bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slow depolarizing stimuli differentially activate mechanosensitive and silent C nociceptors in human and pig skin
Authors: Rukwied Roman , Thomas Christian , Obreja Otilia , Werland Fiona , Kleggetveit Inge Petter , Jorum Ellen , Carr Richard W. , Namer Barbara , Schmelz Martin 
Published: May 2020

Abstract
High-threshold mechanosensitive and mechanoinsensitive (“silent”) nociceptors have similar electrical thresholds for transcutaneous sine wave stimulation at 4 Hz that selectively activates cutaneous C nociceptors in human skin. Their fundamentally different functions particularly in chronic pain warrant differential stimulation protocols. We used transcutaneously delivered slow depolarizing stimuli (half-sine, 500 ms duration, 0.01-1 mA) in humans to assess intensity–response relations for the induction of pain psychophysically and recorded activation of mechanosensitive and silent nociceptors in healthy volunteers by microneurography. Differential C-fiber activation was confirmed in single-fiber recordings in pig allowing for stimulation amplitudes up to 10 mA. Perception and pain thresholds to half-sine wave pulses were 0.06 ± 0.03 mA and 0.18 ± 0.1 mA, respectively, and caused pain in an amplitude-dependent manner (n = 24). When matched for pain intensity, only sine wave stimulation induced an instant widespread axon reflex erythema (n = 10). In human microneurography, half-sine stimulation activated mechanosensitive nociceptors (n = 13), but only one of 11 silent nociceptors. In pig skin, the amplitude-dependent activation of mechanosensitive nociceptors was confirmed (0.2-1 mA, n = 28), and activation thresholds for most silent nociceptors (n = 13) were found above 10 mA. Non-nociceptive low-threshold mechanosensitive C fibers (n = 14) displayed lower activation thresholds for half-sine wave stimuli with an amplitude-dependent discharge increase between 0.01 and 0.1 mA. We conclude that transcutaneous electrical stimulation with 500-ms half-sine wave pulses between 0.2 and 1 mA causes amplitude-dependent pain by preferential activation of mechanosensitive C nociceptors.
Experience of Workplace Violence Toward Nursing Students in Iran: A Qualitative Study
Authors: Tee Stephen , Valiee Sina 
Published: May 2020

ABSTRACT

Background and Aims
This study explored the dimensions of violence experienced by Iranian nursing students, during their nursing education. Violence toward students has become a major concern in recent years, and strategies are needed to reduce the incidence.

Methods
A qualitative study was conducted. Participants were seven male and nine female third-year undergraduate nursing students. Purposive sampling was used, and qualitative data from semistructured interviews were analyzed using thematic content analysis.

Results
From the qualitative data, five categories emerged: instances of violence, causes of violence, emotions after experiencing violence, reactions after violence, and violence prevention strategies.

Conclusion
To reduce the incidence of violence and provide safer learning environments, nursing students need to be taught preventive measures, but moreover, they need to receive appropriate support from nurses, instructors, and educational managers, Forensic nurses should be active stakeholders in monitoring, supporting, and referring nursing students who experience workplace violence.
An Evaluation of Verbal, Physical, and Sexual Violence Against Healthcare Workers in Ankara, Turkey
Authors: Demirci Şenol , Uğurluoğlu Özgür 
Published: May 2020

ABSTRACT

Background
Healthcare professionals work in high-stress, fast-paced settings where individuals from different professions work together and who are exposed to many types of violence. The phenomenon of violence has become a concern of utmost importance for healthcare professionals that should be addressed with due attention.

Objectives
The aim of this study was to evaluate the verbal, physical, and sexual workplace violence experienced by healthcare professionals.

Methods
A survey was conducted in a public hospital in Ankara, Turkey, among 104 physicians, 93 nurses, and 150 other medical staff.

Results
Of the participating healthcare workers, 96.2%, 95.7%, and 80.7% of the physicians, nurses, and other medical personnel, respectively, reported having been exposed to verbal violence at least once in their professional life. Physicians were identified as a source of violence among other healthcare professionals. A logistic regression analysis was performed to determine the effects of sociodemographic features on violence. The statistically significant results showed that nurses are exposed to sexual violence more than other medical personnel are (OR = 3.11, 95% CI [1.29, 7.49]). Nurses were more exposed to verbal (OR = 5.08, 95% CI [1.54, 16.75]) and physical (OR = 3.68, 95% CI [1.15, 11.80]) violence compared with other medical personnel working in the hospital.

Conclusions
This study shows that a great majority of healthcare professionals are subjected to violence ranging from verbal violence in particular to physical and sexual violence.
Enhancing medication adherence in older adults at two nurse practitioner–owned clinics
Authors: Kulsick Cecily , Votta Jennie , Wright Wendy L. , White Patricia , Strowman Shelley 
Published: May 2020

ABSTRACT

Background:
The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes.

Local problem:
A prior study at two nurse practitioner (NP)–owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker.

Methods:
Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers.

Intervention:
Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes.

Results:
Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change.

Conclusions:
This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.
Mentoring: A vital link in nurse practitioner development
Authors: Barker Elizabeth , Kelley Patricia Watts 
Published: May 2020

ABSTRACT
Mentoring has been recognized in the discipline since the inception of nursing as a profession. The core elements of mentoring are a formal dyadic relationship, reciprocity, mutual respect, professional growth, personal development, trustworthiness, objectives, and a pathway to meet the objectives, clear expectations, shared values, personal connection, provision of a safe place for asking hard questions, navigation of roadblocks, and using lessons learned. Mentoring is important at all stages of professional development. Given that nursing is a profession dedicated to lifelong learning, mentoring can and should be employed at many stages of a career.
Managing emotional support animal letters in clinical practice
Authors: Thompson Summer , Elad Jennifer 
Published: May 2020

ABSTRACT
The purpose of this brief report is to inform clinical practice and decision making in addressing the increased number of individuals requesting and receiving emotional support animal (ESA) waivers. It is important for providers including nurse practitioners to carefully consider the diagnostic and legal implications of endorsing ESAs. Nurse practitioners should be aware of the legal implications of writing ESA letters before providing them to their patients, understanding that a letter constitutes a determination of a disability. The literature on this topic is sparse, making it difficult to support the evidence-based practice of writing ESA letters. The therapeutic effects and benefits from human–animal interactions warrant further study in the case of ESAs to further support their use. Ultimately, it is up to the individual provider's clinical judgment supported by due diligence on a case-by-case basis should they decide to provide an ESA letter to their patient.
Is dual-phase SPECT/CT with 99mTc-sestamibi better than single-phase SPECT/CT for lesion localization in patients with hyperparathyroidism?
Authors: Lee Suk Hyun , Shin Eonwoo , Ha Sejin , Oh Jungsu S. , Song Dong Eun , Ryu Jin-Sook 
Published: May 2020

Abstract
This study aimed to establish an optimal protocol for 99mTc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).
We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) 99mTc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:
All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.
Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.
Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for 99mTc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.
No association between abortion and risk of breast cancer among nulliparous women
Authors: Tong Huazhang , Wu Yifan , Yan Yin , Dong Yonghai , Guan Xihong , Liu Yun , Lu ZhiHui 
Published: May 2020

Abstract

Background:
Various epidemiological studies have demonstrated the association between abortion and risk of breast cancer among nulliparous women; however, results remain inconclusive. This meta-analysis assessed the association based on previous studies.

Methods:
PubMed, EMBase, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched for relevant articles until February 2018. In this meta-analysis, fixed-effects models were used to estimate the combined effect size and the corresponding 95% confidence interval (CI). All statistical data were analyzed using STATA 12.0.

Results:
A total of 14 articles consisting of 6 cohort studies and 8 case-control studies were included in this review. All articles were of high quality, as determined based on the Newcastle Ottawa Scale assessment. The combined risk ratio (RR) indicated no significant association between abortion and breast cancer among nulliparous women (RR = 1.023, 95%CI = 0.938–1.117; Z = 0.51, P = .607). Subgroup analyses revealed no significant associations between risk of breast cancer and induced abortion or between risk of breast cancer and spontaneous abortion (SA) among nulliparous women (RR = 1.008, 95% CI = 0.909-1.118 and RR = 1.062, 95%CI = 0.902-1.250, respectively). Neither 1 nor >2 abortions increased the risk of breast cancer among nulliparous women. Sensitivity analysis showed that our results were reliable and stable.

Conclusion:
Current evidence based on epidemiological studies showed no association between abortion and risk of breast cancer among nulliparous women.
Nontraumatic Multiple-Organ Fat Embolism
Authors: Meng Yunle , Zhang Mengzhen , Ling Haosen , Huang Shen , Miao Qi , Yu YanGeng , Zhang Fu , Qiu Pingming , Li Dongri 
Published: May 2020

AbstractThe patient was an 88-year-old woman with a 10-year history of hypertension. She was suspected to have been hit by a car. At the time of the event, she was conscious and able to stand on her own and had no obvious injuries. She was sent home, but she lapsed into unconsciousness and was nonresponsive after 2 hours. She was sent to the hospital, and her heartbeat and breathing stopped. After half an hour of rescue attempts, her heartbeat did not recover, and she was declared dead. During the autopsy, a small subcutaneous hemorrhage was observed below the right knee joint. No obvious internal organ injuries or bone fractures were observed. The deceased also had mild atherosclerosis in the coronary arteries and an old cerebral infarction in the right cerebellum. The tissue histopathological tests showed distinct fat embolism in multiple organs, including the brain, lungs, kidneys, liver, and pancreas. A postmortem blood biochemistry test of the heart blood showed that the levels of low-density lipoprotein, cholesterol, triglycerides, and free fatty acids in the blood were increased, and the level of C-reactive protein was elevated. According to the autopsy results, the direct cause of death was multiorgan fat embolism. This case suggests that aging, hypertension, and hyperlipidemia may be risk factors for nontraumatic fat embolism under stressful conditions.
The Association of Malnutrition and Disease Conditions in Mortality of Pediatric Patients Presenting to a Rural Emergency Department in Uganda
Authors: Ku Brandon C. , Zonfrillo Mark R. , Periyanayagam Usha , Bisanzo Mark , Rice Brian , Maling Samuel , Cohn Keri A. 
Published: May 2020

Objectives
The main objectives of this study were to determine the effect of concurrent malnutrition on disease condition and the primary outcome of mortality in children younger than 5 years hospitalized after presenting to a rural emergency department (ED) in Uganda and to identify a high-risk patient population who may benefit from acute ED intervention.

Methods
A retrospective, observational study was performed to examine the effect of any form of malnutrition on the primary disease conditions of lower-respiratory tract infection (LRTI), malaria, and diarrheal illness. This study was conducted via review of a quality assurance database between January 2010 and July 2014.

Results
Of 3428 hospitalized children, the mean age (SD) was 19.8 months (13.9 months) and 56% were boys. Children diagnosed with malaria, an LRTI, or diarrheal illness all had a higher rate of mortality with concurrent malnutrition versus those without malnutrition (malaria, 6.2% [3.6–8.8%] vs 2.8% [2.0–3.7%]; P < 0.01; LRTI, 8.7% [5.0–12.4%] vs. 3.7% [2.6–4.9%], P < 0.01; and diarrheal illness, 10.9% [1.9–19.9%] vs 1.7% [0.1–3.4%], P < 0.01). In children with an LRTI or malaria with concurrent malnutrition, they were statistically significantly less likely to have abnormal temperature and heart rate during the ED encounter than those without concurrent malnutrition.

Conclusions
Based on these results, children with malnutrition and concurrent diseases with known high morbidity may not present with abnormal vital signs. This may have clinical relevance in patient management to the acute care provider in identifying and triaging children with malnutrition and acute disease conditions.
Implementing a Process to Systematically Identify and Address Poor Medication Adherence in Pediatric Liver Transplant Recipients
Authors: Wadhwani Sharad Indur , Nichols Melissa , Klosterkemper Jarrad , Cirincione Ross , Whitesell Kim , Owen Derek , Rengering Rebecca , Walz Benjamin , Heubi James , Hooper David K. 
Published: May 2020

Objectives:
Poor adherence to medication following pediatric liver transplantation remains a major challenge, with some estimates suggesting that 50% of adolescent liver transplant recipients exhibit reduced medication adherence. To date, no gold standard has emerged to address this challenge; however, system interventions are most likely to be successful. We sought to implement a system to identify and address adherence barriers in a liver transplant clinic.

Methods:
Using structured quality improvement methods, including multiple plan-do-study-act cycles, we developed a system to screen for patients at risk of poor adherence, identify patient- and/or parent-reported barriers to adherence, and partner with patients to overcome identified barriers. We developed a process to track key outcomes, including the variability in tacrolimus trough levels and episodes of late acute cellular rejection.

Results:
The practice saw a total of 85 patients over 6 months, and about half were females. Over this period, the improvement team implemented this system-level process with high reliability (>90% of patients received the bundle of interventions). The most commonly identified adherence barrier by patients and caregivers was “forgetting.” The second most commonly identified adherence barrier by patients was that the medication “gets in the way of their activities,” whereas by caregivers, it was “difficulty swallowing pills.”

Discussion:
We identified challenges and opportunities to screen for poor adherence and identify patient- and/or caregiver-reported barriers to immunosuppression adherence. Identifying such barriers and partnering with patients to overcome those barriers using patient-centered, barrier-specific interventions could improve long-term graft survival through improved medication adherence.
Use of Coronary Artery Calcium Scoring to Improve Cardiovascular Risk Stratification and Guide Decisions to Start Statin Therapy in People Living With HIV
Authors: Pereira Branca , Mazzitelli Maria , Milinkovic Ana , Moyle Graeme , Ranasinghe Sachini , Mandalia Sundhyia , Pozniak Anton , Asboe David , Nelson Mark , Al-Hussaini Abhetale , Boffito Marta 
Published: May 2020

Background:
Cardiovascular disease (CVD) risk assessment remains a critical step in guiding decisions to initiate primary prevention interventions in people living with HIV (PLWH).

Setting:
We investigated whether coronary artery calcium (CAC) scoring allowed a more accurate selection of patients who may benefit from statin therapy, compared with current risk assessment tools alone.

Methods:
Cross-sectional analysis of PLWH over 50 years old who underwent CAC scoring between 2009 and 2019. Framingham Risk score (FRS), QRISK2 and D:A:D scores were calculated for each participant at the time of CAC scoring and statin eligibility determined based on current European guidelines on the prevention of CVD in PLWH.

Results:
A total of 739 patients were included (mean age 56 ± 5, 92.8% male, 84% white). Among 417 (56.4%) candidates for statin therapy based on FRS ≥10%, 174 (23.5%) had no detectable calcification (CAC = 0). Conversely, 145 (19.6%) patients with detectable calcification (CAC > 0) were identified as low-risk (FRS < 10%). When compared with FRS, CAC scoring reclassified CVD risk in 43.1% of patients, 145 (19.6%) to a higher risk group that could benefit from statin therapy and 174 (23.5%) statin candidates to a lower risk group. QRISK2 and D:A:D scores performed similarly to FRS, underestimating the presence of significant coronary calcification in 21.1% and 24.9% respectively and overestimating risk in 16.9% and 18.8% patients with CAC = 0.

Conclusions:
Establishing a decision-model based on the combination of conventional risk tools and CAC scoring improves risk assessment and the selection of PLWH who would benefit from statin therapy.
Associations of adiponectin and leptin with brain natriuretic peptide in African Americans: the Jackson Heart Study
Authors: Horbal Steven R. , Hall Michael E. , Dinh Paul C. , Smiley Abbas , Musani Solomon K. , Liu Jiankang , Taylor Herman A. , Fox Ervin R. , Bidulescu Aurelian 
Published: May 2020

Background
Brain natriuretic peptide (BNP) is elevated in decompensated systolic and diastolic heart failure. The plasma levels of adipokines, such as adiponectin and leptin, may provide evidence for mechanistic differences in BNP concentrations. African-American-specific associations are limited in the literature. The objective of this study was to evaluate the associations of adiponectin and leptin with BNP among African Americans.

Methods
Linear and logistic regressions were used to test the associations between adiponectin, leptin, and plasma BNP in 3738 participants of the Jackson Heart Study (JHS), a single-site prospective cohort study of African Americans in Jackson, Mississippi.

Results
A direct relationship of adiponectin was observed in multiple multivariate-adjusted linear models: in men (β = 0.41–0.47), and in women (β = 0.32–0.38). Those in the highest quartile of adiponectin expression were twice as likely to have elevated BNP levels after adjustment [odds ratio 2.66 (95% confidence interval, 1.66–4.34)]. An inverse relationship of leptin with BNP was observed (β = −0.15) but attenuated after adjustment for aldosterone, renin, and adiponectin.

Conclusions
Different linear associations of adiponectin and leptin with BNP were observed. Odds of elevated adiponectin were observed with elevated BNP in multivariate-adjusted models. This paradoxical relationship of adiponectin and plasma BNP is possibly explained through adiponectin resistance.
Correlation between prevalence of tobacco smoking and risk and severity of COVID-19 at the national level in the European Union: an ecological study
Authors: González-Marrón Adrián , Martínez-Sánchez Jose M 
Published: May 2020

AbstractThe Angiotensin-converting enzyme 2 (ACE2) protein is the receptor for different coronaviruses, including Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19). Previous studies suggested the hypothesis that nicotine could downregulate the expression of the ACE2. Due to the high level of nicotine intake, the objective of this preliminary study was to assess, at the ecological level, the correlation between tobacco smoking and the attack rate and severity of COVID-19 in the European Union (EU). We have found that there is a statistically significant negative correlation between the age-standardized prevalence of tobacco smoking and the attack rate of COVID-19 in member states of the EU [Spearman’s correlation coefficient = −0.476 (95% confidence interval −0.117, −0.725) (p-value = 0.012)], meaning that in member states with a higher age-standardized prevalence of tobacco smoking the attack rate of COVID-19 has been so far lower. Further research is needed to understand the possible effect of nicotine exposure in the expression of the ACE2 protein.