bluuebunny/crossref_metadata_2025_split huggingface dataset:
Milk yield and composition from ewes fed diets containing narasin and their lambs’ performance
Authors: Sardinha Lairana A , Marques Rodrigo S , Miszura Alexandre A , Barroso José Paulo R , Oliveira Gabriela B , Martins André S , Limede Arnaldo C , Ferraz Jr Marcos Vinicius C , Ferreira Evandro M , Pires Alexandre V , Eastridge Maurice L , Polizel Daniel M 
Published: March 2020

Abstract
The changes promoted by feed additives in ruminal fermentation, especially increasing the availability of propionate, can improve the energy balance of an animal, which is of great importance in the lactation period. This trial aimed to evaluate the inclusion of narasin in the diet of lactating ewes on milk yield, composition, dry matter intake (DMI), and plasma metabolites of the ewes and growth rate of lambs. Thirty-two lactating ewes (59.0 ± 2.42 kg) were assigned to a randomized complete block design. The experimental diets contained 500 g/kg of dry matter (DM) of coast cross (Cynodon dactylon (L.) Pers) hay and 500 g/kg DM of concentrate, and the treatments were: N0—no narasin inclusion; N13—inclusion of 13 mg of narasin/kg DM. Once a week, from week 2 to 10 of lactation, ewes were separated from their lambs, injected with oxytocin, and milked mechanically to empty the udder. After 3 h, the milk production was recorded, using the same procedure, and sampled to evaluate the composition. The blood samples were taken weekly, 4 h after feeding. The average daily gain (ADG) and starter DMI of the lambs were evaluated weekly from week 2 to 12 of age. The inclusion of narasin did not affect (P = 0.93) DMI of ewes; however, it increased milk production (P &lt; 0.01) and feed efficiency (P = 0.02; FE). Ewes fed N13 had a greater milk fat (P &lt; 0.01), protein (P &lt; 0.01), lactose (P = 0.04), and total solids production (P &lt; 0.01). Narasin inclusion in ewe’s diet increased plasma glucose concentration (P = 0.05) at weeks 8, 9 and 10; however, there was no effect on plasma urea concentration (P = 0.96). The lambs of N0 ewes had a greater starter DMI (P &lt; 0.01) at weeks 7, 8, 9, and 10; however, the ADG and body weight at weaning and after weaning were similar between treatments (P &gt; 0.05). The results showed that the inclusion of 13 mg of narasin/kg DM improved the milk production and FE of the ewes without altering the composition of the milk. The lower initial consumption of concentrate by N13 lambs before weaning was caused by the higher production of milk. The results obtained in the present study demonstrate the possible productive gain with the inclusion of narasin in diets for lactating ewes.
ADN to BSN Transitioning: An Early Decision Model
Authors: Jones Melinda Mitchell , Chapman Karla , Lacy Darlene , Cannon Sharon , Schnetter Vicki 
Published: March 2020

Abstract
Incentivizing nursing students in associate degree programs (ADN) and facilitating transition into RN-to-BSN studies has been a goal of the nursing profession. One partnership has established an “early decision” model for students who want to declare their intent to seek a BSN while earning the ADN. This article discusses how the model creates a relationship between the college, the university, and the student to support the student’s transition to the university and academic success.
Opioid Stewardship Program and Postoperative Adverse Events
Authors: Barreveld Antje M. , McCarthy Robert J. , Elkassabany Nabil , Mariano Edward R. , Sites Brian , Ghosh Roshni , Buvanendran Asokumar 
Published: March 2020

Abstract

Background
A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals.

Methods
Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals.

Results
Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals.

Conclusions
A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics.

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Defining the Minimal Clinically Important Difference and Patient-acceptable Symptom State Score for Disability Assessment in Surgical Patients
Authors: Shulman Mark A. , Kasza Jessica , Myles Paul S. 
Published: March 2020

Abstract

Background
The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery.

Methods
The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centile method.

Results
Data from 4,361 patients were analyzed. The average minimal clinically important difference estimate for the World Health Organization Disability Assessment Schedule 2.0 was 5%, with similar estimates in patients with or without preoperative disability. The patient-acceptable symptom state score was 16%, and the score consistent with at least moderate clinically significant disability was 35%. Using these estimates, between baseline and 6 months after surgery, 21% of patients had a significant increase in disability, and 73% achieved a patient-acceptable symptom state.

Conclusions
A change in World Health Organization Disability Assessment Schedule 2.0 score of 5% or more after surgery is consistent with a clinically important change in disability. Patients with a score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free, whereas patients with a score of 35% or more can be considered as having at least moderate clinically significant disability.

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Association of Surgical Hospitalization with Brain Amyloid Deposition
Authors: Walker Keenan A. , Gottesman Rebecca F. , Coresh Josef , Sharrett A. Richey , Knopman David S. , Mosley Thomas H. , Alonso Alvaro , Zhou Yun , Wong Dean F. , Brown Charles H. 
Published: March 2020

Abstract

Background
As more older adults undergo surgery, it is critical to understand the long-term effects of surgery on brain health, particularly in relation to the development of Alzheimer’s disease. This study examined the association of surgical hospitalization with subsequent brain β-amyloid deposition in nondemented older adults.

Methods
The Atherosclerosis Risk in Communities–Positron Emission Tomography (ARIC–PET) study is a prospective cohort study of 346 participants without dementia who underwent florbetapir PET imaging. Active surveillance of local hospitals and annual participant contact were used to gather hospitalization and surgical information (International Classification of Disease, Ninth Revision, Clinical Modification codes) over the preceding 24-yr period. Brain amyloid measured using florbetapir PET imaging was the primary outcome. Elevated amyloid was defined as a standardized uptake value ratio of more than 1.2.

Results
Of the 313 participants included in this analysis (age at PET: 76.0 [SD 5.4]; 56% female), 72% had a prior hospitalization, and 50% had a prior surgical hospitalization. Elevated amyloid occurred in 87 of 156 (56%) participants with previous surgical hospitalization, compared with 45 of 87 (52%) participants who had no previous hospitalization. Participants with previous surgical hospitalizations did not show an increased odds of elevated brain amyloid (odds ratio, 1.32; 95% CI, 0.72 to 2.40; P = 0.370) after adjusting for confounders (primary analysis). Results were similar using the reference group of all participants without previous surgery (hospitalized and nonhospitalized; odds ratio, 1.58; 95% CI, 0.96 to 2.58; P = 0.070). In a prespecified secondary analysis, participants with previous surgical hospitalization did demonstrate increased odds of elevated amyloid when compared with participants hospitalized without surgery (odds ratio, 2.10; 95% CI, 1.09 to 4.05; P = 0.026). However, these results were attenuated and nonsignificant when alternative thresholds for amyloid-positive status were used.

Conclusions
The results do not support an association between surgical hospitalization and elevated brain amyloid.

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Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States
Authors: Wang Eileen , Glazer Kimberly B. , Howell Elizabeth A. , Janevic Teresa M. 
Published: March 2020

OBJECTIVE:
To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research.

DATA SOURCES:
We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990–2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States.

METHODS OF STUDY SELECTION:
Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion.

TABULATION, INTEGRATION, AND RESULTS:
Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence.

CONCLUSION:
Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42018102415.
Figure-of-eight brace versus sling: a retrospective cohort study of effect on shortening for displaced midshaft pediatric clavicular fractures
Authors: Sugalski Christopher , Mundy Andrew , Buchan Daniel , Everhart Joshua S. , Samora Walter P. 
Published: March 2020

Background:
We sought to determine if there is a difference in clavicle shortening when utilizing figure-of-eight braces versus simple sling treatments for completely displaced midshaft fractures in the pediatric population.

Methods:
A pediatric level I trauma center patient database was queried for diagnosis of clavicular fracture between January 2009 and December 2014 for patients between the ages of 10 to 18 yr. Radiographs were reviewed and 100% displaced midshaft fractures identified. Initial injury and follow-up radiographs were measured for longitudinal shortening. Change in shortening was calculated as the difference in the initial injury and the follow-up measurements.

Results:
Records of 1153 patients with clavicular fractures were reviewed, and 126 were identified with 100% displaced midshaft fractures, adequate radiographic imaging, and nonoperative treatment. Ninety-seven patients (77%) were treated with a figure-of-eight brace. Twenty-nine patients (23%) were treated with a sling. Change in shortening was −0.4 mm and −1.9 mm for the figure-of-eight brace and sling, respectively (P=0.14), indicating further shortening in both treatment groups. No significant differences were observed between treatment groups with respect to age, side injured, length of radiographic follow-up, initial shortening, or change in shortening.

Conclusions:
There is no significant difference in change in shortening for 100% displaced midshaft pediatric clavicular fractures when comparing treatment with a figure-of-eight brace versus treatment with a sling. There is a trend toward improved alignment (2.6 mm lengthening) for more significantly displaced fractures (>10 mm); however, the clinical significance of the finding is indeterminate.

Level of Evidence:
Level III.
Combined medial malleoplasty and Taylor Spatial Frame after a supramalleolar osteotomy in the treatment of ankle deformity in skeletally immature patients: A prospective study of a novel technique and the short-term results
Authors: Meselhy Mohammed Anter , Elhammady Adel Samy 
Published: March 2020

Background:
This study examined the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of deformity and limb shortening caused by distal tibial physeal arrest and the effectiveness in maintaining alignment and stability by reconstruction of the medial malleolus and the medial collateral ligament using an autogenous iliac crest graft and attached sartorius muscle-tendon.

Methods:
Thirteen pediatric patients with angular deformity of the distal tibia were enrolled in this prospective study. The mean age was 8.3 yr (range, 6 to 12 yr). All patients had open fractures with skin loss. Ten patients had Salter-Harris type IV physeal fractures, while three had Salter-Harris type V physeal injury. All patients had a varus ankle deformity (range, 15 to 33 degrees) and limb shortening (range, 1.9-cm to 3.3-cm). All patients were treated by a supramalleolar osteotomy and TSF for deformity correction for limb-length equalization. The absent medial malleolus was treated by medial malleoplasty with a graft from the ipsilateral iliac crest.

Results:
The mean follow-up period was 30 mo. The mean preoperative shortening of the tibia in relation to the fibula was 2.6 cm (range, 1.9 cm to 3.3 cm). The length of the short tibia was restored in all patients, and correction of the ankle deformity and stability were restored with a satisfactory outcome.

Conclusions:
TSF is highly effective in the treatment of distal tibial deformity in pediatric patients due to traumatic physeal arrest. Reconstruction of the medial malleolus and its ligamentous attachment is crucial for ankle joint stability.

Level of Evidence:
Level IV.
Mortality Rate of Geriatric Acetabular Fractures Is High Compared With Hip Fractures. A Matched Cohort Study
Authors: Khoshbin Amir , Atrey Amit , Chaudhry Hasaan , Nowak Lauren , Melo Luana T. , Stavrakis Alexandra , Schemitsch Emil H. , Nauth Aaron 
Published: March 2020

Objectives:
Compare acute complication and mortality rates of geriatric patients with acetabular fractures (AFs) matched to hip fractures (HFs).

Design:
Retrospective cohort study.

Setting:
American College of Surgeons National Surgical Quality Improvement Project.

Patients:
Using Current Procedural Terminology codes, the American College of Surgeons National Surgical Quality Improvement Project registry was used to identify all patients ≥60 years from 2011 to 2016 treated for AFs undergoing open reduction internal fixation (ORIF) and HFs (undergoing ORIF, hemiarthroplasty, or cephalomedullary nail).

Outcome Measurements:
Patient characteristics, comorbidities, functional status, acute complications, and mortality rates were recorded. Patients were matched 1:5 (AF:HF). Chi-square, Fisher exact, and Mann–Whitney U tests were used to compare groups, and multivariable logistic regression was used to compare the risk of complications or death while adjusting for relevant covariates.

Results:
A total of 303 AF patients (age: 78.2 ± 9.2 years/59.7% females/27.1% wall, 28.4% one column and 45.2% 2 columns ORIF) were matched to 1511 HF patients (age: 78.3 ± 9.1 years/60.2% females/37.2% hemiarthroplasty, 16.3% ORIF and 47.4% cephalomedullary nail). Length of stay (8.4 ± 7.1 vs. 6.4 ± 5.9 days) and time to surgery [(TS) 2.3 ± 1.8 versus 1.2 ± 1.4 days] were longer in the AF group (P < 0.01). Unadjusted mortality rates were nonsignificantly higher for AFs versus HFs (6.6% vs. 4.6%, P = 0.14). After covariable adjustment, the risk of mortality was significantly higher for AFs versus HFs (odds ratio: 1.89, 95% confidence interval: 1.07–3.35).

Conclusion:
Geriatric AFs pose a significantly higher adjusted mortality risk when compared with HF patients. Strategies to mitigate risk factors in this population are warranted.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
PROMIS Physical Function Predicts Postoperative Pain and Disability Following Anterior Cervical Discectomy and Fusion
Authors: Parrish James M. , Jenkins Nathaniel W. , Brundage Thomas S. , Hrynewycz Nadia M. , Yoo Joon S. , Singh Kern 
Published: March 2020

Study Design:
This was a retrospective study.

Objective:
The objective of this study was to determine if preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) score is predictive of improvement in pain and physical function following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:
Few studies have investigated the predictive nature of PROMIS PF of patients undergoing spine surgery, such as ACDF.

Methods:
Patients undergoing a primary, 1–3-level ACDF were retrospectively reviewed and were stratified into 3 cohorts according to preoperative PROMIS PF scores: minimal disability (score 50–60), mild disability (score 40–50), moderate disability (score 30–40), and severe disability (score 20–30). Preoperative PROMIS PF cohorts were tested for an association with demographics, perioperative characteristics, and improvement in Neck Disability Index (NDI), 12-Item Short-Form Physical Component Score (SF-12 PCS), and Visual Analog Scale (VAS) neck and arm pain using χ2 analysis and multivariate linear regression.

Results:
A total of 126 patients were included: 11 had a minimal disability, 44 had mild disability, 54 had moderate disability, and 17 had severe disability. Patients with a severe disability experienced no statistically significant increase in their length of stay. Greater preoperative disability demonstrated lower NDI and SF-12 PCS scores preoperatively and at each postoperative timepoint. Greater preoperative disability had worse VAS neck and arm pain preoperatively and 6-week and 3-month postoperatively. Although patients with severe disability trended worse VAS neck and arm pain at the 6-month follow-up, this did not reach statistical significance.

Conclusions:
In this investigation, patients with worse PROMIS PF scores reported greater pain and disability in the preoperative period and experienced less improvement in NDI, SF-12 PCS, and VAS back and leg following ACDF. PROMIS PF is an efficient and accurate instrument that can effectively evaluate strength, mobility, and coordination in the preoperative period and may be used to predict clinical outcomes following ACDF.
Targets of cGMP/cGKI in Cardiac Myocytes
Authors: Adler Julia , Kuret Anna , Längst Natalie , Lukowski Robert 
Published: March 2020

Abstract:The 3′,5′-cyclic guanosine monophosphate (cGMP)-dependent protein kinase type I (cGKIakaPKGI) is a major cardiac effector acting downstream of nitric oxide (NO)-sensitive soluble guanylyl cyclase and natriuretic peptides (NPs), which signal through transmembrane guanylyl cyclases. Consistent with the wide distribution of the cGMP-generating guanylyl cyclases, cGKI, which usually elicits its cellular effects by direct phosphorylation of its targets, is present in multiple cardiac cell types including cardiomyocytes (CMs). Although numerous targets of cGMP/cGKI in heart were identified in the past, neither their exact patho-/physiological functions nor cell-type specific roles are clear. Herein, we inform about the current knowledge on the signal transduction downstream of CM cGKI. We believe that better insights into the specific actions of cGMP and cGKI in these cells will help to guide future studies in the search for predictive biomarkers for the response to pharmacological cGMP pathway modulation. In addition, targets downstream of cGMP/cGKI may be exploited for refined and optimized diagnostic and therapeutic strategies in different types of heart disease and their causes. Importantly, key functions of these proteins and particularly sites of regulatory phosphorylation by cGKI should, at least in principle, remain intact, although upstream signaling through the second messenger cGMP is impaired or dysregulated in a stressed or diseased heart state.