bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous Thrombosis of a Middle Meningeal Arteriovenous Fistula With Subsequent Pseudoaneurysm Formation: Case Report and Review of Literature
Authors: Nazari Pouya , Golnari Pedram , Sukumaran Madhav , Shaibani Ali , Hurley Michael C , Ansari Sameer A , Potts Matthew B , Jahromi Babak S 
Published: July 2020

ABSTRACT

BACKGROUND AND IMPORTANCE
Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results.

CLINICAL PRESENTATION
A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm.

CONCLUSION
Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.
Viral Interference Between Dengue Virus and Hepatitis C Virus Infections
Authors: Liang Po-Cheng , Chen Kuan-Yu , Huang Chung-Hao , Chang Ko , Lu Po-Liang , Yeh Ming-Lun , Huang Chung-Feng , Huang Ching-I , Hsieh Meng-Hsuan , Dai Chia-Yen , Lin Zu-Yau , Chen Shinn-Chern , Chuang Wan-Long , Chen Yen-Hsu , Huang Jee-Fu , Yu Ming-Lung 
Published: July 2020

AbstractBoth dengue virus (DENV) and hepatitis C virus (HCV) belong to the Flaviviridae family and could induce hepatitis. We aimed to investigate the interference between them. In total, 515 patients confirmed with dengue fever (DF) were enrolled. Thirty-two patients (6.21%) were seropositive for anti-HCV; 12 of 32 anti-HCV-positive patients had detectable HCV-RNA at presentation of DF. The proportion of dengue hemorrhagic fever was comparable between patients with or without anti-HCV and between those with or without HCV-RNA. Eleven of 32 patients received HCV-RNA testing during a median interval of 23 months after DF, which revealed significantly increased HCV-RNA levels (5.43 ± 0.77 vs 3.09 ± 1.24 log IU/mL, follow-up vs acute-DF phase; P = .003). Four of 11 patients with baseline HCV-RNA values before DF demonstrated a nadir viremia during acute DF. We also included age-, sex-, and follow-up duration–matched HCV-monoinfected patients as controls; higher delta HCV-RNA changes were demonstrated in patients with DF than in controls during the follow-up period (2.34 ± 1.15 vs –0.27 ± 0.76 log IU/mL; P &lt; .001). Further in vitro experiments showed that HCV nonstructural protein 5A was downregulated in Con1 HCV replicon cells infected by DENV1. These clinical and experimental findings suggested possible viral interference in DENV/HCV. However, HCV viremia did not affect the disease outcomes of DF.
10 years later: revisiting the patchwork quilt of child protection in Canada
Authors: Gullickson Courtney , Bartlett Emma , Ornstein Amy 
Published: July 2020

Abstract

Background
In 2007, a Paediatrics & Child Health article characterized the Canadian academic Child and Youth Protection Programs (CYPPs) depicting the wide variation in clinical services and resources across the country as ‘a threadbare patchwork quilt’. This study aimed to expand and update the knowledge gained from that original project a decade later. The aim of this research was to understand the current structure, functioning, and experiences of the existing Canadian CYPPs.

Methods
A mixed-methods design was utilized and all program directors of Canadian CYPPs were invited to participate. An online survey was distributed using REDCap to collect quantitative data on program characteristics. Program directors participated in one-on-one semi-structured telephone interviews to gather qualitative information regarding their program’s strengths and needs, resources, as wellas reflections on their experiences working within this evolving field.

Results
In total, 15 of 16 CYPP directors participated in the online survey. CYPPs remained relatively consistent in the variety of allied health care professionals on their team, and have ongoing work in research, education, and advocacy. Recurrent themes that emerged from the qualitative interview data included the strength of the team, comments on stress and wellness, expertise in the field, and desire for additional advocacy.

Conclusion
Current information was gathered on the structure, function, and experiences of Canadian CYPPs. Areas of growth include collaborative practice at the Child and Youth Advocacy Centres and deliberate attention to wellness. Child maltreatment continues to be an important health and social issue and review of the present-day landscape is critical to better inform research, education, and resource planning.
Clinician–Patient Racial/Ethnic Concordance Influences Racial/Ethnic Minority Pain: Evidence from Simulated Clinical Interactions
Authors: Anderson Steven R , Gianola Morgan , Perry Jenna M , Losin Elizabeth A Reynolds 
Published: July 2020

Abstract

Objective
Racial and ethnic minorities in the United States report higher levels of both clinical and experimental pain, yet frequently receive inadequate pain treatment. Although these disparities are well documented, their underlying causes remain largely unknown. Evidence from social psychological and health disparities research suggests that clinician–patient racial/ethnic concordance may improve minority patient health outcomes. Yet whether clinician–patient racial/ethnic concordance influences pain remains poorly understood.

Methods
Medical trainees and community members/undergraduates played the role of “clinicians” and “patients,” respectively, in simulated clinical interactions. All participants identified as non-Hispanic Black/African American, Hispanic white, or non-Hispanic white. Interactions were randomized to be either racially/ethnically concordant or discordant in a 3 (clinician race/ethnicity) × 2 (clinician–patient racial/ethnic concordance) factorial design. Clinicians took the medical history and vital signs of the patient and administered an analogue of a painful medical procedure.

Results
As predicted, clinician–patient racial/ethnic concordance reduced self-reported and physiological indicators of pain for non-Hispanic Black/African American patients and did not influence pain for non-Hispanic white patients. Contrary to our prediction, concordance was associated with increased pain report in Hispanic white patients. Finally, the influence of concordance on pain-induced physiological arousal was largest for patients who reported prior experience with or current worry about racial/ethnic discrimination.

Conclusions
Our findings inform our understanding of the sociocultural factors that influence pain within medical contexts and suggest that increasing minority, particularly non-Hispanic Black/African American, physician numbers may help reduce persistent racial/ethnic pain disparities.
Influenza vaccination in chronic inflammatory arthritis undergoing immunosuppressive treatments: temporal trend and factors of adherence
Authors: Quartuccio Luca , Zabotti Alen , Gallo Tolinda , De Vita Salvatore , Valent Francesca 
Published: July 2020

Abstract

Objectives
To verify the level of adherence to the influenza vaccination program in a population of patients suffering from RA, PsA or AS undergoing immunosuppressive treatment.

Methods
Administrative databases from the Regional Health Information System of Friuli Venezia Giulia (FVG), Italy, were used. Subjects were residents in FVG, suffered from chronic inflammatory arthritis and had at least one prescription for a DMARD in the 9 months before the start of the vaccination season (from 1 October to 31 December). The observation ranged from 2006 to 2018. Logistic regression was used to assess the association between vaccination and the patient’s characteristics in the 2018–2019 influenza season.

Results
Overall, vaccination adherence decreased from the highest value of 35.7% (662/1853) in 2006 to the lowest value of 25.3% (926/3663) in 2014; in people ≥65 years of age it also decreased over time from 61.6% (577/936) in 2008 to 43.9% (701/1595) in the 2014. By logistic analysis on the 2018–2019 season, which included 4460 patients, older subjects were more likely to be vaccinated [people 65–74 years, odds ratio (OR) 4.58 (95% CI 3.72, 5.64); people 75–84 years, OR 6.47 (95% CI 5.04, 8.32); both vs &lt;65] as were those with diabetes [OR 1.66 (95% CI 1.05, 2.64)]. Treatment with a biologic agent alone [OR 0.64 (95% CI 0.52, 0.80)] and RA diagnosis [OR 0.69 (95% CI 0.51, 0.93)] were associated with lower adherence.

Conclusion
Influenza vaccination adherence is alarmingly low in a population at higher risk of infectious complications, in particular in elderly patients.
Suicidal ideation is associated with nighttime wakefulness in a community sample
Authors: Tubbs Andrew S , Fernandez Fabian-Xosé , Perlis Michael L , Hale Lauren , Branas Charles C , Barrett Marna , Chakravorty Subhajit , Khader Waliuddin , Grandner Michael A 
Published: July 2020

AbstractStudy ObjectivesNocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends.MethodsData were collected from 888 adults aged 22–60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm–5 am) and morning (5 am–11 am) wakefulness and suicidal ideation.ResultsNocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28–1.64] per hour awake between 11:00 pm and 05:00 am, p &lt; 0.0001) and weekends (OR: 1.22 [1.08–1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72–0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75–0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09–1.44] per hour awake, p = 0.002).ConclusionWakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms
Authors: Liu Xianchen , Yang Yanyun , Liu Zhen-Zhen , Jia Cun-Xian 
Published: July 2020

Abstract

Study objectives
Nightmares are a significant risk factor of suicidal behavior. This study examined the longitudinal associations of nightmare frequency and distress with suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) and mediating role of depressive symptoms in adolescents.

Methods
A total of 6,923 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort were included for the analysis. Participants completed a self-administered questionnaire to assess nightmares, sleep duration, insomnia, depressive symptoms, substance use, prior suicidal behavior, and family demographics in November–December in 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behaviors.

Results
Of the sample, 26.2% reported having frequent nightmares (at least twice/month) at baseline, and 10.0%, 3.6%, and 2.7% reported having ST, SP, and SA over 1-year follow-up. The rates of subsequent ST, SP, and SA all significantly increased with baseline nightmare frequency and distress. Path analyses showed that depressive symptoms played a significant mediating role in the associations of frequent nightmares and elevated nightmare distress with ST, SP, and SA before and after adjusting for adolescent and family covariates and prior suicidal behavior.

Conclusions
Suicidal risk increased with nightmare frequency and distress among adolescents. The association between nightmares and suicidal behavior was at least partially mediated by depressive symptoms. Assessing and intervening nightmares and depressive symptoms associated with nightmares may have important implications for preventing adolescent suicidal behavior.
Conflicting Policy Feedback: Enduring Tensions over Father Quotas in Norway
Authors: Ellingsæter Anne Lise 
Published: July 2020

Abstract
This study aims to advance the understanding of drivers of fathers’ parental leave rights—a new political field and a main area of leave policy debate. Theoretically informed by the policy feedback literature, this case study of father quota policy in Norway demonstrates how conflicting political feedback processes over a quarter of a century, reflected in reforms by shifting government coalitions, have sustained tensions over the policy. The polarized public debate following an extension in the father quota in 2018 suggests that countermobilization via social media may play a new role in magnifying conflict and destabilizing post-reform processes.
Effects of monensin inclusion and level of intake in limit-feeding strategies for beef cows1
Authors: Boardman Caleb J , Wickersham Tryon A , Trubenbach Levi A , Sawyer Jason E 
Published: July 2020

Abstract
A study was conducted to evaluate the effects of intake management and ionophore inclusion on diet utilization under managed intake conditions in beef cattle. Two experiments utilized common diets fed at 120% (H) or 80% (L) of maintenance with either 0 or 200 mg/d monensin in a factorial arrangement. Forty cows were fed for 56 d (Exp. 1) to evaluate effects on diet utilization and energy retention; diets were fed to 16 ruminally cannulated steers (Exp. 2) to determine effects on digestion, energy value, and ruminal fermentation. Cows fed H had greater body weight (BW) gain (P &lt; 0.01) and retained energy (RE; P &lt; 0.01), although estimated heat production was also greater (P &lt; 0.01). Monensin had limited effects on overall BW gain (P = 0.97). Monensin had no effect on RE (P = 0.94) or calculated heat energy (HE; P = 0.53) despite effects on diet utilization observed in steers. In steers, L increased (P &lt; 0.01) digestion of dry matter, organic matter, acid detergent fiber, and gross energy (GE) and reduced (P &lt; 0.01) passage rate; monensin did not affect digestion (P &gt; 0.15) but did reduce passage rate (P &lt; 0.03). Monensin lowered (P &lt; 0.01) acetate:propionate ratio and increased (P &lt; 0.05) ruminal pH. Monensin did not alter feed required for maintenance; however, limit-feeding reduced apparent daily maintenance requirement to 62.85 kcal/kg BW0.75, a 26% reduction from model-predicted values.
Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis: Is 65 The Sweet Spot?
Authors: Patidar Kavish R. , Peng Jennifer Lynn , Pike Francis , Orman Eric S. , Glick Mathew , Kettler Carla D. , Nephew Lauren D. , Desai Archita P. , Nair Kavitha , Khan Babar A. , Buckley Caitriona A. , Machado Roberto F. , Chalasani Naga P. , Ghabril Marwan S. 
Published: July 2020

Objectives:
Mean arterial pressure is critically important in patients with cirrhosis in the ICU, however, there is limited data to guide therapies and targets.

Design:
Retrospective observational study.

Setting:
Tertiary care ICU.

Patients:
Two hundred and seventy-three critically ill patients with cirrhosis.

Interventions:
None.

Measurements and Main Results:
We performed a comprehensive time-weighted mean arterial pressure analysis (time-weighted-average-mean arterial pressure and cumulative-time-below various mean arterial pressure-thresholds) during the first 24-hours after ICU admission (median: 25 mean arterial pressure measurements per-patient). Time-weighted-average-mean arterial pressure captures both the severity and duration of hypotension below a mean arterial pressure threshold and cumulative-time-below is the total time spent below a mean arterial pressure threshold. Individual univariable and multivariable logistic regression models were assessed for each time-weighted-average-mean arterial pressure and cumulative-time-below mean arterial pressure threshold (55, 60, 65, 70, and 75 mm Hg) for ICU-mortality. Time-weighted-average-mean arterial pressure: for 1 mm Hg decrease in mean arterial pressure below 75, 70, 65, 60, and 55 mm Hg, the odds for ICU-mortality were 14%, 18%, 26%, 41%, and 74%, respectively (p < 0.01, all thresholds). The association between time-weighted-average-mean arterial pressure and ICU-mortality for each threshold remained significant after adjusting for model for end-stage liver disease—sodium score, mechanical ventilation, vasopressor use, renal replacement therapy, grade 3/4 hepatic encephalopathy, WBC count, and albumin. Cumulative-time-below: odds for ICU-mortality were 4%, 6%, 10%, 12%, and 12% for each-hour spent below 75, 70, 65, 60, and 55 mm Hg, respectively. In the adjusted models, significant associations only remained for mean arterial pressure less than 65 mm Hg (odds ratio, 1.07; 95% CI, 1.00–1.14; p = 0.05) and < 60 mm Hg (odds ratio, 1.10; 95% CI, 1.01–1.18; p = 0.04).

Conclusions:
These data suggest that maintaining a mean arterial pressure of greater than 65 mm Hg may be a reasonable target in patients with cirrhosis admitted to the ICU. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure-targets in this patient population.
Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation
Authors: Trigonis Russell A. , Holt Daniel B. , Yuan Rebecca , Siddiqui Asma A. , Craft Mitchell K. , Khan Babar A. , Kapoor Rajat , Rahman Omar 
Published: July 2020

Objectives:
One of the defining features of the novel coronavirus disease 2019 infection has been high rates of venous thromboses. The present study aimed to describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation.

Design:
Single-center retrospective review using data from patients with confirmed severe acute respiratory syndrome coronavirus 2 requiring intubation.

Setting:
Tertiary-care center in Indianapolis, IN, United States.

Patients:
Patients hospitalized at international units Health Methodist Hospital with severe acute respiratory syndrome coronavirus 2 requiring intubation between March 23, 2020, and April 8, 2020, who underwent ultrasound evaluation for venous thrombosis.

Interventions:
None.

Measurements and Main Results:
A total of 45 patients were included. Nineteen of 45 patients (42.2%) were found to have deep venous thrombosis. Patients found to have deep venous thrombosis had no difference in time to intubation (p = 0.97) but underwent ultrasound earlier in their hospital course (p = 0.02). Sequential Organ Failure Assessment scores were similar between the groups on day of intubation and day of ultrasound (p = 0.44 and p = 0.07, respectively). d-dimers were markedly higher in patients with deep venous thrombosis, both for maximum value and value on day of ultrasound (p < 0.01 for both). Choice of prophylactic regimen was not related to presence of deep venous thrombosis (p = 0.35). Ultrasound evaluation is recommended if d-dimer is greater than 2,000 ng/mL (sensitivity 95%, specificity 46%) and empiric anticoagulation considered if d-dimer is greater than 5,500 ng/mL (sensitivity 53%, specificity 88%).

Conclusions:
Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019. There was no difference in incidence of deep venous thrombosis among different pharmacologic prophylaxis regimens, although our analysis is limited by small sample size. d-dimer values are elevated in the majority of these patients, but there may be thresholds at which screening ultrasound or even empiric systemic anticoagulation is indicated.
False-Negative Rate of Direct Immunofluorescence on Lower Extremities in Bullous Pemphigoid
Authors: Perry David M. , Wilson Ashley , Self Sally , Maize John C. 
Published: July 2020

Abstract:
Bullous pemphigoid (BP) is the most common autoimmune blistering disorder of the skin. It is typified by tense blisters with a subepidermal split and mixed dermal inflammatory infiltrate on histology. Biopsy of the perilesional skin for direct immunofluorescence (DIF) has become the gold standard in the diagnosis of BP. Currently there is a pervasive clinical opinion that the lower extremity is a site with a high false-negative rate (FNR) for DIF in the diagnosis of BP. This notion is primarily based on 2 early studies from the 1980s without more recent confirmatory studies. To readdress this question regarding the lower extremities, a retrospective study from 2012 to 2018 was performed in our institution that evaluated the FNR of DIF by an anatomical site in the diagnosis of BP. Cases of BP were identified using standard criteria (clinical and histological data reviewed in cases with negative DIF), and overall, 79 patients were included in the study. A total of 4 false-negative DIF biopsies were verified. Two negative DIF were from the lower extremity yielding a FNR of 10% compared with 4% on the trunk and 3% from the upper extremity, with no statistically significant difference by anatomical sites. Our study fails to demonstrate a high FNR of DIF from the lower extremity in the diagnosis of BP.