, may often be taken once daily, and are increasingly available in combination single-tablet regimens. This article provides an overview and prescribing considerations for several primary drugs currently recommended by the US Department of Health and Human Services.
Exploring the Networking of Academic Health Science Leaders: How and Why Do They Do It?
Authors: Lieff Susan J. , Baker Lindsay , Poost-Foroosh Laya , Castellani Brian , Hafferty Frederic W. , Ng Stella L. 
Published: January 2020

Purpose
Networking is essential to leadership effectiveness in the business context. Yet little is known about leadership networking within the academic health science context. If we are going to train academic leaders, we must first understand the relational, network-based activities of their work. The purpose of this study was to explore how academic health science leaders engage in networking activities in the academic health science context.

Method
A constructivist grounded theory approach guided our study. The authors interviewed 24 academic health science leaders who were enrolled in the New and Evolving Academic Leadership program at the University of Toronto and used social network mapping as an elicitation method. Interviews, which were conducted between September 2014 and June 2015, explored participants’ networks and networking activities. Constant comparative analysis was used to analyze the interviews, with attention paid to identifying key networking activities.

Results
Academic health science leaders were found to engage in 4 types of networking activities: role bound, project based, goal/vision informed, and opportunity driven. These 4 types were influenced by participants’ conception of their role and their perceived leadership work context, which in turn influenced their sense of agency.

Conclusions
The networking activities identified in this study of academic health science leaders resonate with effective networking activities found in other fields. The findings highlight that these activities can be facilitated by focusing on leaders’ perceptions about role and work context. Leadership development should thus attend to these perceptions to encourage effective networking skills.
A Central Amygdala–Ventrolateral Periaqueductal Gray Matter Pathway for Pain in a Mouse Model of Depression-like Behavior
Authors: Yin Weiwei , Mei Lisheng , Sun Tingting , Wang Yuping , Li Jie , Chen Changmao , Farzinpour Zahra , Mao Yu , Tao Wenjuan , Li Juan , Xie Wen , Zhang Zhi 
Published: January 2020

Abstract

Background
The mechanisms underlying depression-associated pain remain poorly understood. Using a mouse model of depression, the authors hypothesized that the central amygdala–periaqueductal gray circuitry is involved in pathologic nociception associated with depressive states.

Methods
The authors used chronic restraint stress to create a mouse model of nociception with depressive-like behaviors. They then used retrograde tracing strategies to dissect the pathway from the central nucleus of the amygdala to the ventrolateral periaqueductal gray. The authors performed optogenetic and chemogenetic experiments to manipulate the activity of this pathway to explore its roles for nociception.

Results
The authors found that γ-aminobutyric acid–mediated (GABAergic) neurons from the central amygdala project onto GABAergic neurons of the ventrolateral periaqueductal gray, which, in turn, locally innervate their adjacent glutamatergic neurons. After chronic restraint stress, male mice displayed reliable nociception (control, mean ± SD: 0.34 ± 0.11 g, n = 7 mice; chronic restraint stress, 0.18 ± 0.11 g, n = 9 mice, P = 0.011). Comparable nociception phenotypes were observed in female mice. After chronic restraint stress, increased circuit activity was generated by disinhibition of glutamatergic neurons of the ventrolateral periaqueductal gray by local GABAergic interneurons via receiving enhanced central amygdala GABAergic inputs. Inhibition of this circuit increased nociception in chronic restraint stress mice (median [25th, 75th percentiles]: 0.16 [0.16, 0.16] g to 0.07 [0.04, 0.16] g, n = 7 mice per group, P < 0.001). In contrast, activation of this pathway reduced nociception (mean ± SD: 0.16 ± 0.08 g to 0.34 ± 0.13 g, n = 7 mice per group, P < 0.001).

Conclusions
These findings indicate that the central amygdala–ventrolateral periaqueductal gray pathway may mediate some aspects of pain symptoms under depression conditions.

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What We Already Know about This Topic

What This Article Tells Us That Is New
The Correlation of Spinopelvic Parameters With Biomechanical Parameters Measured by Gait and Balance Analyses in Patients With Adult Degenerative Scoliosis
Authors: Haddas Ram , Hu Xiaobang , Lieberman Isador H. 
Published: January 2020

Study Design:
A prospective cohort study.

Objective:
The objective of this study was to establish the correlation between radiographic spinopelvic parameters with objective biomechanical measures of function in patients with adult degenerative scoliosis (ADS).

Summary of Background Data:
Gait and balance analyses can provide an objective measure of function. Patients with ADS demonstrate altered gait and balance patterns. Spinopelvic parameters are commonly used by clinicians to evaluate patients with ADS. However, to the best of our knowledge, no studies have examined the correlation between patients’ radiographic spinopelvic parameters and biomechanical gait and balance parameters.

Patient Sample:
Forty-four patients with symptomatic ADS who have been deemed, appropriate surgical candidates.

Methods:
Radiographic spinopelvic parameters (CVA: central vertical axis, SVA: sagittal vertical axis, Cobb angle, PI-LL mismatch: pelvic incidence lumbar lordosis mismatch, and T1PA: T1 pelvic angle) were obtained the week before surgery. Then, gait and functional balance analyses (spatiotemporal parameters, center of mass, and head sway parameters) were performed on the same day. Correlations were determined between the radiographic spinopelvic parameters and biomechanical gait and balance parameters using Pearson product correlation.

Results:
Our results show that patients with higher Cobb angle and CVA tend to walk slower (r=−0.494, P<0.05). Furthermore, the higher the Cobb angle (r=0.396), CVA (r=0.412), SVA (r=0.440), and PI-LL mismatch (r=0.493), the more time ADS patients spend with their feet planted during single and double support phases of gait (P<0.05). In addition, patients with a higher Cobb angle, CVA, SVA, PI-LL mismatch, and T1PA, exhibited more trunk sway, increased lower extremity neuromuscular activity, and decreased spine neuromuscular activity (0.331<r<0.716, P<0.05).

Conclusions:
This study demonstrated a moderate correlation between the biomechanical parameters as measured with gait and balance analyses and the radiographic spinopelvic parameters in ADS patients. With higher pathologic spinopelvic parameters, single support time, center of mass, and head sway and lower extremity neuromuscular activity were all increased. Quantified gait and balance analyses can be a useful tool to evaluate patient outcomes. Objective functional performance measures can help to improve the evaluation and understanding of the biomechanical effects of spinal disorders on locomotion.
Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study
Authors: Wang Xian , Mao Mao , Zhang Su-Su , Wang Zhao-Hui , Xu Shi-Qin , Shen Xiao-Feng 
Published: January 2020

Abstract

Background:
In recent years, norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia. Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China. Thus, in this randomized, double-blinded study, we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension.

Methods:
In a tertiary women's hospital in Nanjing, China, 102 women were allocated with computer derived randomized number to receive prophylactic 8 μg norepinephrine (group N; n = 52) or 100 μg phenylephrine (group P; n = 50) immediately post-spinal anesthesia, followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80% of the baseline. Our primary outcome was standardized maternal cardiac output (CO) reading from spinal anesthesia until delivery analyzed by a two-step method. Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes. Maternal side effects and neonatal outcomes were collected as well.

Results:
Compared to group P, women in group N had a higher CO (standardized CO 5.8 ± 0.9 vs. 5.3 ± 1.0 L/min, t = 2.37, P = 0.02) and stroke volume (SV, standardized SV 73.6 ± 17.2 vs. 60.0 ± 13.3 mL, t = 4.52, P < 0.001), and a lower total peripheral resistance (875 ± 174 vs. 996 ± 182 dyne·s/cm5, t = 3.44, P < 0.001). Furthermore, the incidence of bradycardia was lower in group N than in group P (2% vs. 14%, P = 0.023), along with an overall higher standardized heart rate (78.8 ± 11.6 vs. 75.0 ± 7.3 beats/min, P = 0.049). Other hemodynamics, as well as maternal side effects and neonatal outcomes, were similar in two groups (P > 0.05).

Conclusions:
Compared to equivalent phenylephrine, intermittent bolus norepinephrine provides a greater CO for management of maternal hypotension during elective cesarean section with spinal anesthesia; however, no obvious maternal or neonatal clinical advantages were observed for norepinephrine.
Risk factors analysis for surgical site infection following elective colorectal resection: a retrospective regression analysis
Authors: Lei Pu-Run , Liao Jing-Wen , Ruan Ying , Yang Xiao-Feng , Hu Kun-Peng , Liu Jian-Pei , Chen Tu-Feng 
Published: January 2020

Abstract

Background:
A surgical site infection (SSI) is a major post-operative complication from elective colorectal surgery; however, few studies have focused on evaluating the risk factors for SSI. This study aimed to analyze the relative correlation of medical and environmental factors as well as patient-related factors that contribute to the incidence of all types of SSI.

Methods:
A retrospective search for eligible patients was conducted using the patient database of the Gastrointestinal Surgery Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2011 to August 2017. Pre-operative demographic and surgical data were extracted and recoded according to the study protocol. Univariate and multivariate analyses were performed to clarify factors affecting the incidence of SSI. Propensity analysis was conducted to minimize bias in the demographic characteristics to explore the prophylactic effect of pre-operative administration of oral antibiotics.

Results:
Univariate analysis of the baseline characteristics revealed that younger age (odds ratio [OR]: 0.378; 95% confidence interval [CI]: 0.218–0.657) and pre-operative oral antibiotic use (OR: 0.465; 95% CI: 0.255–0.850) were protective factors, while pre-operative anemia (OR: 4.591; 95% CI: 2.567–8.211), neoadjuvant chemotherapy history (OR: 2.398; 95% CI: 1.094–5.256), and longer surgical duration (OR: 2.393; 95% CI: 1.349–4.246; P = 0.002) were identified as risk factors for SSI. Multivariate analysis indicated that age (P = 0.003), surgical duration (P = 0.001), and pre-operative oral antibiotic use (P < 0.001) were independent factors that affect the incidence of SSI. Furthermore, a propensity-matched analysis confirmed the protective effect of oral antibiotic use, with a 1-day course of oral antibiotic producing a similar effect to a 3-day course.

Conclusions:
Age, surgical duration, and pre-operative oral antibiotic use were associated with the incidence of SSI. However, pre-operative oral antibiotic use was the only controllable factor. From the results of our study, pre-operative oral antibiotic use is recommended before elective colorectal surgery and a 1-day course is enough to provide the protective effect.
Melanocytic BAP-1–Mutated Atypical Intradermal Tumor in Two Siblings: A Case Report
Authors: Kolbach-Rengifo Marianne , Alfaro-Sepúlveda Daniela , Villarroel Alejandra , Martin-Parada Celeste , González-Bombardiere Sergio 
Published: January 2020

Abstract:
Melanocytic BAP-1–mutated atypical intradermal tumor (MBAIT) is a tumor that appears early on life. It can be the first manifestation of a tumor predisposition syndrome. Prompt diagnosis will allow for the implementation of early screening techniques for associated malignancies. We present a case of 2 siblings with MBAITs and their future management.
Moral Distress
Authors: Burton Melissa , Caswell Hollis , Porter Courtney , Mott Sandra , DeGrazia Michele 
Published: January 2020

Background/Introduction
Despite a growing population of chronically and acute critically ill neonatal and pediatric patients, there were few published articles related to moral distress as experienced by nurses caring for these patients.

Objectives/Aims
The aim of this study was to define moral distress based on the perceptions and experiences of neonatal and pediatric critical care nurses.

Methods
A qualitative descriptive study using focus group methodology was undertaken. All nurses with 2 or more years of experience from the 4 neonatal and pediatric intensive care units in a large 404-bed urban pediatric hospital located in the northeast were invited to attend 1 of 15 audio-recorded focus groups lasting 60 to 90 minutes. Once data were transcribed, conventional content analysis was used to develop the definition and categories of moral distress.

Results
Nurse participants defined moral distress as “patient care situations where there is a mismatch or incongruity between expected behaviors of the nurse and his/her personal values/beliefs in the neonatal/pediatric critical care setting.” The 2 overarching categories that emerged from the data were patient-focused factors and nurse-focused factors.

Discussion/Conclusions
Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for nursing support and education, with the goal of creating a culture of moral resiliency.
Senior Nursing Students' Perceptions of Their Readiness for Practice Prior to Final Year Internship
Authors: Leufer Therese , Cleary-Holdforth Joanne 
Published: January 2020

Introduction
Preparing nursing students for their role as future registered nurses is an essential and complex endeavor. It is a responsibility that is shared between academic and clinical health care organizations. Arguably, the prevailing economic climate places additional pressures on the fiscal and manpower aspects of health care management. Maintaining a quality practice learning environment for students against this backdrop has become increasingly challenging. Indeed, students themselves have raised these concerns. The authors sought to explore these concerns further with the students, and this article will present the qualitative findings of a study exploring final-year students' perceptions of their readiness for practice in a school of nursing in the Republic of Ireland.

Methods
Two open-ended questions were included on a quantitative survey, which sought to ascertain students' self-reported level of readiness for oral medication administration. A convenience sample of 24 final-year students undertaking a 4-year BSc (honors) in general nursing program was involved. Content analysis was employed to explore and elicit the key components of participants' written responses to the open-ended questions.

Results
Participants highlighted the constraints that they have witnessed in some practice areas, the consequent impact on the availability of particular learning opportunities, and their level of preparedness for practice. Three key areas of concern emerged including medication management, patient caseload management, and communication. A recurring issue centered on the delegation of the more fundamental nursing tasks to students by qualified nurses, to the detriment of students' experience of the more complex aspects of holistic patient care. This proved quite exasperating for these participants.

Conclusion
This study demonstrates that final-year undergraduate nursing students in a school in the Republic of Ireland are concerned about their readiness for practice. Specific areas of concern for students relate to their capacity to develop competence for registered practice. These findings provide both a timely reminder and opportunity for those charged with the responsibility of preparing nurses for registration, in both clinical and academic settings, to raise awareness of factors that can impact on the student experience and learning in practice. They highlight the importance of a collaborative approach to addressing the issues that emerged, if competence and patient safety are to be safeguarded and maintained in the future.