bluuebunny/crossref_metadata_2025_split huggingface dataset:
Private Foundations and EU beneficial ownership registers: towards full disclosure to the general public?
Authors: Panico Paolo 
Published: June 2020

Abstract
Directive (EU) 2015/849, known as the “4th AML Directive”, introduced an obligation on all EU Member States to create and maintain registers of the beneficial owners of their companies and trusts. Prior to such measures coming into force in most member states, Directive (EU) 2018/843, known as the “5th AML Directive”, further introduced some significant changes to the functioning of such registers and, in particular, to the access to their information.
This article considers the impact of the rules introduced under the 5th AML Directive on private foundations. After a brief analysis of the relevant provisions in the Directive, it focuses on three member states in particular: Austria, Malta, and Belgium.
Program Evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): Impact on Career Development and Professional Society Diversity
Authors: Flores Glenn , Mendoza Fernando , Brimacombe Michael B. , Frazier Willie 
Published: June 2020

Purpose
Despite a demographic surge in U.S. minority children, pediatric workforce diversity has failed to keep pace. The study aim was to evaluate the Research in Academic Pediatrics Initiative on Diversity (RAPID), a research-education program aimed at recruiting, retaining, and professionally advancing diverse early-career faculty in general pediatrics who are pursuing research careers.

Method
RAPID includes the following components: small research grants, mentoring by nationally renowned senior investigators, mentoring and networking at an annual breakfast, an annual career-development conference, and monthly mentoring conference calls. Outcomes data from the first 5 years (2012–2017) of RAPID were analyzed. Data sources were Academic Pediatric Association (APA) membership data and postconference, baseline, and end-of-program/follow-up surveys. Outcome measures included mentoring quality, presentations, publications, subsequent grants, impact on career success, conference ratings, and APA membership diversity.

Results
For the 10 Scholars from the first 4 cohorts, mean scores were 4.5 (5 = strongly agree) for RAPID fostering mentoring, developing research skills, and helping Scholars feel more comfortable as underrepresented minority (URM) faculty; 78% delivered platform or poster presentations on their project. They published 56 total articles and received a mean of 2.5 subsequent grants. Their mean score for RAPID “advancing my career by facilitating promotion or getting a job” was 4.6. The first 4 RAPID Conferences were highly rated (mean scores = 4.2–4.8) and brought in 33 additional URM young investigators. Pre-RAPID, URM APA membership stagnated at 6%–7% for 5 years. In RAPID’s first year, URM APA membership rose to 8%, then to 10% by 2017 (43% increase; P < .001).

Conclusions
RAPID Scholars generated multiple presentations and publications. RAPID mentoring and Conferences were highly rated. RAPID was associated with career advancement and increased professional society diversity. RAPID could serve as a national model for enhancing URM career development and professional society diversity.
Early Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study
Authors: Chui Jason , Craen Rosemary , Dy-Valdez Christine , Alamri Rizq , Boulton Mel , Pandey Sachin , Herrick Ian 
Published: June 2020

Background:
Maintenance of euvolemia and cerebral perfusion are recommended for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a pilot randomized controlled study to assess the feasibility and efficacy of goal-directed therapy (GDT) to correct fluid and hemodynamic derangements during endovascular coiling in patients with aSAH.

Methods:
This study was conducted between November 2015 and February 2019 at a single tertiary center in Canada. Adult patients with aSAH within 5 days of aneurysm rupture were randomly assigned to receive either GDT or standard therapy during endovascular coiling. The incidence of dehydration at presentation and the efficacy of GDT were evaluated.

Results:
Forty patients were allocated to receive GDT (n=21) or standard therapy (n=19). Sixty percent of all patients were found to have dehydration before the coiling procedure commenced. Compared with standard therapy, GDT reduced the duration of intraoperative hypovolemia (mean difference 37.6 [95% confidence interval, 6.2-37.4] min, P=0.006) and low cardiac index (mean difference 30.7 [95% confidence interval, 9.5-56.9] min, P=0.035). There were no differences between the 2 treatment groups with respect to the incidence of vasospasm, stroke, death, and other complications up to postoperative day 90.

Conclusions:
A high proportion of aSAH patients presented at the coiling procedure with dehydration and a low cardiac output state; these derangements were more likely to be corrected if the GDT algorithm was used. Compared with standard therapy, use of the GDT algorithm resulted in earlier recognition and more consistent treatment of dehydration and hemodynamic derangement during endovascular coiling.
The Application of Henna (Lawsonia inermis) in Orthopedics
Authors: Arora Sumit , Thora Ankit , Sural Sumit , Dhal Anil 
Published: June 2020

Background:
Many orthopedic procedures require skin marking as part of preoperative planning. The markings obtained from commercially available permanent pens may fade away after vigorous skin preparation before surgery. We describe the use of Henna (Lawsonia inermis) paste as a durable, readily available, and cost-effective material for preoperative skin marker in various orthopedic surgeries.

Patients and Methods:
We performed a retrospective review of prospectively collected data of 50 cases with various indications of preoperative localization of skin incision and divided them in 2 groups: Group A (n=25) were the patients where Henna was to be used as marker and group B (n=25) were the ones where permanent skin marking pen was decided to be used for the purpose of skin marking. The groups were compared for the instances of mark fading after bathing, after scrubbing of surgical part, the need for intraoperative fluoroscopy, and complications because of marking substance.

Results:
Of the 25 cases where henna was used for markings (group A), none had fading of mark after routine bath with soap on the morning of surgery (0 of applicable 11) or after surgical scrubbing (0 of 25). However, for the permanent marker (group B), 3 patients (of applicable 6) had fading of mark beyond recognition after routine bath with soap and additional 10 cases (of applicable 22) had fading of mark beyond recognition after surgical scrubbing (P<0.05). Four cases (of applicable 23) from group A still required intraoperative fluoroscopy, whereas this figure was 15 (of 25 cases) for group B (P<0.05). There was no suggestion of rash/allergy/wound infection in either group.

Conclusions:
Henna paste may reliably be used in various orthopedic procedures like foreign body removal, vertebral-level identification, nail dynamization, marking growth plate in children, identification of sequestrum in nondischarging chronic osteomyelitis, and marking the course of blood vessels in tumor surgery.
Effects of the COVID-19 Pandemic on the Management of Patients With ST-elevation Myocardial Infarction in a Tertiary Cardiovascular Center
Authors: Firouzi Ata , Baay Mohammadreza , Mazayanimonfared Azadeh , Pouraliakbar Hamidreza , Sadeghipour Parham , Noohi Feridoun , Maleki Majid , Peighambari Mohamad Mehdi , Kiavar Majid , Abdi Seifollah , Maadani Mohsen , Shakerian Farshad , Zahedmehr Ali , Kiani Reza , Alemzadeh-Ansari Mohammad Javad , Rashidinejad Alireza , Hosseini Zahra 
Published: June 2020

Background:
In the Coronavirus Disease 2019 (COVID-19) pandemic, the appropriate reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) is unclear.

Methods:
This retrospective single-center study consecutively enrolled patients who presented with STEMI and scheduled for primary percutaneous coronary intervention (PPCI) during the outbreak of COVID-19. Due to the delay in the reporting of the polymerase chain reaction test results, our postprocedural triage regarding COVID-19, followed by the isolation strategy, was based on lung computerized tomography scan results.

Results:
Forty-eight patients with STEMI referred to our center. PPCI was done for 44 (91%) of these patients. The mean symptom-to-device time was 490.93 ± 454.608 minutes, and the mean first medical contact-to-device time was and 154.12 ± 36.27 minutes. Nine (18%) patients with STEMI were diagnosed as having typical/indeterminate features indicating COVID-19 involvement. During hospitalization, 1 (2.0%) patient died of cardiogenic shock. The study population was followed for 35.9 ± 12.7 days. Two patients expired in another centers due to COVID-19. No cardiac catheterization laboratory staff members were infected by COVID-19 during the study period.

Conclusions:
Our small report indicates that by taking the recommended safety measures and using appropriate PPE, we can continue PPCI as the main reperfusion strategy safely and effectively.
The Influence and Treatment of the Intestinal Microbiome on Child Respiratory Diseases
Authors: Zhang Chuanxin , Huang Junlin , Ren Yifan , Zhu Shenghong , Yin Fangxue , Zhu Yixin 
Published: June 2020

Abstract
The intestinal microbiome has a great influence on human health through its close interaction with the human body, including growth, development, maturation, immunity, and anti-aging. Numerous studies have reported that the intestinal microbiome is related to the pathogenesis, diagnosis, and treatment of diseases. Variable clinical interventions, such as prebiotics and probiotics have been widely used to cure people. However, probiotics might suffer from viability issues. Therefore, new technologies are being exploited to solve these problems. In this review, we describe the correlation between the intestinal microbiome and children respiratory diseases, present therapies based on microecological theory, and introduce some new technologies aimed to improve the efficacy of microbiological therapies.
Premature ovarian insufficiency: clinical orientations for genetic testing and genetic counseling
Authors: Barros Francisco , Carvalho Filipa , Barros Alberto , Dória Sofia 
Published: June 2020

Abstract
Premature ovarian insufficiency (POI) is a heterogeneous disorder diagnosed in women before 40 years old and describes a wide range of impaired ovarian function, from diminished ovarian reserve to premature ovarian failure. Genetic etiology accounts for 20% to 25% of patients. The evidence that POI can be isolated (nonsyndromic) or part of a pleiotropic genetic syndrome highlights its high heterogeneous etiology. Chromosomal abnormalities as a cause of POI have a prevalence of 10% to 13%, being 45,X complement the most common cytogenetic cause of primary amenorrhea and mosaicism with a 45,X cell line more frequently associated with secondary amenorrhea. Other X chromosome aberrations include deletions, duplications, balanced, and unbalanced X-autosome rearrangements involving the critical region for the POI phenotype (Xq13-Xq21 to Xq23-Xq27).
The identification of 2 or more pathogenic variants in distinct genes argues in favor of a polygenic origin for POI. Hundreds of pathogenic variants (including mitochondrial) have been involved in POI etiology mainly with key roles in biological processes in the ovary, such as meiosis and DNA damage repair mechanism, homologous recombination, follicular development, granulosa cell differentiation and proliferation, and ovulation.
The most common single gene cause for POI is the premutation for FMR1 gene (associated with fragile X syndrome) with alleles ranging from about 55 to about 200 CGG trinucleotide repeats. POI occurs in 20% of women with this premutation. As females with premutation or full mutation alleles are also at risk of having affected children, their genetic counseling should include the indication for prenatal diagnosis or preimplantation genetic testing after intracytoplasmic sperm injection and trophectoderm biopsy.
In conclusion, in clinical practice high-resolution karyotype and FMR1 gene molecular study should be performed as first-tier tests in the assessment of POI. In addition, array Comparative Genomic Hybridization or specific next generation sequencing panels should be considered to identify chromosomal deletions/duplications under karyotype resolution or other pathogenic variants in specific genes associated with POI. This is particularly important in patients with first- or second-degree relatives also affected with POI, improving their reproductive and genetic counseling.
Nurses' Experiences of “Being Swamped” in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines
Authors: Roth Cheryl , Brewer Melanie A. , Bay R. Curtis , Gosselin Kevin P. 
Published: June 2020

Abstract

Purpose:
Being swamped is defined as “when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing.” The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the AWHONN (2010) nurse staffing guidelines.

Study Design and Methods:
A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines.

Results:
Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix. Teamwork and someone stepping in to help without being asked were identified as most helpful when a nurse feels swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared with those in hospitals that followed the guidelines some of the time, or rarely (p < 0.001).

Clinical Implications:
Being swamped is a common phenomenon among AWHONN members responding to the survey. The reported incidence of being swamped daily is significantly associated with the extent to which hospitals follow the AWHONN nurse staffing guidelines. Nurse leaders, hospital administrators, and staff nurses must work together to identify and initiate timely, feasible nurse staffing solutions that support the safety of patients and nurses.
Gen2EpiGUI: User-Friendly Pipeline for Analyzing Whole-Genome Sequencing Data for Epidemiological Studies of Neisseria gonorrhoeae
Authors: Singh Reema , Yarmovich Trevor , Kusalik Anthony , Dillon Jo-Anne R. 
Published: June 2020

Abstract
We have developed a graphical user interface for our Gen2Epi computational pipeline named Gen2EpiGUI. A total of 594 published whole-genome sequence datasets of Neisseria gonorrhoeae were used to validate the program. Gen2Epi facilitates an understandable analysis of N. gonorrhoeae whole-genome sequence data for users with limited bioinformatics skills.
Persistent Verrucous Plaques in an HIV-Positive Patient With Secondary and Neurosyphilis
Authors: Thanyathorn Nuchanatanon , Pravit Asawanonda , Chanat Kumtornrut 
Published: June 2020

Abstract
A 23-year-old HIV-positive woman presented with persistent yellowish verrucous plaques on both ankles, which had been present for 2 years, and blurred vision, which had persisted for 1 month. Serological tests confirmed a syphilis diagnosis. Her condition improved after systemic penicillin treatment, with no topical treatment except petrolatum ointment.
An Evaluation of Syndromic Surveillance–Related Practices Among Selected State and Local Health Agencies
Authors: Romano Sebastian , Yusuf Hussain , Davis Cassandra , Thomas Mathew J. , Grigorescu Violanda 
Published: June 2020

Context:
Syndromic surveillance consists of the systematic collection and use of near real-time data about health-related events for situational awareness and public health action. As syndromic surveillance programs continue to adopt new technologies and expand, it is valuable to evaluate these syndromic surveillance systems and practices to ensure that they meet public health needs.

Objective:
This assessment's aim is to provide recent information about syndromic surveillance systems and practice characteristics among a group of state and local health departments.

Design/Setting:
Information was obtained between November 2017 and June 2018 through a telephone survey using an Office of Management and Budget–approved standardized data collection tool. Participants were syndromic surveillance staff from each of 31 state and local health departments participating in the National Syndromic Surveillance Program funded by the Centers for Disease Control and Prevention. Questions included jurisdictional experience, data sources and analysis systems used, syndromic system data processing characteristics, data quality verification procedures, and surveillance activities conducted with syndromic data.

Measures:
Practice-specific information such as types of systems and data sources used for syndromic surveillance, data quality monitoring, and uses of data for public health situational awareness (eg, investigating occurrences of or trends in diseases).

Results:
The survey analysis revealed a wide range of experiences with syndromic surveillance. Participants reported the receipt of data daily or more frequently. Emergency department data were the primary data source; however, other data sources are being integrated into these systems. All health departments routinely monitored data quality. Syndromes of highest priority across the respondents for health events monitoring were influenza-like illness and drug-related syndromes. However, a wide variety of syndromes were reported as priorities across the health departments.

Conclusion:
Overall, syndromic surveillance was relevantly integrated into the public health surveillance infrastructure. The near real-time nature of the data and its flexibility to monitor different types of health-related issues make it especially useful for public health practitioners. Despite these advances, syndromic surveillance capacity, locally and nationally, must continue to evolve and progress should be monitored to ensure that syndromic surveillance systems and data are optimally able to meet jurisdictional needs.
Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study
Authors: Morrison Shane D. , Capitán-Cañadas Fermín , Sánchez-García Anabel , Ludwig David C. , Massie Jonathan P. , Nolan Ian T. , Swanson Marco , Rodríguez-Conesa Marina , Friedrich Jeffrey B. , Cederna Paul S. , Bellinga Raúl J. , Simon Daniel , Capitán Luis , Satterwhite Thomas 
Published: June 2020

Background:
No data exist on the prospective outcomes of facial feminization surgery. This study set out to determine the effects of facial feminization surgery on quality-of-life outcomes for gender-diverse patients.

Methods:
A prospective, international, multicenter, cohort study with adult gender-diverse patients with gender dysphoria was undertaken. Facial feminization outcome score was calculated preoperatively and postoperatively (1-week to 1-month and >6 months). Photogrammetric cephalometries were measured at the same time points. Self-perceived preoperative masculinity and femininity were recorded. Externally rated gender appearance (scale of 1 to 5, with 1 being most feminine) and general aesthetics (scale of 1 to 10, with 10 being very good) for 10 facial feminization surgery patients were compared with those of five cisgender controls. Univariate linear regression analyses were used to predict outcomes from facial feminization surgery.

Results:
Sixty-six consecutive patients were enrolled. Patients noted that their brows, jaws, and chins were the most masculine aspects of their faces (54.5 percent, 33.3 percent, and 30.3 percent, respectively). Median facial feminization outcome score increased from 47.2 preoperatively to 80.6 at 6 months or more postoperatively (p < 0.0001). Mean satisfaction was excellent (3.0 at both 1-month and ≥6-month follow-up; p = 0.46). Cephalometric values were significantly more feminine after surgery. Gender appearance was feminine to very feminine (1.83 ± 0.96) and general aesthetics were good (6.09 ± 2.01) but different from those of cisgender women controls (1.25 ± 0.49 and 7.63 ± 1.82, respectively; p < 0.001 for each).

Conclusion:
Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at 1 month and stable at more than 6 months.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Slowing the Spread and Minimizing the Impact of COVID-19: Lessons from the Past and Recommendations for the Plastic Surgeon
Authors: MacKenzie Ethan L. , Poore Samuel O. 
Published: June 2020

Background:
Coronavirus disease 2019 (COVID-19), a novel coronavirus originating in December of 2019 in Wuhan, People’s Republic of China, has spread rapidly throughout the globe over 3 months. On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. COVID-19 represents a nearly unprecedented threat to both the public health and the durability of our health care systems and will profoundly affect the field of plastic and reconstructive surgery. The objective of this article is to provide a natural history of COVID-19—including virology, epidemiology, and transmission patterns—and a guide for plastic surgeons regarding patient and resource management.

Methods:
The authors reviewed existing literature regarding COVID-19, both primary research and secondary reviews, by means of PubMed queries, and recommendations from relevant professional organizations (e.g., American College of Surgeons and American Society of Plastic Surgeons). The literature and recommendations were summarized to provide a specific guide for plastic surgeons.

Results:
Internationally, over 5.7 million cases and 357,000 deaths from COVID-19 have been reported at the time of writing. No pharmacologic treatments have been identified, but epidemiologic strategies were identified to prevent viral spread, preserve health care resources, and protect patients and surgeons globally. Specific recommendations for plastic and reconstructive surgeons include postponing elective cases and transitioning to telecommunication platforms for patient consultations and education.

Conclusions:
COVID-19 represents a nearly unprecedented threat to the public health and the durability of health care systems in the contemporary era. Although plastic and reconstructive surgery may seem relatively remote from the pandemic in direct patient care and exposure, our field can significantly enhance health care resource management.