bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety assessment and results of coronary spasm provocation testing in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronary arteries
Authors: Probst Sabine , Seitz Andreas , Martínez Pereyra Valeria , Hubert Astrid , Becker Alexander , Storm Klaus , Bekeredjian Raffi , Sechtem Udo , Ong Peter 
Published: June 2020

Abstract

Background
Coronary spasm is an established cause for myocardial infarction with unobstructed coronary arteries, and can be diagnosed using intracoronary acetylcholine testing. However, it has been questioned whether such testing is feasible and safe in the acute phase. The aim of this study was to assess the frequency of coronary spasm and the safety of the acetylcholine test in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronaries.

Methods
One hundred and eighty selected patients (52% women, mean age 62 ± 13 years) with either myocardial infarction with unobstructed coronary arteries (n = 80) or stable angina and unobstructed coronaries (n = 100) were enrolled from 2007–2018. All patients underwent the acetylcholine test according to a standardised protocol immediately after diagnostic angiography. Apart from assessment of clinical, demographic and risk factor data, side effects and complications during the acetylcholine test were recorded.

Results
Overall, epicardial spasm was found in 26% with a higher prevalence among the myocardial infarction with unobstructed coronary arteries compared to the stable angina patients (35% vs 19%, p = 0.017). Microvascular spasm was found in 42% with a higher prevalence among the stable patients compared to the myocardial infarction with unobstructed coronary arteries cohort (53% vs 29%, p = 0.0014). There were no statistically significant differences in the rate of side effects (16% vs 14%, p = 0.674) or complications (1% vs 2.5%, p = 0.438) between the two groups. None of the patients experienced irreversible complications.

Conclusion
Coronary spasm is a frequent cause for myocardial infarction with unobstructed coronary arteries. Spasm provocation testing using acetylcholine is feasible in such patients in the acute phase. The complication rate during acetylcholine testing in myocardial infarction with unobstructed coronary arteries patients is low and comparable to patients with stable angina.
Delivering Breast Reconstruction Information to Patients—Part 2: Women Report on Preferred Information Content
Authors: Jacox Natalie , Webb Carmen , Sharma Vishal , Temple-Oberle Claire 
Published: June 2020

Purpose: To determine the type of information women want to be provided in order to make an informed decision as to whether, when, and using what technique to proceed with breast reconstruction. Method: Using purposeful sampling, 19 patients who had recently undergone various breast reconstruction procedures were recruited to each participate in a 30- to 45-minute semi-structured interview. Participants shared their insights and beliefs regarding the type of breast reconstruction information they most valued prior to undergoing breast reconstruction surgery. Participants were also queried as to perceived information gaps. In some cases, the participants’ partners or support persons were also interviewed. Grounded theory and thematic analysis assisted in interview transcript analysis. Results: Eight topics were identified relating to women’s informational needs around breast reconstruction. Examples include how to weigh the pros and cons of various breast reconstruction options to decide between flap or implant reconstruction, whether there are safety concerns with immediate breast reconstruction or nipple-sparing reconstruction, and expectations and advice on how to manage possibly unexpected intimacy issues after breast reconstruction. Conclusions: Using mixed methods research methodology, 19 women reported on preoperative informational gaps relating to their recent breast reconstruction experiences. Patients report that adequate breast reconstruction information prior to breast reconstruction surgery helps them to manage their expectations, prepare for surgery and recovery, and improve postoperative satisfaction.
Assessment of Patient Experiences in Otolaryngology Virtual Visits During the COVID‐19 Pandemic
Authors: Itamura Kyohei , Rimell Franklin L. , Illing Elisa A. , Higgins Thomas S. , Ting Jonathan Y. , Lee Matthew K. , Wu Arthur W. 
Published: June 2020

This study evaluates the patient experience during virtual otolaryngology clinic visits implemented during the coronavirus disease 2019 (COVID‐19) pandemic. Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020, for both telehealth and in‐person visits. A descriptive analysis of the question responses was performed. There were 195 virtual and 4013 in‐person visits with surveys completed in this time period. Ratings related to provider‐patient communication were poor for virtual visits. Telehealth has become the new norm for most health care providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent.
Protection for Otolaryngologic Surgery in the COVID‐19 Pandemic
Authors: Lagos Antonia E. , Ramos Phoebe H. , Andrade Tomás 
Published: June 2020

ObjectiveThe coronavirus disease 2019 (COVID‐19) has placed unprecedented challenges on the world and the medical community. It is transmitted through droplets, contact, the fecal‐oral route, and airborne transmission under certain conditions that allow droplets to combine with air particles to form an aerosol. Viral loads are higher in the nasal area and similar in symptomatic and asymptomatic patients. Medical situations have been classified into high and low risk of generating aerosols. Most procedures and surgery in otolaryngology correspond to high‐risk medical situations. This review aims to gather the vast amount of available information and generate recommendations for different surgical procedures according to aerosolization risk and COVID‐19 status, with use of specific personal protective equipment in each case.Data SourcesPubMed, MEDLINE, and Embase. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Food and Drug Administration.Review MethodsWe conducted a review on the literature on personal protective equipment for otolaryngologic surgery and surgical indication restrictions during the COVID‐19 pandemic.ConclusionsSARS‐CoV‐2 is an easily transmitted virus. Asymptomatic and symptomatic patients with COVID‐19 present an upper airway high viral load, conferring otolaryngologic procedures a high risk of aerosolization. Surgical procedures must be categorized according to aerosolization risk and the possibility of COVID‐19 diagnosis, according to use of personal protective equipment.Implications for PracticeThis review contributes to scientific knowledge regarding the detailed description of protective personal equipment and, most important, surgical recommendations to reduce the risk of infection in the otolaryngology community during the COVID‐19 pandemic.
Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia
Authors: Wong Li Ping , Alias Haridah , Bhoo-Pathy Nirmala , Chung Ivy , Chong Yew Ching , Kalra Sonesh , Shah Zia U Bahkt Sultan 
Published: June 2020

AbstractBackground/objectiveProductivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.MethodsA cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.ResultsOf the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.ConclusionThe significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.
SAPK2 contributes to rice yield by modulating nitrogen metabolic processes under reproductive stage drought stress
Authors: Lou Dengji , Chen Zhen , Yu Diqiu , Yang Xiaoyan 
Published: June 2020

AbstractBackgroundThe sucrose non-fermenting 1-related kinases 2 (SnRK2s) play important roles in osmotic stress responses inA. thalianaand rice (Oryza sativaL.). Osmotic stress/ABA–activated protein kinase 2 (SAPK2) is a member of SnRK2s subclass II in rice, but its function in rice yield under drought stress is unclear.ResultsCompared with wild-type (Oryza.Sativa L.spp.japonica, WT) plants, thesapk2rice mutant lines were shorter and produced fewer grains per panicle, smaller grains and lower grain yield under reproductive stage drought stress (RDS). Subsequent analysis suggested that SAPK2 considerably influences the nitrogen, phosphorus, and potassium contents of rice grains. The examination of rice seedling growth and development under nutrient-deprived conditions (−N, −K, and − P) proved that SAPK2 can significantly affect rice seedling growth and root development in hydroponic cultures lacking N and K. Moreover, the NO3−influx rate and nitrate concentration analysis indicated that SAPK2 promotes nitrate uptake and assimilation by regulating nitrate-related transporters.ConclusionThese results suggest thatSAPK2could enhance grain production by regulating nitrogen utilization efficiency under RDS. Our work provided insights to breeding drought tolerant rice with high nutrient uptake.
Perceived facilitators and predictors of positive change and posttraumatic growth following a first episode of psychosis: a mixed methods study using a convergent design
Authors: Jordan Gerald , Malla Ashok , Iyer Srividya N. 
Published: June 2020

Abstract
Background
This study aimed to identify predictors and perceived facilitators of positive change and posttraumatic growth in persons with a first episode of psychosis using a mixed methods convergent design.

Methods
In the quantitative component, 94 participants completed measures of posttraumatic growth and predictors of posttraumatic growth. The qualitative component involved in-depth interviews with 12 participants.

Results
Quantitative results revealed that being hospitalized for psychosis, spiritual coping, positive reframing and subjective recovery were significant predictors of posttraumatic growth. Qualitative findings revealed that positive change was perceived to be facilitated by the psychosis itself; receiving mental health services; drawing on personal and social resources and strategies; healing and recovering; a meaning-making and knowledge gaining process; and normative developmental processes.

Conclusions
Posttraumatic growth following a first episode of psychosis may therefore be facilitated by complex person-environment interactions.
The thermostability of the RTS,S/AS01 malaria vaccine can be increased by co-lyophilizing RTS,S and AS01
Authors: Fortpied Juliette , Collignon Sylvie , Moniotte Nicolas , Renaud Frédéric , Bayat Babak , Lemoine Dominique 
Published: June 2020

Abstract
Background
Developing thermostable vaccines is a challenge for pharmaceutical companies due to the inherent instability of biological molecules in aqueous solution. The problem is even more stringent in regions subjected to high temperatures in which protective cold chain is difficult to maintain due to a lack of infrastructure. Here, a simple, cost-effective solution to increase the thermostability of the malaria candidate vaccine RTS,S/AS01 is described. This vaccine currently needs to be stored between 2 and 8  °C due to the sensitivity of liquid AS01 to higher temperatures. The strategy was to increase thermostability by co-lyophilizing the RTS,S antigen and AS01.

Methods
Co-lyophilization was achieved in a solution containing 5% sucrose, 10 mM potassium phosphate and 0.0312% polysorbate 80 at pH 6.1. The physicho-chemical characteristics and immunogenic properties of the resulting solid product, called CL-vac, fresh or stored at high temperature, were compared to those of the candidate RTS,S/AS01.

Results
CL-vac proved to be acceptable in terms of visual appearance and physico-chemical characteristics. The structural integrity of both RTS,S and AS01 within CL-vac and its equivalence to the RTS,S/AS01 candidate vaccine were shown. Further, the stability of CL-vac was demonstrated for storage periods including 1 year at 4  °C, 1 year at 30  °C, and up to 6 months at 37  °C. In addition, CL-vac could withstand a heat excursion consisting of 1 month at 45  °C after storage for 1 year at 30  °C. Equivalence and stability were demonstrated by the various analytical tools and the immunogenicity of the samples after storage was also demonstrated in mice.

Conclusions
In conclusion, the co-lyophilization process appeared as a promising approach to increase RTS/AS01 vaccine thermostability.
Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China
Authors: Yi Ming , Peng Jiachao , Zhang Lian , Zhang Yao 
Published: June 2020

Abstract
Background
Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China’s medical and health reform.

Methods
Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE).

Results
(1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state’s allocation of medical and health resources has undergone major changes during “The Twelfth Five-Year Plan”.

Conclusion
This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China’s existing investment in medical and health resources is generally not effective. Therefore, although China’s health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.
Who is going to pay the price of Covid-19? Reflections about an unequal Brazil
Authors: Ribeiro Fabiana , Leist Anja 
Published: June 2020

AbstractThe COVID-19 pandemic has caused high mortality rates among older people, and in order to avoid a healthcare system crisis, almost all countries worldwide have adopted social isolation measures to prevent the spread of the disease. However, in Brazil, a country demarcated by economic inequalities, in which approximately 25% of the population live below the poverty line, these measures will cost severe economic losses and accentuated starvation. For this reason, the underprivileged population should be immediately prioritized and well informed through good practice to avoid the virus. Since, government discrepancies in dealing with the COVID-19 outbreak leaves the population without congruent guidelines on how to react or what to believe, allowing the spread of fake news and political crises. Here, we discuss who will pay the price of the Brazilian government denying the impact of COVID-19 pandemic and suggest some measures to ensure that clear information and protection reach this population.
Prenatal exposure to pesticides and risk for holoprosencephaly: a case-control study
Authors: Addissie Yonit A. , Kruszka Paul , Troia Angela , Wong Zoë C. , Everson Joshua L. , Kozel Beth A. , Lipinski Robert J. , Malecki Kristen M. C. , Muenke Maximilian 
Published: June 2020

Abstract
Background
Pesticide exposure during susceptible windows and at certain doses are linked to numerous birth defects. Early experimental evidence suggests an association between active ingredients in pesticides and holoprosencephaly (HPE), the most common malformation of the forebrain in humans (1 in 250 embryos). No human studies to date have examined the association. This study investigated pesticides during multiple windows of exposure and fetal risk for HPE. It is hypothesized that pre-conception and early pregnancy, the time of brain development in utero, are the most critical windows of exposure.

Methods
A questionnaire was developed for this retrospective case-control study to estimate household, occupational, and environmental pesticide exposures. Four windows of exposure were considered: preconception, early, mid and late pregnancy. Cases were identified through the National Human Genome Research Institute’s ongoing clinical studies of HPE. Similarly, controls were identified as children with Williams-Beuren syndrome, a genetic syndrome also characterized by congenital malformations, but etiologically unrelated to HPE. We assessed for differences in odds of exposures to pesticides between cases and controls.

Results
Findings from 91 cases and 56 controls showed an increased risk for HPE with reports of maternal exposure during pregnancy to select pesticides including personal insect repellants (adjusted odds ratio (aOR) 2.89, confidence interval (CI): 0.96–9.50) and insecticides and acaricides for pets (aOR 3.84, CI:1.04–16.32). Exposure to household pest control products during the preconception period or during pregnancy was associated with increased risk for HPE (aOR 2.60, OR: 0.84–8.68). No associations were found for occupational exposures to pesticides during pregnancy (aOR: 1.15, CI: 0.11–11.42), although exposure rates were low. Higher likelihood for HPE was also observed with residency next to an agricultural field (aOR 3.24, CI: 0.94–12.31).

Conclusions
Observational findings are consistent with experimental evidence and suggest that exposure to personal, household, and agricultural pesticides during pregnancy may increase risk for HPE. Further investigations of gene by environment interactions are warranted.
From COVID-19 research to vaccine application: why might it take 17 months not 17 years and what are the wider lessons?
Authors: Hanney Stephen R. , Wooding Steven , Sussex Jon , Grant Jonathan 
Published: June 2020

AbstractIt is often said that it takes 17 years to move medical research from bench to bedside. In a coronavirus disease (COVID-19) world, such time-lags feel intolerable. In these extraordinary circumstances could years be made into months? If so, could those lessons be used to accelerate medical research when the crisis eases?To measure time-lags in health and biomedical research as well as to identify ways of reducing them, we developed and published (in 2015) a matrix consisting of overlapping tracks (or stages/phases) in the translation from discovery research to developed products, policies and practice. The matrix aids analysis by highlighting the time and actions required to develop research (and its translation) both (1) along each track and (2) from one track to another, e.g. from the discovery track to the research-in-humans track. We noted four main approaches to reducing time-lags, namely increasing resources, working in parallel, starting or working at risk, and improving processes.Examining these approaches alongside the matrix helps interpret the enormous global effort to develop a vaccine for the 2019 novel coronavirus SARS-CoV-2, the causative agent of COVID-19. Rapid progress in the discovery/basic and human research tracks is being made through a combination of large-scale funding, work being conducted in parallel (between different teams globally and through working in overlapping tracks), working at greater (but proportionate) risk to safety than usual, and adopting various new processes. The overlapping work of some of the teams involves continuing animal research whilst entering vaccine candidates into Phase I trials alongside planning their Phase II trials. The additional funding available helps to reduce some of the usual financial risks in moving so quickly. Going forward through the increasingly large human trials for safety, dosage and efficacy, it will be vital to overlap work in parallel in the often challenging public policy and clinical tracks. Thus, regulatory and reimbursement bodies are beginning and preparing rapid action to pull vaccines proving to be safe and effective through to extraordinarily rapid application to the general population. Monitoring the development of a COVID-19 vaccine using the matrix (modified as necessary) could help identify which of the approaches speeding development and deployment could be usefully applied more widely in the future.