bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decrease in sleep depth is associated with higher cerebrospinal fluid neurofilament light levels in patients with Alzheimer’s disease
Authors: Targa Adriano , Dakterzada Faride , Benítez Ivan , López Ricard , Pujol Montserrat , Dalmases Mireia , Arias Alfonso , Sánchez-de-la-Torre Manuel , Zetterberg Henrik , Blennow Kaj , Pamplona Reinald , Jové Mariona , Barbé Ferran , Piñol-Ripoll Gerard 
Published: August 2020

Abstract

Study Objectives
The majority of studies investigating the association between sleep and Alzheimer’s disease (AD) biomarkers have been performed in healthy participants. Our objective was to investigate the association between sleep and several biomarkers that reflect distinct aspects of AD physiopathology.

Methods
The cohort included 104 individuals with mild-moderate AD. The participants were submitted to one-night polysomnography, and cerebrospinal fluid was collected in the following morning to measure the selected biomarkers associated with amyloid deposition, tau pathology, neurodegeneration, axonal damage, synaptic integrity, neuroinflammation, and oxidative damage.

Results
There was a positive correlation between neurofilament light (NF-L) and the time spent in stage 1 of non-rapid eyes movement (NREM) (N1) sleep and a negative correlation between this marker and the time spent in stage 3 of NREM (N3) sleep. Accordingly, we observed that deep sleep was associated with lower levels of NF-L, whereas light sleep increased the probability of having higher levels of this marker. Furthermore, chitinase-3-like-1 (YKL-40) was negatively correlated with sleep efficiency, the time spent in stage 2 of NREM (N2) sleep, and the time spent in N3 sleep. Conversely, there was a positive correlation between N3 sleep and the oxidative protein damage markers N-ε-(carboxyethyl)lysine and N-ε-(malondialdehyde)lysine.

Conclusions
There were significant correlations between sleep parameters and AD biomarkers related to axonal damage and neuroinflammation, such as NF-L and YKL-40. A lack of deep sleep was associated with higher levels of NF-L. This highlights a potential role for NF-L as a biomarker of sleep disruption in patients with mild-moderate AD in addition to its role in predicting neurodegeneration and cognitive decline.
Advancing implementation frameworks with a mixed methods case study in child behavioral health
Authors: Barwick Melanie , Barac Raluca , Kimber Melissa , Akrong Lindsay , Johnson Sabine N , Cunningham Charles E , Bennett Kathryn , Ashbourne Graham , Godden Tim 
Published: August 2020

Abstract
Despite a growing policy push for the provision of services based on evidence, evidence-based treatments for children and youth with mental health challenges have poor uptake, yielding limited benefit. With a view to improving implementation in child behavioral health, we investigated a complementary implementation approach informed by three implementation frameworks in the context of implementing motivational interviewing in four child and youth behavioral health agencies: the Active Implementation Frameworks (AIF) (process), the Consolidated Framework for Implementation Research (factors), and the Implementation Outcomes Framework (evaluation). The study design was mixed methods with embedded interrupted time series and motivational interviewing (MI) fidelity was the primary outcome. Focus groups and field notes informed perspectives on the implementation approach, and a questionnaire explored the salience of Consolidated Framework for Implementation Research (CFIR) factors. Findings validate the process guidance provided by the AIF and highlight CIFR factors related to implementation success. Novel CFIR factors, not elsewhere reported in the literature, are identified that could potentially extend the framework if validated in future research. Introducing fidelity measurement in practice proved challenging and was not sustained beyond the study. A complementary implementation approach was successful in implementing MI in child behavioral health agencies. In contrast with the typical train and hope approach to implementation, practice change did not occur immediately post-training but emerged over a 7 month period of consultation and practice following a discrete interactive training period. The saliency of CFIR constructs aligned with findings from studies conducted in other contexts, demonstrating external validity and highlighting common factors that can focus planning and measurement.
Community delivery of brief therapy for depressed older adults impacted by Hurricane Sandy
Authors: Sirey Jo Anne , Raue Patrick J , Solomonov Nili , Scher Clara , Chalfin Alexandra , Zanotti Paula , Berman Jacquelin , Alexopoulos George S 
Published: August 2020

AbstractOlder adults frequently under-report depressive symptoms and often fail to access services after a disaster. To address unmet mental health needs, we developed a service delivery program (SMART-MH) that combines outreach, assessment, and therapy and implemented it in New York City after Hurricane Sandy. This study aimed to examine the feasibility, effectiveness, and patients’ engagement of our brief psychotherapy (“Engage”). We predicted that Engage would result in reductions of depression, and that the benefits would be comparable to those of a historical comparison group who received Engage in a controlled experimental setting. A total of 2,831 adults (age ≥ 60) impacted by Hurricane Sandy were screened for depression. Assessments and therapy were conducted in English, Spanish, Cantonese, and Russian. Depressed individuals (PHQ-9 ≥ 10) who were not in treatment were offered Engage therapy in their native language at local senior center/nutrition sites. Twelve percent of the participants reported depression (N = 333). Of these 333 participants, 201 (60%) were not receiving treatment and 143 agreed to receive Engage therapy. Linear mixed-effects model showed that depression severity decreased significantly over time. More than two thirds had a five-point reduction in PHQ-9 scores and post-treatment scores ≤9. Post-hoc comparison of standardized slopes of change found patterns of depression reductions equivalent to Engage provided in a controlled setting. Partnerships to integrate mental health care into community settings can increase detection of mental-health needs and access to services in patients’ native language. Brief reward exposure-based psychotherapy delivered in the community can provide comparable benefits to those achieved in research settings.
Enhancing the scalability of the collaborative care model for depression using mobile technology
Authors: Carleton Kelly E , Patel Urvashi B , Stein Dana , Mou David , Mallow Alissa , Blackmore Michelle A 
Published: August 2020

Abstract
The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p &lt; .001) and shorter time to follow up compared with the standard CoCM sample (mean = 11 vs. 19 days, p &lt; .001). App-augmented CoCM patients had clinical outcomes similar to the standard CoCM group (47% vs. 46% with ≥50% depression improvement or score &lt;10), despite app-augmented patients having more prior depression treatment episodes. Further, the app-augmented group with greater app engagement demonstrated increased behavioral health appointment compliance, including more completed appointments and fewer no shows, and greater depression symptom improvement than those with less app engagement. App-augmented CoCM may improve patient engagement in treatment and provide opportunities to implement key CoCM elements without overburdening practice resources. CoCM sustainability and scalability in primary care may be enhanced by using this technology.
Integration of an evidence-based tobacco cessation program into a substance use disorders program to enhance equity of treatment access for northern, rural, and remote communities
Authors: Smith Patricia M , Seamark Lisa D , Beck Katie 
Published: August 2020

Abstract
Integrating tobacco cessation interventions into substance use disorder (SUD) programs is recommended, yet few are implemented into practice. This translational research implementation study was designed to integrate an evidence-based tobacco cessation intervention into a 2-week hospital outpatient SUD program that served a rural municipality and 33 remote Indigenous communities. Objectives included determining tobacco use prevalence, intervention uptake, and staffing resources required for intervention delivery.
A series of 1-hr tobacco and health/well-being interactive education and behavior-change groups were developed for the SUD program to create a central access point to offer an evidence-based, intensive tobacco cessation intervention that included an initial counseling/planning session and nine post-SUD treatment follow-ups (weekly month 1; biweekly month 2; and 3, 6, and 12 months). Group sign-in data included age, gender, community, tobacco use, and interest in receiving tobacco cessation help.
Thirty-two groups (April 2018 to February 2019) were attended by 105 people from 22 communities—56% were female, mean age = 30.9 (±7.3; 93% &lt;45 years), 86% smoked, and 38% enrolled in the intensive tobacco cessation intervention. The age-standardized tobacco use ratio was two times higher than would be expected in the general rural population in the region. Average staff time to provide the intervention was 1.5–2.5 hr/week.
Results showed that a Healthy Living group integrated into SUD programming provided a forum for tobacco education, behavior-change skills development, and access to an intensive tobacco cessation intervention for which enrollment was high yet the intervention could be delivered with only a few staff hours a week.
Older and Less Deviant? The Paths Through Emotional Labor and Organizational Cynicism
Authors: Peng Yisheng , Ma Jie , Zhang Wenqin , Jex Steve 
Published: August 2020

AbstractPrevious research suggests that workplace deviance, one of the most pressing problems for today’s organizations, tends to decline as employees age. However, little is known about the mechanisms underlying the age-deviance relationship. Using aggregated 5-day daily diary data in a sample of 158 Chinese full-time employees, the present study examined age differences in the use of emotional labor strategies (i.e., surface acting and deep acting) and how these age differences relate to employee workplace deviance via organizational cynicism. Results found that age was negatively related to the use of both surface acting and deep acting. Emotional labor strategies (i.e., surface acting and deep acting) and organizational cynicism serially mediated the relationship between employee age and workplace deviance. The current research deepens our understanding of the process by which employee age relates to workplace deviance. This study also has implications for the management of an increasingly age-diverse workforce and can guide future interventions aiming at reducing workplace deviance, an issue of increasing concern to both organizations and society in general.
10Religion and Representation
Authors: Rzepa Joanna 
Published: August 2020

Abstract
This review is divided into three sections: 1. Jeffrey T. Zalar, Reading and Rebellion in Catholic Germany, 1770–1914; 2. Edward Baring, Converts to the Real: Catholicism and the Making of Continental Philosophy; 3. ‘Translation and Religion: Crafting Regimes of Identity’, a thematic issue of Religion edited by Hephzibah Israel and Matthias Frenz. Taken together, these works provide an overview of approaches that demonstrate the value of interdisciplinary research into religion and representation. Drawing on the disciplines of social, political, and cultural history, literary studies, book history, theology, religious studies, translation studies, and postcolonial studies, they highlight the importance of research that contextualizes the relationship between religion and representation, bringing attention to its historically overlooked aspects.
“I Was Worried About the Patient, but I Wasn’t Feeling Worried”: How Physicians Judge Their Comfort in Settings of Uncertainty
Authors: Ilgen Jonathan S. , Bowen Judith L. , de Bruin Anique B.H. , Regehr Glenn , Teunissen Pim W. 
Published: August 2020

Purpose
Clinical educators often raise concerns that learners are not comfortable with uncertainty in clinical work, yet existing literature provides little insight into practicing clinicians’ experiences of comfort when navigating the complex, ill-defined problems pervasive in practice. Exploring clinicians’ comfort as they identify and manage uncertainty in practice could help us better support learners through their discomfort.

Method
Between December 2018 and April 2019, the authors employed a constructivist grounded theory approach to explore experiences of uncertainty in emergency medicine faculty. The authors used a critical incident technique to elicit narratives about decision making immediately following participants’ clinical shifts, exploring how they experienced uncertainty and made real-time judgments regarding their comfort to manage a given problem. Two investigators analyzed the transcripts, coding data line-by-line using constant comparative analysis to organize narratives into focused codes. These codes informed the development of conceptual categories that formed a framework for understanding comfort with uncertainty.

Results
Participants identified multiple forms of uncertainty, organized around their understanding of the problems they were facing and the potential actions they could take. When discussing their comfort in these situations, they described a fluid, actively negotiated state. This state was informed by their efforts to project forward and imagine how a problem might evolve, with boundary conditions signaling the borders of their expertise. It was also informed by ongoing monitoring activities pertaining to patients, their own metacognitions, and their environment.

Conclusions
The authors’ findings offer nuances to current notions of comfort with uncertainty. Uncertainty involved clinical, environmental, and social aspects, and comfort dynamically evolved through iterative cycles of forward planning and monitoring.
Reported Pediatrics Milestones (Mostly) Measure Program, Not Learner Performance
Authors: Hu Kimberly , Hicks Patricia J. , Margolis Melissa , Carraccio Carol , Osta Amanda , Winward Marcia L. , Schwartz Alan 
Published: August 2020

Purpose
Semiannually, U.S. pediatrics residency programs report resident milestone levels to the Accreditation Council for Graduate Medical Education (ACGME). The Pediatrics Milestones Assessment Collaborative (PMAC, consisting of the National Board of Medical Examiners, American Board of Pediatrics, and Association of Pediatric Program Directors) developed workplace-based assessments of 2 inferences: readiness to serve as an intern with a supervisor present (D1) and readiness to care for patients with a supervisor nearby in the pediatric inpatient setting (D2). The authors compared learner and program variance in PMAC scores with ACGME milestones.

Method
The authors examined sources of variance in PMAC scores and milestones between November 2015 and May 2017 of 181 interns at 8 U.S. pediatrics residency programs using random effects models with program, competency, learner, and program × competency components.

Results
Program-related milestone variance was substantial (54% D1, 68% D2), both in comparison to learner milestone variance (22% D1, 14% D2) and program variance in the PMAC scores (12% D1, 10% D2). In contrast, learner variance represented 44% (D1) or 26% (D2) of variance in PMAC scores. Within programs, PMAC scores were positively correlated with milestones for all but one competency.

Conclusions
PMAC assessments provided scores with little program-specific variance and were more sensitive to differences in learners within programs compared with milestones. Milestones reflected greater differences by program than by learner. This may represent program-based differences in intern performance or in use of milestones as a reporting scale. Comparing individual learner milestones without adjusting for programs is problematic.
Emerging From the COVID-19 Crisis With a Stronger Health Care Workforce
Authors: Dow Alan W. , DiPiro Joseph T. , Giddens Jean , Buckley Peter , Santen Sally A. 
Published: August 2020

The COVID-19 pandemic has highlighted the limitations of the current health care workforce. As health care workers across the globe have been overwhelmed by the crisis, oversight entities and training programs have sought to loosen regulations to support ongoing care. Notably, however, workforce challenges preceded the current crisis. Now may be the time to address these underlying workforce challenges and emerge from the COVID-19 pandemic with a stronger health care workforce.
Building upon historical exemplars in the context of the current crisis, the authors of this Perspective provide a roadmap to rapidly and safely increase the workforce for COVID-19 and beyond. The authors recommend the following: (1) a comprehensive approach to guide health care workforce development, (2) streamlining transitions to the next level of practice, (3) reciprocity among state licensing boards or national licensure, (4) payment reform to support a strengthened health care workforce, and (5) efforts by employers to ensure the ongoing safety and competence of the bolstered workforce. These steps require urgent collaboration among stakeholders commensurate with the acuity of the pandemic. Implemented together, these actions could address not only the novel challenges presented by COVID-19 but also the underlying inadequacies of the health care workforce that must be remedied to create a healthier society.
Intraoperative hypotension and neurological outcomes
Authors: Yu Qiong , Qi Jiangtao , Wang Yingwei 
Published: August 2020

Purpose of review
Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes.

Recent findings
Although both absolute and relative blood pressure (BP) thresholds, with or without a cumulative period, have been used in collective clinical studies, no definitive threshold of IOH has been established for neurological complications, including perioperative stroke, postoperative cognitive disorder and delirium. The CBF is jointly modulated by multiple pressure processes (i.e. cerebral pressure autoregulation) and nonpressure processes, including patient, surgical and anaesthesia-related confounding factors. The confounding factors and variability in cerebral pressure autoregulation might impede evaluating the effect of IOH on the neurological outcomes. Furthermore, the majority of the evidence presented in this review are cohort studies, which are weak in demonstrating a cause--effect relationship between IOH and neurological complications. The maintenance of target BP based on the monitoring of regional cerebral oxygen saturation (rScO2) or cerebral pressure autoregulation seems to be associated with the decreased incidence of postoperative neurological complications.

Summary
Despite the lack of a known threshold value, IOH is a modifiable risk factor targeted to improve neurological outcomes. Ideal BP management is recommended in order to maintain target BP based on the monitoring of rScO2 or cerebral pressure autoregulation.
Accuracy of Patient-Specific Meshes as a Reconstruction of Orbital Floor Blow-Out Fractures
Authors: Kormi Eeva , Männistö Ville , Lusila Niilo , Naukkarinen Hanna , Suojanen Juho 
Published: August 2020

Abstract
Computer-aided design and manufacturing (CAD-CAM)-based techniques are developing fast in facial reconstruction and osteosynthesis. Patient-specific implant (PSI) production is already sufficiently fast for everyday use and can be utilized even for primary trauma surgery such as orbital floor reconstruction after blowout fracture. Purpose of our study is to retrospectively analyze the 3-dimensional (3D) success of PSI reconstructions of orbital floor fractures in our unit. The authors analyzed retrospectively a 1-year cohort (n = 8) of orbital floor blow-out fractures that have been reconstructed using virtual surgical plan and CAD-CAM PSI. Postoperative computed topographies of patients were compared to their original virtual surgical plans. The 3D outcome and fitting of the PSI was good in all patients. Mean error for 3D position of the PSI was 1.3 to 1.8 mm (range 0.4 to 4.8 mm) and postoperative orbital volume was successfully restored in all of the patients. Use of CAD-CAM PSI for reconstruction of orbital floor blow out fracture is reliable method and thus recommended.
A Rare Cause of Hemoptysis: Hypopharyngeal Leech
Authors: Aslan Mehmet 
Published: August 2020

Abstract
A 58-year-old male patient was admitted to the Otorhinolaryngology department with acute hemoptysis. In his history, it was understood that he drank natural water 2 days ago. The patient had hemoptysis, which occurred with spitting. The patient had difficulty swallowing and discomfort when swallowing. Endoscopic examination revealed a blackish live foreign object in the hypopharynx with right local posterior hypopharyngeal oozing. Hypopharyngeal leech was suspected and removed immediately using forceps. After the leech was removed, the bleeding stopped immediately and the patient started swallowing and breathing comfortably. Pharyngeal leeches should be included in the differential diagnosis of patients with hemoptysis, especially in patients with a history of drinking unfiltered water from sources where aquatic leeches are commonly found.
Reconstruction of a Hemirhinectomy Defect Using a Three-Dimensional Printed Custom Soft Tissue Cutting Guide
Authors: Brower Jonathan P. , Crozier Joseph W. , McIntire Damon R. T. , Boyajian Michael K. , Woo Albert S. 
Published: August 2020

Abstract
The 3-stage paramedian forehead flap is the gold standard for subtotal and complete nasal defects, but significant surgeon artistry and experience are required to achieve good, consistent results. The authors describe the use of virtual surgical planning and three-dimensional printing to create a patient-specific soft tissue cutting guide for the design of a forehead flap in the reconstruction of a hemirhinectomy defect. Application of this technology to these challenging reconstructive scenarios promises to improve accessibility and consistency of results.