bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Insulin Initiation and Time to Insulin Initiation on within-Person Change of Healthcare Utilization in Medicaid Enrollees with type 2 Diabetes
Authors: Xue Lingshu , Strotmeyer Elsa S. , Zgibor Janice , Costacou Tina , Boudreau Robert , Kelley David , Donohue Julie M. 
Published: July 2020

Abstract
Background: Insulin use, time to insulin initiation, and subsequent healthcare utilization in low-income adults with type 2 diabetes (T2DM) are poorly understood.Methods: Our objectives were to examine whether 1) insulin initiation and 2) every 1-year decrease in the time from first-line glucose-lowering agents (GLAs) to insulin initiation reduced healthcare utilization within 12 months after insulin initiation in Pennsylvania (PA) Medicaid enrollees with T2DM. We included a cohort of 12,648 PA Medicaid enrollees (age 47.3±10.3 years) with first-line non-insulin GLAs between 2008 and 2016. Insulin users (N=3,625) were matched with non-insulin users (N=9,023) on dates of 1st GLA prescription and propensity scores calculated based on baseline characteristics to account for potential confounders. Generalized estimating equations models estimated within-person changes in inpatient stays and emergency room (ER) visits 12 months after vs. 12 months before insulin initiation. We performed sensitivity analyses in young (18-45 years) and middle-aged enrollees (>45 to 64 years). Results: The average time from first-line GLAs to insulin initiation was 2.0±1.7 years. Neither insulin initiation (rate ratio [RR]:1.0 [1.0, 1.1]) nor time to insulin initiation (RR: 1.0 [1.0, 1.0]) was associated with within-person change in ER visits. In young T2DM adults, insulin users had a greater subsequent increase in inpatient stays after insulin initiation vs. non-insulin users over the same time period (RR: 1.3 [1.1, 1.5]). Conclusions: In T2DM Medicaid enrollees, no reduction in healthcare utilization was observed after insulin initiation, even in early stages of pharmacotherapy. Studies investigating primary contributors to the increased inpatient use in young insulin users with T2DM are needed.
The Experiences of Individuals With Cervical Spinal Cord Injury and Their Family During Post-injury Care in Non-Specialised and Specialised Units in UK
Authors: McRae Jackie , Smith Christina , Emmanuel Anton , Beeke Suzanne 
Published: July 2020

Abstract
BackgroundIndividuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom.MethodsSemi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis.Results The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, “the golden opportunity”, “when you can’t eat”, communication, and “in the hands of the nurses and doctors”.ConclusionsWhilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.
Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage
Authors: Liu Zhengcheng , Yang Rusong , Sun Yang 
Published: July 2020

Abstract
Background: To investigate whether tubeless uniportal thoracoscopic wedge resection has better short-term outcomes than non-intubated approach with chest tube drainage.Methods: Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Perioperative outcomes between two groups were compared. Results: After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 minutes in tubeless group and 52.8 minutes in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. The postoperative pain VAS score was pain score was significantly lower in tubeless group in post-operative day 1 and 3. Side effects were rare and mild, including cough and hemoptysis. No reintervention or readmission occurred.Conclusions: Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.
Surgical Care in Poland after COVID19 Outbreak: A National Survey.
Authors: Stefura Tomasz , Rymarowicz Justyna , Wysocki Michał , Szeliga Jacek , Wallner Grzegorz , Pędziwiatr Michał , Nowakowski Michał , Major Piotr 
Published: July 2020

Abstract
Background: During COVID-19 pandemic, it is necessary to collect and analyze data concerning management of hospitals and wards to work out solutions for potential future crisis. The objective of the study was to investigate how surgical wards in Poland are managing during rapid development of the COVID-19 pandemicMethods: An anonymous, online survey was designed and distributed to surgeons and surgery residents working in surgical departments during pandemic. Responders were divided into two groups: Group 1 (responders working in a “COVID-19-dedicated” hospital) and Group 2 (responders working in other hospitals). Results: Overall, 323 responders were included in the study group, 30.03% of which were female. Medical staff deficits were reported by 21.15% responders from Group 1 and 29.52% responders from Group 2 (p=0.003). The mean number of elective surgeries performed weekly prior to the pandemic in Group 1 was 40.37±46.31 and during the pandemic was 13.98±37.49 (p<0.001). In Group 2, the mean number of elective surgeries performed weekly before the start of the pandemic was 26.85±23.52 and after the start of the pandemic, it was 7.65±13.49 (p<0.001). There were significantly higher reported levels of preparedness in Group 1 in terms of: theoretical training of the staff, equipping the staff and adapting the operating theater to safely perform procedures on patients with COVID-19. Overall, 62.23% of responders presume being infected with SARS-CoV-2.Conclusions: SARS-CoV-2 pandemic had a significantly negative impact on surgical wards. Despite the preparations, the number of responders who presume being infected with SARS-CoV-2 during present crisis is high.Trial registration: The study was registered in https://www.clinicaltrials.gov/ registry (NCT04368026).
Insulin receptor activation by proinsulin preserves synapses and vision in retinitis pigmentosa
Authors: Sánchez-Cruz Alonso , Hernández-Pinto Alberto , Lillo Concepción , Isiegas Carolina , Marchena Miguel , Lizasoain Ignacio , Bosch Fátima , Villa Pedro de la , Hernández-Sánchez Catalina , Rosa Enrique J. de la 
Published: July 2020

Abstract
Background Synaptic loss, neuronal cell death, and circuit remodeling are common features of central nervous system neurodegenerative disorders. Retinitis pigmentosa, the leading cause of inherited blindness, is a group of retinal dystrophies characterized by photoreceptor cell dysfunction and death. The insulin receptor, a key controller of metabolism, also regulates neuronal survival and synaptic formation, maintenance, and activity. Indeed, deficient insulin receptor signaling has been implicated in several brain neurodegenerative pathologies. Methods We employed a gene therapy strategy to enhance insulin receptor signaling in the Pde6b rd10/rd10 mouse model of RP by using recombinant AAV serotype 2/1 viral vectors bearing cDNA from the human proinsulin gene. Insulin receptor expression and signaling were analyzed by PCR and immunostaining. Synaptic connectivity was evaluated by electron microscopy and immunostaining. Proinsulin levels were measured by ELISA. Photoreceptor preservation was assayed by histological analysis and visual function was assessed by electroretinography and optomotor test. Results We present evidence linking impaired insulin receptor signaling with retinitis pigmentosa. We found a selective decrease in the levels of the insulin receptor and its downstream effector phospho-S6 in retinal horizontal cell axons in the rd10 mouse model of retinitis pigmentosa, as well as aberrant synapses between rod photoreceptors and the postsynaptic terminals of horizontal and bipolar cells. A gene therapy strategy to induce sustained proinsulin production restored retinal insulin receptor signaling, by increasing S6 phosphorylation, without peripheral metabolic consequences. Moreover, proinsulin preserved photoreceptor synaptic connectivity and prolonged visual function as determined by electroretinography and optomotor tests. Conclusion These findings point to a disease-modifying role of insulin receptor and support the therapeutic potential of proinsulin in retinitis pigmentosa.
Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting
Authors: Lestin-Bernstein Franka , Harberg Ramona , Schumacher Ingo , Briedigkeit Lutz , Heese Oliver , Biedermann Kristina 
Published: July 2020

Abstract
Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.
Rumen microbiome structure and metabolites activity in dairy cows with clinical and subclinical mastitis
Authors: Wang Yue , Nan xuemei , Zhao Yiguang , Wang Mengling , Wang Hui , Zhang Fan , Xue Fuguang , Hua Dengke , Liu Jun , Jiang Linshu , Yao Junhu , Xiong Benhai 
Published: July 2020

Abstract
Background: With high prevalence and complex etiology, bovine mastitis (BM) often causes serious damage to dairy cows’ health and milk quality. Although the shift in milk has been the main research interest on mastitis, recent studies have suggested that gastrointestinal microorganism has a crucial effect on the inflammation of the tissues outside the gut, such as mammary gland. However, studies related to the variation of rumen inner-environment during mastitis were limited. This study compared the differences of rumen microorganisms and metabolites under different udder health conditions, in order to investigate the correlation between udder health status and rumen microbiome structure and metabolites activity. Based on the somatic cell counts (SCC), California mastitis test (CMT) parameters and clinical symptoms of mastitis, 60 lactating Holstein dairy cows with similar body conditions (excepted for udder health condition) were divided into 3 groups (n = 20 per group): healthy (H) group, subclinical mastitis (SM) group and clinical mastitis (CM) group. Lactation and rumen fermentation parameters were detected, and rumen microbiota and metabolites were analyzed via 16S rRNA amplicon sequencing and untargeted metabolomics, respectively. Results: As the degree of mastitis increased, milk SCC and milk protein were significantly increased (P < 0.01). Milk yield, milk fat and lactose (P < 0.01), and rumen lactic acid (LA) (P < 0.01), acetate, propionate, butyrate, valerate (P < 0.001), total volatile fatty acids (TVFAs) concentrations (P < 0.01) and pH value (P = 0.024) were significantly decreased. In the rumen of CM cows, the significantly increased pathogens related to intestinal and oral inflammation, such as g__Lachnospiraceae_UCG-006 (P = 0.03), g__Moraxella and g__norank_f__Neisseriaceae (P < 0.01), etc., were accompanied by a significant increase in 12-oxo-20-dihydroxy-leukotriene B4 and 10beta-Hydroxy-6beta-isobutyrylfuranoeremophilane (P < 0.01). Meanwhile, in the rumen of SM cows, the g__Ruminiclostridium_9 (P = 0.04) and g_Enterorhabdus (P = 0.01) were increased with methenamine, 5-Hydroxymethyl-2-furancarboxaldehyde (5-HMF) and 6-Methoxymellein (P < 0.01). During mastitis, the decrease of short-chain fatty acids (SCFAs)-producing bacteria and intestinal probiotics in rumen, including g__Prevoterotoella_1 and g__Bifidobacterium (P = 0.03), etc., were significantly reduced, accompanied by a reduction in 2-Phenylbutyric acid (2-PBA) (P < 0.01).Conclusion: This study suggested that the microflora and metabolites associated with pathogen invasion, inflammatory response and rumen wall damage in the rumen of cows suffered mastitis were prominent.
What are the challenges of pedestrian safety from the viewpoints of traffic and transport stakeholders? A qualitative Study
Authors: Haghighi Morteza , Aghdam Fatemeh Bakhtari , Sadeghi-Bazargani Homayoun , Nadrian Haidar 
Published: July 2020

Abstract
Background

Pedestrians are among the most vulnerable groups in traffic accidents. Our aim in this study was to explore the challenges associated to pedestrian safety from the perspective of traffic and transport stakeholders.
Methods

In 2018, applying a qualitative approach, twenty-four traffic and transport stakeholders were invited to participate in semi-structured individual interviews in Tabriz, Iran. To analyze data, conventional content analysis approach was used. MAXQDA software version 11 was applied to manage data analysis process.
Findings:

Participants reported a wide range of challenges which were grouped into six categories: "Challenges related to pedestrians", "Challenges related to drivers", "Management system challenges", "Environmental infrastructure challenges", "Educational and media challenges", and "Challenges of legislation and enforcement".
Conclusion

We identified pedestrian safety as a challenging urban traffic and transport issue with specific complexities, particularly in the management system. With a holistic approach to the challenges, as discussed inside, all reported obstacles seem to be overshadowed by one core challenge, namely the lack of a traffic management system with health-oriented approach and enough authority. Using evidence while policy-making and intervention planning, as well as media support is recommended.
Comparison of CRB/CRB-65, qSOFA, and SIRS for Risk Prediction in Patients with Urinary Tract Infection
Authors: Bae Sung Jin , Lee Jae Hee , Choi Yoon Hee 
Published: July 2020

Abstract
Background: Early recognition of sepsis is critical for improving patient outcomes. In approximately 20%-30% of patients, sepsis resulted from urinary tract infection (UTI). This study aimed to investigate the effectiveness of CRB (confusion, respiratory rate, blood pressure), CRB-65, and quick sequential organ failure assessment (qSOFA) in predicting intensive care unit (ICU) admission and in-hospital mortality of patients with UTI and compare them with Systemic Inflammatory Response Syndrome (SIRS). Methods: This retrospective cohort study included patients with UTI who visited the emergency department of a single medical center between February 2018 and March 2020. Baseline characteristic data were obtained and compared with the prevalence of ICU admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: Overall, 1151 patients were included in this study, of whom 132 (11.5%) were admitted to the ICU and 30 (2.6%) succumbed to in-hospital mortality. AUROC values of CRB, CRB-65, and qSOFA as predictors of ICU admission and in-hospital mortality were similar. The CRB score of ≥1 had a sensitivity and specificity of 71.3% and 73.5%, respectively, for ICU admission and 66.7% and 69.2%, respectively, for in-hospital mortality. The CRB-65 score of ≥2 had a sensitivity and specificity of 61.2% and 80.9%, respectively, for ICU admissions and 60% and 76.9%, respectively, for in-hospital mortality. The qSOFA score of ≥1 had a sensitivity and specificity of 71.3% and 79.6%, respectively, for ICU admission and 66.7% and 74.8%, respectively, for in-hospital mortality. Conclusion: CRB, CRB-65, and qSOFA were more effective predictors than SIRS for patients with UTI. CRB, CRB-65, and qSOFA had similar general values for predicting outcomes in patients with UTI in the emergency department.
Peer Assisted Study Session (PASS): Are the Millennial Leaders the Leaders of Tomorrow? A Prospective Cohort Study.
Authors: Shafiaai Mohd Syameer Firdaus Mohd , Kadirvelu Amudha , Pamidi Narendra 
Published: July 2020

Abstract
Background PASS is a peer-led structured academic mentoring program designed to provide academic assistance for new students in their transition from college to university studies and also for students struggling in certain units. This study aims to establish acquired skills by peer leaders associated with peer-led mentoring via PASS program, and to explore the role played by these acquired skills in their journey to become a successful doctor.Methods Study participants were forty selected second-year undergraduate medical students at Monash University Malaysia with commendable examination results. Validated pre-test and post-test questionnaires were administered to explore changes in the level of communication, leadership, professional, and pedagogical skills before and after participation in peer mentoring program. Qualitative analysis of focused group interviews was performed by an independent investigator to identify how the skills developed as a peer mentor may help with becoming a good doctor. Major themes were identified with the thematic-analysis approach.Results Thirty-eight students completed the pre-test and post-test questionnaires. Peer leaders reported improvement in oral and written skills for teaching; increased confidence to give constructive feedback; better stress management; efficient time management; improved interpersonal skills; and enhanced problem-solving and critical thinking capabilities. Eight major themes were identified from the interview and peer leaders reported positive experience of working in diverse environments and shouldering of responsibilities.Conclusions Peer-led mentoring provides a good opportunity for medical students to shoulder responsibilities as a leader and offers an of experience of managing a team of their peers and juniors which in turn may enhance their communication, interpersonal, and leadership skills.
New insights in the reproducibility of visual and electronic tooth color assessment for dental practice
Authors: Ratzmann Anja , Welk Alexander , Hoppe Stephanie , Fanghaenel Jochen , Schwahn Christian 
Published: July 2020

Abstract
Background The aim of the study was to compare a 2D and 3D color system concerning a variety of statistical and graphical methods to assess validity and reliability of color measurements, and to give some guidance when to use which system and how to interpret color distance measures, including ΔE and d(0M1).Methods The tooth color of teeth 14 to 24 of 35 patients with a regular bleaching treatment (BT) was visually assessed and electronically measured with the spectrophotometer Shade Inspector™. Tooth color was recorded before BT (T1/T2- Baseline), 14d (T3/T4) and 6 months (T5/T6) after BT. VITAPAN® Classical (VC) and VITA-3D-Master® (3D) served as reference systems.Results Intra-rater variability. The 2D system is better than the 3D system both visually and electronically in terms of ΔE and d(0M1) for statistics of agreement and reliability. All four methods show strong patterns of disagreement between repeated measurements in Bland-Altman plots. The 3D system lacks reliability of hue compared with that of lightness and chroma, which is more pronounced visually than electronically. The smallest detectable color difference (SDCD) differs by the four methods used and is most favorable in the electronical 2D system. Inter-rater variability. The agreement between the 2D and 3D system in terms of ΔE is not good according to Byrt’s classification. It is lower within the electronical method than within the visual method. Comparability of the 2D and 3D system is uncertain because confidence intervals of ICCs accounting for systematic error are wide. The systematic error between the 2D and 3D system cannot be neglected. The reliability of the visual and electronical method is substantially the same within the 2D and 3D system; this comparability is fair to good.Clinical Relevance: According to the results of this study, the 3D system may confuse human raters and even electronical devices. The 2D system is the natural and best choice.