bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left Atrial Appendage Thrombus Detected During Hyperacute Stroke Imaging Is Associated With Atrial Fibrillation
Authors: Senadeera Sajith C. , Palmer David G. , Keenan Ross , Beharry James , Yuh Lim Jen , Hurrell Michael A. , Mouthaan Paul , Fink John N. , Wilson Duncan , Lim Anthony , Wu Teddy Y. 
Published: November 2020

Background and Purpose:
Left atrial appendage (LAA) is the likely embolic source in atrial fibrillation (AF)–related cardioembolic strokes. We sought to determine the prevalence of LAA thrombus on hyperacute stroke imaging and its association with AF.

Methods:
We retrospectively examined the clinical and radiological features of patients assessed through the hyperacute stroke imaging pathway over a 12-month period at Christchurch Hospital. The LAA was included in the computed tomography angiogram scan-range as part of the multimodal imaging protocol. Two radiological readers blinded to clinical information independently assessed for the presence of LAA thrombus. The association between AF and LAA thrombus was determined by multivariable logistic regression analysis.

Results:

Of 303 patients included in the analysis, the overall prevalence of LAA thrombus was 6.6% and 14.9% in patients with known AF. Patients with LAA thrombus were older (85 versus 75 years,
P
<0.01), more commonly had known or newly diagnosed AF (75% versus 30%,
P
<0.01) and heart failure (30% versus 8%,
P
=0.01), and was associated with intracranial large vessel occlusion (65% versus 39%,
P
=0.02). In the multivariable model, AF (odds ratio, 3.71 [95% CI, 1.25–11.01]
P
=0.02) was independently associated with LAA thrombus after adjusting for age and congestive heart failure. Interrater reliability was moderate (kappa=0.56).

Conclusions:
LAA thrombus is a potential radiological marker of AF and can be assessed as a part of hyperacute stroke imaging.
Microglial Calcium Waves During the Hyperacute Phase of Ischemic Stroke
Authors: Liu Lei , Kearns Kathryn N. , Eli Ilyas , Sharifi Khadijeh A. , Soldozy Sauson , Carlson Elizabeth W. , Scott Kyle W. , Sluzewski M. Filip , Acton Scott T. , Stauderman Kenneth A. , Kalani M. Yashar S. , Park Min , Tvrdik Petr 
Published: November 2020

Background and Purpose:
Ischemic injury triggers multiple pathological responses in the brain tissue, including spreading depolarizations across the cerebral cortex (cortical spreading depolarizations [CSD]). Microglia have been recently shown to play a significant role in the propagation of CSD. However, the intracellular responses of myeloid cells during ischemic stroke have not been investigated.

Methods:
We have studied intracellular calcium activity in cortical microglia in the stroke model of the middle cerebral artery occlusion, using the murine Polr2a-based and Cre-dependent GCaMP5 and tdTomato reporter (PC::G5-tdT). High-speed 2-photon microscopy through cranial windows was employed to record signals from genetically encoded indicators of calcium. Inflammatory stimuli and pharmacological inhibition were used to modulate microglial calcium responses in the somatosensory cortex.

Results:
In vivo imaging revealed periodical calcium activity in microglia during the hyperacute phase of ischemic stroke. This activity was more frequent during the first 6 hours after occlusion, but the amplitudes of calcium transients became larger at later time points. Consistent with CSD nature of these events, we reproducibly triggered comparable calcium transients with microinjections of potassium chloride (KCl) into adjacent cortical areas. Furthermore, lipopolysaccharide-induced peripheral inflammation, mimicking sterile inflammation during ischemic stroke, produced significantly greater microglial calcium transients during CSD. Finally, in vivo pharmacological analysis with CRAC (calcium release-activated channel) inhibitor CM-EX-137 demonstrated that CSD-associated microglial calcium transients after KCl microinjections are mediated at least in part by the CRAC mechanism.

Conclusions:
Our findings demonstrate that microglia participate in ischemic brain injury via previously undetected mechanisms, which may provide new avenues for therapeutic interventions.
Attractiveness in the Eyes: A Possibility of Positive Loop between Transient Pupil Constriction and Facial Attraction
Authors: Liao Hsin-I , Kashino Makio , Shimojo Shinsuke 
Published: November 2020

Abstract
Contrary to the long-held belief of a close linkage between pupil dilation and attractiveness, we found an early and transient pupil constriction response when participants viewed an attractive face (and the effect of luminance/contrast was controlled). While human participants were making an attractiveness judgment on faces, their pupil constricted more for the more attractive (as-to-be-rated) faces. Further experiments showed that the effect of pupil constriction to attractiveness judgment extended to intrinsically esthetic visual objects such as natural scene images (as well as faces) but not to line-drawing geometric figures. When participants were asked to judge the roundness of faces, pupil constriction still correlated with their attractiveness but not the roundness rating score, indicating the automaticity of the pupil constriction to attractiveness. When pupillary responses were manipulated implicitly by relative background luminance changes (from the prestimulus screen), the facial attractiveness ratings were in accordance with the amount of pupil constriction, which could not be explained solely by simultaneous or sequential luminance contrast. The overall results suggest that pupil constriction not only reflects but, as a part of self-monitoring and attribution mechanisms, also possibly contributes to facial attractiveness implicitly.
Tropical Pacific Decadal Variability and ENSO Precursor in CMIP5 Models
Authors: Zhao Yingying , Di Lorenzo Emanuele , Sun Daoxun , Stevenson Samantha 
Published: November 2020

AbstractObservational analyses suggest that a significant fraction of the tropical Pacific decadal variability (TPDV) (~60%–70%) is energized by the combined action of extratropical precursors of El Niño–Southern Oscillation (ENSO) originating from the North and South Pacific. Specifically, the growth and decay of the basin-scale TPDV pattern (time scale = ~1.5–2 years) is linked to the following sequence: ENSO precursors (extratropics, growth phase) → ENSO (tropics, peak phase) → ENSO successors (extratropics, decay phase) resulting from ENSO teleconnections. This sequence of teleconnections is an important physical basis for Pacific climate predictability. Here we examine the TPDV and its connection to extratropical dynamics in 20 models from phase 5 of the Coupled Model Intercomparison Project (CMIP). We find that most models (~80%) can simulate the observed spatial pattern (R > 0.6) and frequency characteristics of the TPDV. In 12 models, more than 65% of the basinwide Pacific decadal variability (PDV) originates from TPDV, which is comparable with observations (~70%). However, despite reproducing the basic spatial and temporal statistics, models underestimate the influence of the North and South Pacific ENSO precursors to the TPDV, and most of the models’ TPDV originates in the tropics. Only 35%–40% of the models reproduce the observed extratropical ENSO precursor patterns (R > 0.5). Models with a better representation of the ENSO precursors show 1) better basin-scale signatures of TPDV and 2) stronger ENSO teleconnections from/to the tropics that are consistent with observations. These results suggest that better representation of ENSO precursor dynamics in CMIP may lead to improved Pacific decadal variability dynamics and predictability.
Representation of Climate in Reanalyses: An Intercomparison for Europe and North America
Authors: Keller Jan D. , Wahl Sabrina 
Published: November 2020

AbstracTAtmospheric reanalysis datasets are a major tool to assess climate and its variability for past decades in a broad spectrum of applications. Nowadays, global reanalysis systems are available in third- and fourth-generation versions. They benefit from continuous improvements of numerical models and data assimilation schemes thus utilizing a growing number of observing systems. In the past decade, global reanalyses have been complemented by several regional reanalyses with enhanced horizontal resolution and appropriate model physics. Due to the considerable technical overhead associated with the comparison of reanalyses, it is difficult for users to identify an optimal dataset for their needs. Therefore, this study strives to provide a comprehensive intercomparison of the representation of climate in various reanalyses. The study compares four global reanalyses and three regional reanalyses over Europe and North America with in situ observations. The focus lies on the representation of near-surface temperature and precipitation expressed through various climate indices. The comparison shows that performances of the different reanalyses vary considerably depending on the parameter(s) of interest, the region, and the type of aggregation. The main findings are that regional reanalyses provide added value especially with regard to precipitation. While ECMWF’s newest reanalysis ERA5 is in better agreement with observations compared to the other global reanalyses for most climate indices over Europe, it is still outperformed by its predecessor ERA-Interim over North America. To support users in identifying an appropriate reanalysis for their needs, the study is complemented by comprehensive supplemental material.
Comparison of pre- and post-hemodialysis PHQ-9 depression scores in patients with end-stage renal disease: A cross-sectional study
Authors: AlAwwa Izzat , Ibrahim Sarah , Obeid Ahmad , Alfraihat Nadeen , Al-Hindi Reham , Jallad Shatha , Al-Awwa Ahmad 
Published: November 2020

Objectives An overlap between the somatic symptoms of depression and those of uremia seen in end-stage renal disease (ESRD) patients may affect the diagnosis of depression. This study aims to evaluate the effect of hemodialysis on the diagnosis of depression among patients on maintenance hemodialysis as dialysis diminishes the uremic symptoms, and to compare depression scores before and after dialysis. Methods This was a cross-sectional analytic study conducted from November 2018 through April 2019, in three tertiary hospitals. Consenting participants aged 18 years or older, who had received hemodialysis for at least three months were included. The Patient Health Questionnaire (PHQ-9) tool was used to collect patients’ data and to identify symptoms of depression Pre- and post-hemodialysis. Depression scores were compared using the paired sample Wilcoxon rank test or the McNemar test, where appropriate. Results Overall, 163 participants were enrolled in the study. The average age of the participants was 56.5 years old, whereas 44.8% were females. The prevalence of depressive symptoms before hemodialysis was 48.5%, with prevalence of mild, moderate and moderately severe of 34.4%, 11.7% and 2.5%, respectively. On the other hand, the prevalence of depressive symptoms after hemodialysis was 46.6% with 36.8%, 9.2% and 0.6% of the participants reporting mild, moderate and moderately severe symptoms, respectively. We found no significant difference in depression scores before and after dialysis (p-values > 0.05). Conclusion Our study supports the fact that the prevalence of depression is high among patients with ESRD on maintenance hemodialysis. We didn’t find a significant difference in depression scores among hemodialysis patients before and after dialysis, with negligible effect of uremic symptoms on the diagnosis of depression. We suggest adopting routine screening of depression among this high-risk group of patients.
Pet Medications: A Tail of Caution
Authors: Nguyen Tammy T. , Kirkwood Craig F. , Reilly Denise , Lee Danyae , Coggin Christy 
Published: November 2020

Purpose: A case report of pet medications appearing along with the patient’s medications (pet owner) in the external medication history list of the electronic medical record (EMR). Case Presentation: A 67-year-old female presented to the emergency department for altered mental status. A medication history was performed by the pharmacist in an attempt to identify possible etiologies of the patient’s clinical status. An external prescription refill report from the EMR included 2 medications that could not be confirmed by the family as the patient’s: phenobarbital 50 mg twice daily and zonisamide 200 mg every 12 hours. The patient’s pharmacy identified that the prescriptions were pet medications registered under the patient’s name and date of birth for the state’s prescription monitoring program. Conclusion: A lack of standardization between pet identifiers in community pharmacy databases and state Board of Pharmacy regulations for prescription monitoring programs, has led to the association of pet medications with their human owners in the EMR. Patient medication histories should always be verified and validated utilizing patient/patient family interviews and prescription refill histories. Utilization of pharmacists to identify and scrutinize inconsistencies can reduce medication errors that could occur during medication history or reconciliation.
Clinical Response and Cost-Savings Associated With Generic Fluticasone Propionate/Salmeterol Multidose, Dry-Powder Inhaler in Asthma Patients Managed in an Ambulatory Care Practice Setting
Authors: McCarthy Patrick , Iliadis Tanya , Zaiken Kathy 
Published: November 2020

Background: Fluticasone propionate/salmeterol multidose, dry powder inhaler (MDPI) was the first and only authorized generic inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination inhaler at the time of this study. This offers the potential for significant prescription cost-savings for both patients and accountable care organizations. The objective of the study was to demonstrate patients’ clinical response to generic fluticasone propionate/salmeterol MDPI when switched from one of its brand name competitors. Methods: The study was approved by the Institutional Review Board at MCPHS University. This was a prospective chart review of a large, multi-center ambulatory care organization in the Greater Boston area. Patients 12 years of age or older who were switched from a brand-name ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI were included in the study. The primary endpoint was worsened asthma control requiring a change in therapy, oral corticosteroid therapy, or hospitalization at or before 12 weeks after the inhaler was switched. Results: In total, 203 patients met inclusion criteria. Of those 203 patients, 35 had a change in therapy due to worsened asthma control (17.2% of patients, 95% CI 12.0% to 22.4%) within 12 weeks. Total projected yearly prescription cost-savings for patients who were switched and remained on the generic inhaler was $581,628. Conclusion: Eighty-three percent of patients maintained appropriate asthma control after switching from a brand ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI for 12 weeks. Switching to the generic inhaler resulted in significant prescription cost-savings for the accountable care organization.
Cognition and Alertness in Medical Students: Effects of a Single Night of Partial Sleep Deprivation
Authors: Mishra Priyadarshini , Panigrahi Madhuri , Ankit D. 
Published: November 2020

Background: Partial sleep deprivation is common among young adults today. Though multiple studies have stressed on the benefits of having a good sleep, medical students often compromise their sleep due to academic targets and stress. This can lead to changes in attention and cognition. The effects of acute partial sleep deprivation of a single night have been studied less and studies in the past in Indian context have shown controversial results that reaction time is decreased following acute partial sleep deprivation. Purpose: The purpose of the study was to evaluate the effects of a single night of partial sleep deprivation on the cognitive status and alertness of medical students in the Indian context and to find out the change in auditory event-related potential (AERP) and psychomotor vigilance of medical students following a single night of partial sleep deprivation. Methods: The study was a before–after experimental trial conducted among 20 medical student volunteers of a tertiary care hospital of eastern India. Baseline psychomotor vigilance task measured by unprepared serial reaction time, and AERP measured by P300, were assessed at baseline (after normal sleep) and after four hours of sleep deprivation (intervention). Results: It was seen that median RT had increased from 320.4 ms to 337.6 ms after acute partial sleep deprivation ( P < .001). P300 and lapses ( P < .05) were also found to increase significantly ( P < .05), while there was significant decrease in correctness ( P < .01). Conclusion: The study concluded that cognition is affected, including alertness and latency, following partial sleep deprivation even for a single night and contradicted earlier results of Indian studies stating variable effect on psychomotor vigilance.
Implementing a Protocol to Address Risk for Burnout Among Mental Health Professionals
Authors: Via Kamala D. , Oliver Joann S. , Shannon Donna 
Published: November 2020

BACKGROUND: The magnitude for potential burnout is enormous. The Centers for Disease Control and Prevention, Center for Addiction and Mental Health, and Substance Abuse and Mental Health Services Administration reported diagnoses of psychiatric and substance use disorders are at an all-time high for physicians, psychiatrists, nurses, social workers, and psychologists. OBJECTIVE: Reduce the potential for burnout among outpatient mental health clinicians and staff. METHOD: Develop an agency wellness protocol utilizing evidence-based interventions to reduce the potential for clinician and staff burnout. RESULTS: Survey data indicated low to moderate levels of burnout and depersonalization. Staff and clinician recommendations provided during feedback sessions were incorporated with evidence-based interventions to establish a wellness protocol. CONCLUSION: Implementing evidence-based interventions in a wellness protocol may reduce the potential for clinician and staff burnout.
Using Evidence: A Nursing Assessment Protocol for Acute Geropsychiatric Patients
Authors: Corn Ashley Sechrist , Sevy-Majers Joan , Tyson R. Lee 
Published: November 2020

Introduction: The Centers for Disease Control and Prevention estimates that approximately 20% of the United States population lives with at least one mental health issue. The most common mental illnesses affecting older Americans include anxiety, cognitive, and mood disorders. These patients may exhibit behaviors indicating agitation or anxiety during necessary hospital stays that warrant de-escalation techniques and appropriate medications to help manage emergent symptoms. Aims: This quality improvement intervention was intended to demonstrate enhancement of the nursing assessment and reassessment of patients demonstrating symptoms of agitation and anxiety requiring intervention. Methods: Assessment of the established nursing practice demonstrated compromised patient safety and led to planning and implementation of a new practice standard that incorporated an evidence-based tool. Nurses utilized a protocol that employed the Pittsburgh Agitation Scale to augment documentation of the nursing assessment for patients exhibiting symptoms of marked anxiety and agitation. Results: Following a 3-month trial, chart audits were completed to assess results of the protocol’s implementation. Significant improvement was noted in the nursing assessment process as evidenced in required documentation of nursing assessment and reassessment including use of the protocol. Conclusions: Implementing standards to guide nursing care can support both patient safety and professional practice.
Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study
Authors: Liu Hengchang , Li Chunxiang , Zhao Zhixun , Guan Xu , Yang Ming , Liu Zheng , Tang Yuan , Jiang Zheng , Wang Xishan 
Published: November 2020

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed. Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.
Development and Validation of a Scoring System Based on 9 Glycolysis-Related Genes for Prognosis Prediction in Gastric Cancer
Authors: Luo Tianqi , Du Yufei , Duan Jinling , Liang Chengcai , Chen Guoming , Jiang Kaiming , Chen Yongming , Chen Yingbo 
Published: November 2020

Gastric cancer is a malignant tumor with high morbidity and mortality worldwide. However, increasing evidences have revealed the correlation between the glycolysis process and tumorigenesis. This study is aim to develop a list of glycolysis-related genes for risk stratification in gastric cancer patients. We included 500 patients’ sample data from GSE62254 and GSE26942 datasets, and classified patients into training (n = 350) and testing sets (n = 150) at a ratio of 7: 3. Univariate and multivariate Cox regression analysis were performed to screen genes having prognostic value. Based on HALLMARK gene sets, we identified 9 glycolysis-related genes (BPNT1, DCN, FUT8, GMPPA, GPC3, LDHC, ME2, PLOD2, and UGP2). On the basis of risk score developed by the 9 genes, patients were classified into high- and low-risk groups. The survival analysis showed that the high-risk patients had a worse prognosis ( p < 0.001). Similar finding was observed in the testing cohort and 2 independent cohorts (GSE13861 and TCGA-STAD, all p < 0.001). The multivariate Cox regression analysis showed that the risk score was an independent prognostic factor for overall survival ( p < 0.001). Furthermore, we constructed a nomogram that integrated the risk score and tumor stage, age, and adjuvant chemotherapy. Through comparing the results of the receiver operating characteristic curves and decision curve analysis, we found that the nomogram had a superior predictive accuracy than conventional TNM staging system, suggesting that the risk score combined with other clinical factors (age, tumor stage, and adjuvant chemotherapy) can develop a robust prediction for survival and improve the individualized clinical decision making of the patient. In conclusion, we identified 9 glycolysis-related genes from hallmark glycolysis pathway. Based on the 9 genes, gastric cancer patients were separated into different risk groups related to survival.