bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Simulation to Measure and Improve Pediatric Primary Care Offices Emergency Readiness
Authors: Garrow Amanda L. , Zaveri Pavan , Yuknis Matthew , Abulebda Kamal , Auerbach Marc , Thomas Eileen M. 
Published: June 2020

Introduction
Emergencies in the pediatric primary care office are high-risk, low-frequency events that offices may be ill-prepared to manage. We developed an intervention to improve pediatric primary care office emergency preparedness involving a baseline measurement, a customized report out with action plans for improvement (based on baseline measures), and a plan to repeat measurement at 6 months. This article reports on the baseline measurement.

Methods
This baseline measurement consisted of 2 components: preparedness checklists and in situ simulations. The preparedness checklists were completed in person to measure compliance with the American Academy of Pediatrics Policy Statement: preparation for emergencies in the offices of pediatricians and pediatric primary care providers, in the domains of equipment, supplies, medication, and guidelines. Two in situ simulations, a child in respiratory distress and a child with a seizure, were conducted with the offices' interprofessional teams; performance was scored using checklists.

Results
Baseline measurements were conducted in 12 pediatric offices from October to December 2018. Wide variability was noted for compliance with the American Academy of Pediatrics recommendations (range = 47%–87%) and performance during in situ simulations (range = 43%–100%).

Conclusions
Pediatric primary care office emergency preparedness was found to be variable. Simulation can be used to augment existing measures of emergency preparedness, such as checklists. By using simulation to measure office emergency preparedness, areas of knowledge deficit and latent safety threats were identified and are being addressed through ongoing collaboration.
Comparative Analysis of Laparoscopic Inguinal Hernia Repair in Neonates and Infants
Authors: Walsh Caoimhe M. , Ng Jessica , Saxena Amulya K. 
Published: June 2020

Background:
This study analyzed our cohort of infants (age below 12 mo) who underwent laparoscopic inguinal hernia repair (LIHR), comparing those 3 months and below (corrected premature) to above 3 months (term infants) corrected age at the time of surgery.

Materials and Methods:
Retrospective analysis of a single surgeon and associated trainees’ experience of LIHR in infants below 12 months over a 5-year period (2013-2018) was performed. The operative technique involved a 5-mm scope and 3-mm instruments for herniorrhaphy with 4/0 Prolene purse-string suture. Data collected included patient demographics, prematurity (<37 wk), corrected age and weight at surgery, preoperative hemoglobin level, comorbidities, anesthetic time, major perioperative complications, and inguinal hernia recurrence. A comparison was made between those operated at 3 months and below and above 3 months corrected age. Perioperative issues affecting infants 3 months and below were identified and analyzed. Statistical analysis includes T test and Fisher exact test (P<0.05 significance).

Results:
Eighty infants underwent LIHR (age below 12 mo), of which 67 (84%) were male with a median corrected age of 10.5 (range 2.5 to 44) weeks, the median weight of 5.5 kg (range 2.1 to 10.8). A total of 47 (59%) infants had a unilateral inguinal hernia repair and 33 (41%) had a bilateral repair. The median anesthetic time was significantly greater for infants 3 months and below at 93 (range 61 to 125) minutes, compared with 83 (range 47 to 146) minutes for the above 3 months age group (P=0.001) There were no perioperative complications or mortality. One patient had a recurrence of an inguinal hernia. Low hemoglobin levels, comorbidities, and extreme prematurity required more attention during preoperative assessment and postoperative management.

Conclusions:
Comparable cohorts demonstrated no significant difference in recurrences despite significant differences in weight and median anesthetic time. Preoperative hemoglobin is an important factor that needs to be addressed in infants 3 months and below for scheduling the procedure date (transfusion vs. iron supplementation).
Development of a novel patient focussed symptom severity index for use in assessing and treating inflammatory conditions of the lactating breast: a Delphi study
Authors: Cooper Melinda , Lowe Helen , McArdle Adelle 
Published: June 2020

ABSTRACT

Aim:
To investigate the content and face validity of a patient-reported outcome measure used by Australian physiotherapists in the assessment of inflammatory conditions of the lactating breast.

Methods:
Sixty one experts representing ‘women who previously had inflammatory conditions of the lactating breast’ (48%), ‘clinicians’ (38%) and ‘academics’ (8%) interested in women's health and 7% unidentified participants were invited to complete a three round Delphi study.

Results:
Ninety five percent of participants agreed that overall, the patient-reported outcome measure was appropriate for use in assessing and treating inflammatory conditions of the lactating breast. The item ‘impact’ was added to ensure the appropriate assessment of functional aspects of daily life. The item terminology used in the patient-reported outcome measure was simplified to ‘pain’, ‘redness’, ‘hardness/tightness’, ‘temperature of affected area’, ‘sickness/wellness’ and ‘affected area. A clinician script was developed to ensure the patient-reported outcome measure has utility and consistency regardless of the experience of the women presenting with inflammatory conditions of the lactating breast or the clinician.

Conclusion:
The resultant Breast Inflammatory Symptom Severity Index (BISSI) is a patient-reported outcome measure for use in the diagnosis and monitoring of clinical changes of symptoms associated with inflammatory conditions of the lactating breast including engorgement, blocked ducts and mastitis. It utilizes person-centred language and assesses symptoms considered important to both patient and clinician. The development of the clinician script facilitates utility regardless of the experience of either the woman with the inflammatory condition or the treating clinician.
COVID-19 Hospitalization is More Frequent and Severe in Down Syndrome and Affects Patients a Decade Younger.
Authors: Malle Louise , Gao Cynthia , Bouvier Nicole , Percha Bethany , Bogunovic Dusan 
Published: June 2020

AbstractBackgroundIndividuals with rare disorders, like Down syndrome (DS) are historically understudied. Currently, it is not known how COVID-19 pandemic affects individuals with DS. Herein, we report an analysis of individuals with DS who were hospitalized with COVID-19 in the Mount Sinai Health System in New York City, USA.MethodsIn this retrospective, single-center study of 4,615 patients hospitalized with COVID-19, we analyzed all patients with DS admitted in the Mount Sinai Health System. Hospitalization rates, clinical and outcomes were assessed.FindingsContrary to an expected number of one, we identified six patients with DS. We found that patients with DS are at an 8.9-fold higher risk of hospitalization with COVID-19 when compared to non-DS patients. Hospitalized DS individuals are on average 10 years younger than non-DS patients with COVID-19. Moreover, type 2 diabetes mellitus appears to be an important driver of this susceptibility to COVID-19. Finally, patients with DS have more severe outcomes than controls, and are more likely to progress to sepsis in particular.InterpretationWe demonstrate that individuals with DS represent a higher risk population for COVID-19 compared to the general population and conclude that particular care should be taken for both the prevention and treatment of COVID-19 in these patients.FundingNational Institute of Allergy and Infectious Diseases.Research in contextEvidence before this studyWe searched PubMed and Google Scholar on May 26, 2020, for articles describing the features of patients in Down syndrome infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the search terms “SARS-CoV-2” or “COVID-19” and “Down syndrome” or “Trisomy 21.” We found only one case report describing a cluster of 4 cases of COVID-19 in a healthcare facility for patients with mental retardation.Added value of this studyWe compared the hospitalization rates of DS patients to over 4,500 individuals without DS, and we assessed comorbidities and outcomes of individuals with DS compared to age, race, and sex-matched controls hospitalized with COVID-19. To the best of our knowledge, we provide the first evidence that patients with DS with are at higher risk of hospitalization with COVID-19 and more severe disease progression than non-DS patients.Implications of all the available evidenceWe demonstrate that individuals with DS are a high-risk population for COVID-19 and suggest appropriate measures should be taken for both the prevention and treatment of COVID-19 in these patients.
Accuracy of machine learning-based prediction of medication adherence in clinical research
Authors: Koesmahargyo Vidya , Abbas Anzar , Zhang Li , Guan Lei , Feng Shaolei , Yadav Vijay , Galatzer-Levy Isaac R. 
Published: June 2020

AbstractBackgroundMedication non-adherence represents a significant barrier to treatment efficacy. Remote, real-time measurement of medication dosing can facilitate dynamic prediction of risk for medication non-adherence, which in-turn allows for proactive clinical intervention to optimize health outcomes. We examine the accuracy of dynamic prediction of non-adherence using data from remote real-time measurements of medication dosing.MethodsParticipants across a large set of clinical trials (n = 4,182) were observed via a smartphone application that video records patients taking their prescribed medication. The patients’ primary diagnosis, demographics, and prior indication of observed adherence/non-adherence were utilized to predict (1) adherence rates ≥ 80% across the clinical trial, (2) adherence ≥ 80% for the subsequent week, and (3) adherence the subsequent day using machine learning-based classification models.ResultsEmpirically observed adherence was demonstrated to be the strongest predictor of future adherence/non-adherence. Collectively, the classification models accurately predicted adherence across the trial (AUC = 0.83), the subsequent week (AUC = 0.87) and the subsequent day (AUC = 0.87).ConclusionsReal-time measurement of dosing can be utilized to dynamically predict medication adherence with high accuracy.
Closed microbial communities self-organize to persistently cycle carbon
Authors: de Jesús Astacio Luis Miguel , Prabhakara Kaumudi H. , Li Zeqian , Mickalide Harry , Kuehn Seppe 
Published: June 2020

Nutrient cycling is an emergent property of ecosystems at all scales, from microbial communities to the entire biosphere. Understanding how nutrient cycles emerge from the collective metabolism of ecosystems is a challenging problem. Here we use closed microbial ecosystems (CES), hermetically sealed consortia that sustain nutrient cycles when provided with only light, to learn how microbial communities cycle carbon. A new technique for quantifying carbon exchange shows that CES comprised of an alga and diverse bacteria self-organize to robustly cycle carbon. Comparing a library of CES, we find that carbon cycling does not depend strongly on the taxonomy of the bacteria present. Metabolic profiling reveals functional redundancy across CES: despite strong taxonomic differences, self-organized CES exhibit a conserved set of metabolic capabilities.SummaryClosed microbial communities of algae and bacteria self-organize to robustly cycle carbon via emergent metabolite exchange.
Identifying rare, medically-relevant genetic variation in a diverse population: opportunities and pitfalls
Authors: Bowling Kevin M. , Thompson Michelle L. , Gray David E. , Lawlor James M.J. , Williams Kelly , East Kelly M. , Kelley Whitley V. , Moss Irene P. , Absher Devin M. , Partridge E. Christopher , Hurst Anna C.E. , Edberg Jeffrey C. , Barsh Gregory S. , Korf Bruce R. , Cooper Gregory M. 
Published: June 2020

ABSTRACTPurposeTo evaluate the effectiveness and specificity of population-based genomic screening in Alabama.MethodsThe Alabama Genomic Health Initiative (AGHI) has enrolled and evaluated 5,369 participants for the presence of pathogenic/likely pathogenic (P/LP) variants using the Illumina Global Screening Array (GSA), with validation of all P/LP variants via Sanger sequencing in a CLIA-certified laboratory before return of results.ResultsAmong 131 variants identified by the GSA that were evaluated by Sanger sequencing, 67 (51%) were false positives (FP). For 39 of the 67 FP variants, a benign/likely benign variant was present at or near the targeted P/LP variant. Importantly, African-Americans were significantly enriched for FP variants, likely due to a higher rate of non-targeted alternative alleles close to array-targeted P/LP variants.ConclusionIn AGHI, we have implemented an array-based process to screen for highly penetrant genetic variants in actionable disease genes. We demonstrate the need for clinical validation of array-identified variants in direct-to-consumer or population testing, especially for diverse populations.
Global between-countries variance in SARS-CoV-2 mortality is driven by reported prevalence, age distribution, and case detection rate
Authors: Babačić Haris , Lehtiö Janne , Pernemalm Maria 
Published: June 2020

AbstractObjectiveTo explain the global between-countries variance in number of deaths per million citizens (nDpm) and case fatality rate (CFR) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.DesignSystematic analysis.Data sourcesWorldometer, European Centre for Disease Prevention and Control, United NationsMain outcome measuresThe explanators of nDpm and CFR were mathematically hypothesised and tested on publicly-available data from 88 countries with linear regression models on May 1st 2020. The derived explanators – age-adjusted infection fatality rate (IFRadj) and case detection rate (CDR) – were estimated for each country based on a SARS-CoV-2 model of China. The accuracy and agreement of the models with observed data was assessed with R2 and Bland-Altman plots, respectively. Sensitivity analyses involved removal of outliers and testing the models at five retrospective and four prospective time points.ResultsGlobally, IFRadj estimates varied between countries, ranging from below 0.2% in the youngest nations, to above 1.3% in Portugal, Greece, Italy, and Japan. The median estimated global CDR of SARS-CoV-2 infections on April 16th 2020 was 12.9%, suggesting that most of the countries have a much higher number of cases than reported.At least 93% and up to 99% of the variance in nDpm was explained by reported prevalence expressed as cases per million citizens (nCpm), IFRadj, and CDR. IFRadj and CDR accounted for up to 97% of the variance in CFR, but this model was less reliable than the nDpm model, being sensitive to outliers (R2 as low as 67.5%).ConclusionsThe current differences in SARS-CoV-2 mortality between countries are driven mainly by reported prevalence of infections, age distribution, and CDR. The nDpm might be a more stable estimate than CFR in comparing mortality burden between countries.
A Novel Water-Soluble Photosensitizer for Photodynamic Inactivation of Gram-Positive Bacteria
Authors: Yang Zihuayuan , Qiao Ying , Li Junying , Wu Fu-Gen , Lin Fengming 
Published: June 2020

AbstractAntimicrobial photodynamic therapy (APDT) is a promising alternative to traditional antibiotics for bacterial infections, which inactivates a broad spectrum of bacteria. However, it has some disadvantages including poor water solubility and easy aggregation of hydrophobic photosensitizers (PS), and poor tissue penetration and cytotoxicity when using UV as the light source, leading to undesired photodynamic therapy efficacy. Herein, we develop a novel water-soluble natural PS (sorbicillinoids) obtained by microbial fermentation using recombinant filamentous fungusTrichoderma reesei(T.reesei). Sorbicillinoids could effectively generate singlet oxygen (1O2) under ultraviolet (UV) light irradiation, and ultimately display photoinactivation activity on Gram-positive bacteria, but not Gram-negative ones.Staphylococcus aureus(S.aureus) treated with sorbicillinoids and UV light displayed high levels of intracellular reactive oxygen species (ROS), notable DNA photocleavage, and compromised cell semi-permeability without overt cell membrane disruption. Moreover, the dark toxicity, phototoxicity or hemolysis activity of sorbicillinoids is negligible, showing its excellent biocompatibility. Therefore, sorbicillinoids, a type of secondary metabolite from fungus, has a promising future as a new PS for APDT using nontoxic dose of UV light irradiation.ImportanceIt is of great value to develop novel PSs for APDT to enhance its efficacy for the reason that many traditional PSs have disadvantages like low water solubility and poor biocompatibility. In this study, we develop a novel water-soluble natural PS - sorbicillinoids obtained by microbial fermentation using T. reesei. Sorbicillinoids could effectively generate singlet oxygen under UV light irradiation, and ultimately display photoinactivation activity on Gram-positive bacteria, but not Gram-negative ones. More importantly, UV light can generally only be used to inactivate bacteria on the surface due to its weak penetration. However, it can penetrate deep into the solution and inactivate bacteria in the presence of sorbicillinoids. Therefore, sorbicillinoids, a type of secondary metabolite from fungus, has a promising future as a new PS for APDT using nontoxic dose of UV light irradiation.
A qualitative exploration of patient flow in a developing Caribbean emergency department
Authors: De Freitas Loren , Goodacre Steve , O’Hara Rachel , Thokala Praveen , Hariharan Seetharaman 
Published: June 2020

AbstractObjectivesEmergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This is important for developing countries where flow concerns are compounded by resource constraints. The Caribbean is one region with developing emergency care systems and limited research in the area. This study aimed to explore the patient flow process in an emergency department in Trinidad and Tobago, identifying organizational factors influencing patient flow.MethodsMultiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyze the data.SettingThe study was conducted at a major tertiary level emergency department in Trinidad and Tobago.ParticipantsPatient and staff journeys in the emergency department were observed.ResultsSix broad categories were identified-1) ED organizational work processes, 2) ED design and layout, 3) material resources, 4) nursing staff levels, roles, skill mix and use 5) non-clinical ED staff and 6) external clinical and non-clinical departments. The study findings were combined with existing literature to produce a model of factors influencing ED patient flow. Barriers and facilitators to patient flow were highlighted.ConclusionThe knowledge gained may be used to strengthen the emergency care system in the local context. The model of ED patient flow may be used to systematically examine factors influencing patient flow, informing policy and practice. However, the study findings should be validated in other settings.Article summaryStrengths and limitations of this studyPrevious studies have been predominantly conducted in developed countries using quantitative methodsStrengthening emergency care systems is becoming a priority in developing countries but the Caribbean remains an under-represented region.This study explores ED patient flow in a developing Caribbean country using a multi-method qualitative design, primarily observational process mappingSingle observer used to collect dataSinge site may produce context specific findings
Improved and Simplified Diagnosis of Covid-19 using TE Extraction from Dry Swabs
Authors: Kiran Uday , Gokulan C. G. , Kuncha Santosh Kumar , Vedagiri Dhiviya , Tallapaka Karthik Bharadwaj , Mishra Rakesh K , Harshan Krishnan Harinivas 
Published: June 2020

ABSTRACTRigorous testing is the way forward to fight the Covid-19 pandemic. Here we show that the currently used and most reliable RT-PCR based SARS-CoV-2 procedure can be further simplified to make it faster, safer and economical by bypassing the RNA isolation step. The modified method is not only fast and convenient but also at par with the traditional method in terms of accuracy, and therefore, can be used for mass screening. Our method takes about half the time and is cheaper by about 40% compared to current most widely used method. We also provide a variant of the new method that increases the efficiency of detection by about 20% compared to the currently used method. Taken together, we demonstrate a more effective and reliable method of SARS-CoV-2 detection.
Covid-19 pandemic and the unprecedented mobilisation of scholarly efforts prompted by a health crisis: Scientometric comparisons across SARS, MERS and 2019-nCov literature
Authors: Haghani Milad , Bliemer Michiel C. J. 
Published: June 2020

AbstractDuring the current century, each major coronavirus outbreak has triggered a quick and immediate surge of academic publications on this topic. The spike in research publications following the 2019 Novel Coronavirus (Covid-19) outbreak, however, has been like no other. The global crisis caused by the Covid-19 pandemic has mobilised scientific efforts in an unprecedented way. In less than five months, more than 12,000 research items have been indexed while the number increasing every day. With the crisis affecting all aspects of life, research on Covid-19 seems to have become a focal point of interest across many academic disciplines. Here, scientometric aspects of the Covid-19 literature are analysed and contrasted with those of the two previous major Coronavirus diseases, i.e. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The focus is on the co-occurrence of key-terms, bibliographic coupling and citation relations of journals and collaborations between countries. Certain recurring patterns across all three literatures were discovered. All three outbreaks have commonly generated three distinct and major cohort of studies: (i) studies linked to the public health response and epidemic control, (ii) studies associated with the chemical constitution of the virus and (iii) studies related to treatment, vaccine and clinical care. While studies affiliated with the category (i) seem to have been the first to emerge, they overall received least numbers of citations compared to those of the two other categories. Covid-19 studies seem to have been distributed across a broader variety of journals and subject areas. Clear links are observed between the geographical origins of each outbreak or the local geographical severity of each outbreak and the magnitude of research originated from regions. Covid-19 studies also display the involvement of authors from a broader variety of countries compared to SARS and MRS.