bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Physicians' Physical Activity Prescription on Indicators of Health Service Quality
Authors: Asiamah Nestor , Kouveliotis Kyriakos , Opoku Emmanuel 
Published: August 2020

ABSTRACT

Introduction
Many researchers are of the opinion that the incorporation of physical activity prescription (PAP) into healthcare is a move that can add value to healthcare, but there are others who think this move would rather disrupt clinical practice. This study, therefore, examined the influence of physicians' PAP (PPAP) on healthcare quality indicators.

Methods
The study adopted a correlational approach and was performed at a primary care facility. Participants were 605 patients in wards and the outpatient department of a district healthcare facility. A self-reported questionnaire was used to gather data. Structural equation modeling was used to present findings.

Results
The study found that PPAP has a positive influence on care quality (β = 0.4, critical ratio = 10.59, and p = .000), patient satisfaction, and patient loyalty. Physical activity prescription also has a positive indirect influence on patient loyalty through patient satisfaction.

Conclusions:
Physicians' physical activity prescription in healthcare can improve healthcare quality indicators. A key implication of our results is that the incorporation of PPAP into healthcare could be in harmony with the key mission of hospitals. Physical activity prescription in healthcare could be a way to satisfy and retain patients.
Loperamide Abuse and Its Sequelae
Authors: Strzyzewski Lauren , Key Phillip , Jones Prentiss , Prahlow Joseph A. 
Published: August 2020

Introduction
Loperamide is an opioid available over the counter and in prescription form. Loperamide functions as a μ-agonist within the enteric nervous system to slow intestinal motility. Its antidiarrheal properties and primarily peripheral activity make loperamide an important tool in the management of inflammatory bowel disease.

Case Report
A 42-year-old man was found unconscious in cardiac arrest, and emergency medical personnel restored normal sinus rhythm. Family reported complaints of abdominal pain and that he “went through a lot” of loperamide. In the emergency department, the patient exhibited symptoms consistent with an opioid overdose. Mental status improved after administration of naloxone, an opioid antagonist. An electrocardiogram revealed a prolonged QTc interval, which progressed into Torsades de Pointes rhythm during admission. The patient succumbed from hypoxic brain injury, and there was evidence of acute pancreatitis at autopsy. Loperamide and desmethylloperamide (loperamide metabolite) were detected in blood samples. Cause of death was ruled loperamide toxicity.

Discussion
Because of reduced central nervous system activity and associated euphoria at therapeutic doses, loperamide abuse is rarely reported. This case demonstrates that an overdose on loperamide can occur in patients seeking symptom alleviation, and may mimic the presentation of opioid overdose.
Traumatic Decapitation of the Fetus During Birth
Authors: Vojtíšek Tomáš , Pohlová Kučerová Štěpánka , Duchaňová Svatava , Krajsa Jan , Hejna Petr 
Published: August 2020

Abstract
Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few days. Permanent effects or fatal outcomes occur infrequently. We report an unusual case of intrapartum complete fetal decapitation. The labor was complicated by shoulder dystocia, with resultant repeated mechanical trauma to the fetal neck and, finally, decapitation. The tragic results of biological processes in human organisms do not automatically confirm medical malpractice. However, there may be grave ethical and forensic outcomes.
Coral evolutionary responses to microbial symbioses
Authors: van Oppen Madeleine J. H. , Medina Mónica 
Published: August 2020

This review explores how microbial symbioses may have influenced and continue to influence the evolution of reef-building corals (Cnidaria; Scleractinia). The coral holobiont comprises a diverse microbiome including dinoflagellate algae (Dinophyceae; Symbiodiniaceae), bacteria, archaea, fungi and viruses, but here we focus on the Symbiodiniaceae as knowledge of the impact of other microbial symbionts on coral evolution is scant. Symbiosis with Symbiodiniaceae has extended the coral's metabolic capacity through metabolic handoffs and horizontal gene transfer (HGT) and has contributed to the ecological success of these iconic organisms. It necessitated the prior existence or the evolution of a series of adaptations of the host to attract and select the right symbionts, to provide them with a suitable environment and to remove disfunctional symbionts. Signatures of microbial symbiosis in the coral genome include HGT from Symbiodiniaceae and bacteria, gene family expansions, and a broad repertoire of oxidative stress response and innate immunity genes. Symbiosis with Symbiodiniaceae has permitted corals to occupy oligotrophic waters as the algae provide most corals with the majority of their nutrition. However, the coral–Symbiodiniaceae symbiosis is sensitive to climate warming, which disrupts this intimate relationship, causing coral bleaching, mortality and a worldwide decline of coral reefs.This article is part of the theme issue ‘The role of the microbiome in host evolution’.
In the beginning: egg–microbe interactions and consequences for animal hosts
Authors: Nyholm Spencer V. 
Published: August 2020

Microorganisms are associated with the eggs of many animals. For some hosts, the egg serves as the ideal environment for the vertical transmission of beneficial symbionts between generations, while some bacteria use the egg to parasitize their hosts. In a number of animal groups, egg microbiomes often perform other essential functions. The eggs of aquatic and some terrestrial animals are especially susceptible to fouling and disease since they are exposed to high densities of microorganisms. To overcome this challenge, some hosts form beneficial associations with microorganisms, directly incorporating microbes and/or microbial products on or in their eggs to inhibit pathogens and biofouling. Other functional roles for egg-associated microbiomes are hypothesized to involve oxygen and nutrient acquisition. Although some egg-associated microbiomes are correlated with increased host fitness and are essential for successful development, the mechanisms that lead to such outcomes are often not well understood. This review article will discuss different functions of egg microbiomes and how these associations have influenced the biology and evolution of animal hosts.This article is part of the theme issue ‘The role of the microbiome in host evolution’.
Microbial control of host gene regulation and the evolution of host–microbiome interactions in primates
Authors: Grieneisen Laura , Muehlbauer Amanda L. , Blekhman Ran 
Published: August 2020

Recent comparative studies have found evidence consistent with the action of natural selection on gene regulation across primate species. Other recent work has shown that the microbiome can regulate host gene expression in a wide range of relevant tissues, leading to downstream effects on immunity, metabolism and other biological systems in the host. In primates, even closely related host species can have large differences in microbiome composition. One potential consequence of these differences is that host species-specific microbial traits could lead to differences in gene expression that influence primate physiology and adaptation to local environments. Here, we will discuss and integrate recent findings from primate comparative genomics and microbiome research, and explore the notion that the microbiome can influence host evolutionary dynamics by affecting gene regulation across primate host species.
This article is part of the theme issue ‘The role of the microbiome in host evolution’.
The study of host–microbiome (co)evolution across levels of selection
Authors: Koskella Britt , Bergelson Joy 
Published: August 2020

Microorganismal diversity can be explained in large part by selection imposed from both the abiotic and biotic environments, including—in the case of host-associated microbiomes—interactions with eukaryotes. As such, the diversity of host-associated microbiomes can be usefully studied across a variety of scales: within a single host over time, among host genotypes within a population, between populations and among host species. A plethora of recent studies across these scales and across diverse systems are: (i) exemplifying the importance of the host genetics in shaping microbiome composition; (ii) uncovering the role of the microbiome in shaping key host phenotypes; and (iii) highlighting the dynamic nature of the microbiome. They have also raised a critical question: do these complex associations fit within our existing understanding of evolution and coevolution, or do these often intimate and seemingly cross-generational interactions follow novel evolutionary rules from those previously identified? Herein, we describe the known importance of (co)evolution in host–microbiome systems, placing the existing data within extant frameworks that have been developed over decades of study, and ask whether there are unique properties of host–microbiome systems that require a paradigm shift. By examining when and how selection can act on the host and its microbiome as a unit (termed, the holobiont), we find that the existing conceptual framework, which focuses on individuals, as well as interactions among individuals and groups, is generally well suited for understanding (co)evolutionary change in these intimate assemblages.
This article is part of the theme issue ‘The role of the microbiome in host evolution’.
Time to negative PCR from symptom onset in COVID-19 patients on Hydroxychloroquine and Azithromycin - A real-world experience
Authors: Saleemi Sarfraz , Alrajhi Abdulrahman , Alhajji Mohammed , Alfattani Areej , Albaiz Faisal 
Published: August 2020

ABSTRACTBackgroundThe role of hydroxychloroquine (HCQ) and azithromycin in the treatment of COVID-19 and its effect on SARS-CoV-2 viral clearance is not known.MethodsThis is a retrospective observational study to assess the effect of HCQ and Azithromycin on duration from symptom onset to negative SARS-CoV-2 PCR using nasopharyngeal swab in hospitalized patient with COVID-19. Eighty-five patients were included in the study, 65 in HCQ (Hydroxychloroquine + Azithromycin) and 20 in non-HCQ group. Measurement of duration from symptom onset to negative PCR and effect of gender, age and disease severity on time to viral clearance was measured.ResultsMedian time to negative PCR in HCQ group was 23 days (IQR: 9, Mean 24+8, N=65) compared with non-HCQ group, 19 days (IQR: 8, Mean 18±6, N=20), (p <0.05). Forty-one (63%) patients in HCQ group and all patients (100%) in non-HCQ group had mild disease. Multivariate regression model (F=6.8, P<0.002, R2=0.20) shows that being in HCQ group would delay the time to negative PCR by 7 days (95%CI: 2-12) and with every year increase in the age, the time to negative PCR would be delayed by 0.12 days (95%CI: 0.017-0.22). Among HCQ sub-groups, gender and disease severity had no effect on duration (p 0.142 and 0.156 respectively) but older patients ≥60 year had longer duration compared to patients <60 year of age although p value did not reach significance (p 0.073). Median time to negative PCR in mild- HCQ group (23 days, IQR: 9, Mean 23+8, N=41) was longer when compared with non-HCQ group (p <0.05). On day 28, all patients in non-HCQ group had negative PCR while only 50/65 (77%) were negative in HCQ group.ConclusionHydroxychloroquine (HCQ) and azithromycin delay SARS-CoV-2 virus clearance in hospitalized patients with COVID-19 and it is correlated with older age. Larger studies are needed to confirm this finding.
Indirect Impact of the COVID-19 Pandemic on Activity and Outcomes of Transcatheter and Surgical Treatment of Severe Aortic Stenosis in England
Authors: Martin Glen P. , Curzen Nick , Goodwin Andrew T. , Nolan James , Balacumaraswami Lognathen , Ludman Peter , Kontopantelis Evangelos , Wu Jianhua , Gale Chris , de Belder Mark A , Mamas Mamas A. 
Published: August 2020

AbstractBackgroundAortic stenosis requires timely treatment with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). This study aimed to investigate the indirect impact of COVID-19 on national SAVR and TAVR activity and outcomes.MethodsThe UK TAVR Registry and the National Adult Cardiac Surgery Audit were used to identify all TAVR and SAVR procedures in England, between January 2017 and June 2020. The number of isolated AVR, AVR+coronary artery bypass graft (CABG) surgery, AVR+other surgery and TAVR procedures per month was calculated. Separate negative binomial regression models were fit to monthly procedural counts, with functions of time as covariates, to estimate the expected change in activity during COVID-19.ResultsWe included 13376 TAVR cases, 12328 isolated AVR cases, 7829 AVR+CABG cases, and 6014 AVR+Other cases. Prior to March 2020 (UK lockdown), monthly TAVR activity was rising, with a slight decrease in SAVR activity during 2019. We observed a rapid and significant drop in TAVR and SAVR activity during the COVID-19 pandemic, especially for elective cases. Cumulatively, over the period March to June 2020, we estimated an expected 2294 (95% CI 1872, 2716) cases of severe aortic stenosis who have not received treatment.ConclusionThis study has demonstrated a significant decrease in TAVR and SAVR activity in England following the COVID-19 outbreak. This situation should be monitored closely, to ensure that monthly activity rapidly returns to expected levels. There is potential for significant backlog in the near-to-medium term, and potential for increased mortality in this population.
Decoding distinctive features of plasma extracellular vesicles in amyotrophic lateral sclerosis
Authors: Pasetto Laura , Callegaro Stefano , Corbelli Alessandro , Fiordaliso Fabio , Ferrara Deborah , Brunelli Laura , Sestito Giovanna , Pastorelli Roberta , Bianchi Elisa , Cretich Marina , Chiari Marcella , Potrich Cristina , Moglia Cristina , Corbo Massimo , Sorarù Gianni , Lunetta Christian , Calvo Andrea , Chiò Adriano , Mora Gabriele , Pennuto Maria , Quattrone Alessandro , Rinaldi Francesco , D’Agostino Vito Giuseppe , Basso Manuela , Bonetto Valentina 
Published: August 2020

AbstractBackgroundAmyotrophic lateral sclerosis (ALS) is a multifactorial, multisystem motor neuron disease for which currently there is no effective treatment. There is an urgent need to identify biomarkers to tackle the disease’s complexity and help in early diagnosis, prognosis, and therapy. Extracellular vesicles (EVs) are nanostructures released by any cell type into body fluids. Their biophysical and biochemical characteristics vary with the parent cell’s physiological and pathological state and make them an attractive source of multidimensional data for patient classification and stratification.MethodsWe analyzed plasma-derived EVs of ALS patients (n= 106) and controls (n=96), and SOD1G93Aand TDP-43Q331Kmouse models of ALS. We purified plasma EVs by nickel-based isolation, characterized their EV size distribution and morphology respectively by nanotracking analysis and transmission electron microscopy, and analyzed EV markers and protein cargos by Western blot and proteomics. We used machine learning techniques to predict diagnosis and prognosis.ResultsOur procedure resulted in high-yield isolation of intact and polydisperse plasma EVs, with minimal lipoprotein contamination. There were more particles in the plasma of ALS patients and the two mouse models of ALS while their average diameter was smaller. HSP90 was differentially represented in ALS patients and mice compared to the controls. In terms of disease progression, the levels of cyclophilin A, with the EV size distribution, distinguished fast and slow disease progressors, suggesting a new means for patient stratification. We also measured the levels of phosphorylated TDP-43 and showed that is not an intravesicular cargo of plasma-derived EVs.ConclusionsOur analysis unmasked features in plasma EVs of ALS patients with potential straightforward clinical application. We conceived an innovative mathematical model based on machine learning which, by integrating EV size distribution data with protein cargoes, gave very high prediction rates for disease diagnosis and prognosis.
Natural Polymorphisms in Mycobacterium tuberculosis Conferring Resistance to Delamanid in Drug-naïve Patients
Authors: Reichmuth Martina L. , Hoemke Rico , Zürcher Kathrin , Sander Peter , Avihingsanon Anchalee , Collantes Jimena , Loiseau Chloé , Borrell Sonia , Reinhard Miriam , Wilkinson Robert J. , Yotebieng Marcel , Fenner Lukas , Böttger Erik C. , Gagneux Sebastien , Egger Matthias , Keller Peter M. 
Published: August 2020

ABSTRACTMutations in the genes of the F420 signaling pathway, including dnn, fgd1, fbiA, fbiB, fbiC, and fbiD, of Mycobacterium tuberculosis (Mtb) complex can lead to delamanid resistance. We searched for such mutations among 129 Mtb strains from Asia, South-America, and Africa using whole-genome sequencing; 70 (54%) strains had at least one mutation in one of the genes. For ten strains with mutations, we determined the minimum inhibitory concentration (MIC) of delamanid. We found one strain from a delamanid-naïve patient carrying the natural polymorphism Tyr29del (ddn) that was associated with a critical MIC to delamanid.
Mask-associated de novo headache in healthcare workers during the Covid-19 pandemic
Authors: Ramírez-Moreno José M , Ceberino David , González-Plata Alberto , Rebollo Belen , Macías-Sedas Pablo , Ramchandani Roshu Hariranami , Roa Ana M , Constantino Ana B 
Published: August 2020

SummaryIntroductionThe pandemic caused by the new coronavirus (COVID-19) has led to changes in the development of health care activities by health professionals. We analysed whether there is an association between the appearance of “de novo” headache according to the type of mask used, the related factors, as well as the impact of the headache on health professionals.Methodcross-sectional study in a tertiary hospital in Extremadura, Spain. We administered an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting.Resultsn=306, 244 women (79.7%), with an average age of 43 years (range 23-65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filtering masks. Of all those surveyed, 158 (51.6%) presented “de novo” headache. The occurrence of headache was independently associated with the use of a filtering mask, OR 2.14 (IC95% 1.07-4.32), being a nurse OR 2.09 (IC95% 1.18-3.72) or another health worker OR 6.94 (IC95% 3.01-16.04) or having a history of asthma OR 0.29 (IC95% 0.09-0.89). Depending on the type of mask used there were differences in headache intensity. And the impact of headache in the subjects who used a filtering mask was worse in the all aspects evaluated.ConclusionsThe appearance of “de novo” headache is associated with the use of filtering masks and is more frequent in certain health care workers, causing a greater occupational, family, personal and social impact.
Reflux Esophagitis is Associated with Higher Risks of Acute Stroke and Transient Ischemic Attacks in Patients Hospitalized with Atrial Fibrillation: A Nationwide Inpatient Sample Analysis
Authors: Jiang Yi , Damiris Konstantinos , Suero-Abreu Giselle A. , Ahlawat Sushil 
Published: August 2020

AbstractObjectiveReflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study.MethodsThe National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used.Results667,520 patients were admitted for primary diagnosis of AF out of which 5,396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (p <0.01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (p<0.05), longer LOS (p<0.001), and higher hospital charges (p<0.05) with no difference in acute heart failure (p=0.08), hospital mortality (p=0.12), or CHA2DS2-VAS score (p=0.67).ConclusionIn hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIA, longer LOS, and greater hospital charges.
Retrospective study on the clinicogenomic characteristics of EGFR mutant and wildtype NSCLC
Authors: Dhar Chirag 
Published: August 2020

AbstractBackgroundLung cancer is among the leading causes of mortality. Nearly 90% of all lung cancers are histologically classified as non-small cell lung cancer (NSCLC). A subset of these tumors harbor mutations on the epidermal growth factor receptor gene (EGFR) and such patients are candidates for targeted therapy with EGFR tyrosine kinase inhibitors (EGFR TKIs).AimTo compare and contrast the clinicogenomic characteristics of EGFR mutant and wildtype NSCLC.Methods and resultsA retrospective cohort study design was used to analyze publicly available data on cBioPortal.org. Patients with EGFR mutations were more likely to be female, of Asian ethnicity, never-smokers, and diagnosed with lung adenocarcinoma. Metastasis to the pleura, pleural fluid, and liver were common in patients with EGFR mutant NSCLC. On the other hand, lymph node, brain and adrenal gland metastases were more common in patients with other mutations. While the median overall survival was about the same in the two groups, progression free survival was significantly shorter in the EGFR mutant group. The mutational landscape was significantly different in the two groups with EGFR mutant NSCLCs having a lower mutational burden. Differences in copy number alterations between the two groups were also noted.ConclusionsThe clinicogenomic profiles of EGFR mutant and EGFR wildtype significantly differ. Further studies on these differences and underlying mechanisms are likely to lead to new “druggable” targets that overcome EGFR TKI resistance.