bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Simulation Games
Authors: Besse Cheryl , Vogelsang Laura , Zdunich Jill 
Published: May 2020

Background
Although nursing students practice skills in labs as part of the curriculum, many report feeling anxious and unprepared for their first clinical experience.

Purpose
A capstone lab, integrating gaming with simulation, was implemented to assimilate previous learning and promote critical thinking before beginning clinical experiences.

Methods
Second-year baccalaureate nursing students participated in a gamified lab with simulated scenarios working in teams in various roles to manage patient situations. Remediation opportunities throughout the lab and formal structured debriefing further maximized their learning.

Results
Students reported the lab was beneficial. Most students found the lab “stressful, but in a good way,” which challenged them to apply previous learning. Most students cited reduced anxiety and increased confidence for practice after the labs.

Conclusions
Integrating gaming with simulated scenarios maintained student engagement while encouraging critical thinking and knowledge synthesis to better prepare them for clinical experiences.
Economic and Epidemiological Impact of an Improvement Plan for the Decrease of Ventilator-Associated Pneumonia in a Tertiary Hospital in Mexico
Authors: Sosa-Hernández Oscar , Matías-Téllez Bernardina , Silva-López Yefté Efraín , Alarcón-Hernández Verónica , Bello-López Juan Manuel , Cureño-Díaz Mónica Alethia , Lugo-Zamudio Gustavo Esteban 
Published: May 2020

Introduction
The objective of this work is to measure the economic and epidemiological impact of the implementation of a comprehensive quality improvement plan (CQIP) for the prevention and reduction of ventilator-associated pneumonia (VAP) in the adult intensive care unit in a Mexican hospital.

Materials and Methods
A cross-sectional, ambispective, comparative, analytical, observational study was conducted with epidemiological data on cases of health care–associated infections and with information from the Hospital Epidemiological Surveillance Unit from August 2017 to July 2018.

Results
Before to the implementation of the CQIP, there were a total of 26 VAPs, with a rate of 32.2 per 1000 ventilator-days. After the implementation of CQIP, there were 14 VAPs, with a rate of 23.4 per 1000 ventilator-days, with a 46.2% decrease in incidence (P = 0.02). Before the installation of the interventions, the expense was $4,471,073.80, with an average cost per case of $171,964.38. The total cost per bed-day in the adult intensive care unit was $331,280.00, and for hospitalization, the cost was $192,038.00; for the use of antimicrobials, an expense of $749,689.20 was calculated, and for the use of mechanical ventilation, the cost was $2,974,275.60. The percentage of decrease in the cost of VAP after CQIP implementation was 46.5%.

Conclusions
The implementation of CQIP based on the risk evaluation factors of VAP resulted in their decrease, which is reflected in a patient safety and quality care improvement.
Periorbital and Perioral Regions in Relation to Aging
Authors: Hwang Kun 
Published: May 2020

Abstract
The aim of this study was to determine the boundary between the periorbital and perioral regions based on a literature review.
PubMed was searched for the terms (zone [OR] area [OR] region) [AND] (face-lift [OR] rhytidectomy), and 872 abstracts were found. Additionally, the terms (levator labii superioris [AND] orbicularis oculi) resulted in 20 abstracts. The author separately searched for (Lightoller) because searching PubMed for terms in abstracts does not yield results for older papers that do not have abstracts.
Among the papers identified through this search strategy, the author did not find any that defined the boundary of the periorbital and perioral regions. However, the author found Lightoller's research on the subject and retrieved 8 articles that he authored. Two of his papers showed and described the origins of the facial muscles. Burkitt and Lightoller reported that the inferior bony origin of the pars orbitalis extended laterally to the medial end of the caput infraorbitale M. quadrati labii superioris. According to those authors, there was a definite boundary between the origins of the periorbital muscles (pars orbitalis and pars oculobuccalis of the orbicularis oculi) and the perioral muscles (caput infraorbitale of the quadratus labii superioris). Based on that article, it is possible to divide the face into periorbital and perioral regions based on the origin of the circumoral and circumocular muscles.
With this division, the surgical technique based on the concept of these 2 regions could be followed.
Prophylactic Use of the Pectoralis Major Flap to Prevent Anastomotic Leak in the Reconstruction of a Total Laryngopharyngoesophagectomy Defect Combined With Gastric Pull-Up After Chemoradiotherapy
Authors: Scott Britney , Harrison Lucas , Kadakia Sameep , Ducic Yadranko , Johnson R. Michael 
Published: May 2020

Abstract
Total laryngopharyngoesophagectomy defects after surgical ablation for laryngopharyngeal carcinoma with involvement of the cervical esophagus represents a challenge to the reconstructive surgeon. Complicating an already challenging operation is when surgical ablation occurs after failure of primary chemoradiation requiring the surgeon to operate and reconstruct in an irradiated field limiting potential reconstructive options. Due to the advanced stage at diagnosis, some studies have shown that while traditional management with radiotherapy may be considered as an initial treatment modality, often times this has failed to provide sustainable improvement in survival with reported high local recurrence rates. With relatively high local recurrence rates following radiotherapy, movement towards aggressive surgical resection is favored in some institutions. Despite this movement, primary treatment with chemoradiation is still commonly used as a primary modality opening up the opportunity for residual or recurrent disease leading the surgeon to perform salvage surgery to eradicate disease after primary treatment failure. With advanced ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional outcomes which has shown to be particularly challenging when operating in a post-radiated field with a higher risk for pharyngocutaneous fistulas. The authors present a case where reconstruction of such a defect after local failure with primary chemoradiation was successful using a single stage reconstruction with the gastric pull up technique in combination with a pectoralis major myocutaneous flap. As the risk of anastomotic leak is significantly higher in patients following radiation, this method showed utilizing a prophylactic muscle flap at the time of reconstruction may further bolster the repair and prevent anastomotic leak.
Best Practice Guidelines for the Management of Acute Craniomaxillofacial Trauma During the COVID-19 Pandemic
Authors: DeSerres Joshua J. , Al-Shaqsi Sultan Z. , Antonyshyn Oleh M. , Fialkov Jeffrey A. 
Published: May 2020

Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease that is caused by severe respiratory syndrome coronavirus 2. Although elective surgical procedures are being cancelled in many parts of the world during the COVID-19 pandemic, acute craniomaxillofacial (CMF) trauma will continue to occur and will need to be appropriately managed. Surgical procedures involving the nasal, oral, or pharyngeal mucosa carry a high risk of transmission due to aerosolization of the virus which is known to be in high concentration in these areas. Intraoperative exposure to high viral loads through aerosolization carries a very high risk of transmission, and the severity of the disease contracted in this manner is worse than that transmitted through regular community transmission. This places surgeons operating in the CMF region at particularly high risk during the pandemic. There is currently a paucity of information to delineate the best practice for the management of acute CMF trauma during the COVID-19 pandemic. In particular, a clear protocol describing optimal screening, timing of intervention and choice of personal protective equipment, is needed. The authors have proposed an algorithm for management of CMF trauma during the COVID-19 pandemic to ensure that urgent and emergent CMF injuries are addressed appropriately while optimizing the safety of surgeons and other healthcare providers. The algorithm is based on available evidence at the time of writing. As the COVID-19 pandemic continues to evolve and more evidence and better testing becomes available, the algorithm should be modified accordingly.
Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy
Authors: Brunt L. Michael , Deziel Daniel J. , Telem Dana A. , Strasberg Steven M. , Aggarwal Rajesh , Asbun Horacio , Bonjer Jaap , McDonald Marian , Alseidi Adnan , Ujiki Mike , Riall Taylor S. , Hammill Chet , Moulton Carol-Anne , Pucher Philip H. , Parks Rowan W. , Ansari Mohammed T. , Connor Saxon , Dirks Rebecca C. , Anderson Blaire , Altieri Maria S. , Tsamalaidze Levan , Stefanidis Dimitrios 
Published: May 2020

Background:
BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI.

Methods:
Literature reviews were conducted for 18 key questions across 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus.

Results:
Consensus was reached on 17 of 18 questions by the guideline development group and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team.

Conclusions:
These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
The Work Organisation Assessment Questionnaire: validation for use with community nurses and paramedics
Authors: Karimi Leila , Oakman Jodi 
Published: May 2020

ABSTRACT

Aim:
The current study aimed to assess the suitability of the Work Organisation Assessment Questionnaire (WOAQ) for use in the healthcare sector, specifically for community nurses and paramedics. Community nurses and paramedics work in complex environments and are exposed to a range of psychosocial hazards linked with the development of musculoskeletal and mental health disorders. To reduce the incidence of these disorders, assessment and then control of psychosocial hazards is required. WOAQ addresses this need through an employee survey to identify key hazards, with the responses used to underpin a participative development of solutions.

Method:
Using a bifactor model, the WOAQ and five nested factors were cross validated using a sample of 1255 community nurses and paramedics using data collected in 2011 and 2012.

Results:
The results of metric invariance testing demonstrated that the WOAQ is a valid tool across health organizations. Full invariance testing at mean constructs level also showed strong support of validity of the ‘general score’ of the WOAQ. However, minor mean differences were found between two nested factors (workload issues and the relationships with the coworkers).

Conclusion:
The WOAQ is a valid assessment tool for application within the nursing and paramedic settings. Practical implications for these findings in healthcare settings are discussed.
Evidence of Protective Role of Ultraviolet-B (UVB) Radiation in Reducing COVID-19 Deaths Manuscript
Authors: Moozhipurath Rahul Kalippurayil , Kraft Lennart , Skiera Bernd 
Published: May 2020

AbstractBackgroundResearch is ongoing to identify an effective way to prevent or treat COVID-19, but thus far these efforts have not yet identified a possible solution. Prior studies indicate the protective role of Ultraviolet-B (UVB) radiation in human health, mediated by vitamin D synthesis. In this study, we empirically outline a negative association of UVB radiation as measured by ultraviolet index (UVI) with the number of deaths attributed to COVID-19 (COVID-19 deaths).MethodsWe carry out an observational study, applying a fixed-effect log-linear regression model to a panel dataset of 64 countries over a period of 78 days (n=4992). We use the cumulative number of COVID-19 deaths and case-fatality rate (CFR) as the main dependent variables to test our hypothesis and isolate UVI effect from potential confounding factors such as underlying time trends, country-specific time-constant and time-varying factors such as weather.FindingsAfter controlling for time-constant and time-varying factors, we find that a permanent unit increase in UVI is associated with a 2.2 percentage points decline in daily growth rates of cumulative COVID-19 deaths [p < 0.01] as well as a 1.9 percentage points decline in the daily growth rates of CFR [p < 0.05]. These results represent a significant percentage reduction in terms of the daily growth rates of cumulative COVID-19 deaths (−22.92%) and CFR (−73.08%). Our results are consistent across different model specifications.InterpretationWe find a significant negative association between UVI and COVID-19 deaths, indicating evidence of the protective role of UVB in mitigating COVID-19 deaths. If confirmed via clinical studies, then the possibility of mitigating COVID-19 deaths via sensible sunlight exposure or vitamin D intervention will be very attractive because it is cost-effective and widely available.
Analysis of heterozygous PRKN variants and copy number variations in Parkinson’s disease
Authors: Yu Eric , Rudakou Uladzislau , Krohn Lynne , Mufti Kheireddin , Ruskey Jennifer A. , Asayesh Farnaz , Estiar Mehrdad A. , Spiegelman Dan , Surface Matthew , Fahn Stanley , Waters Cheryl H. , Greenbaum Lior , Espay Alberto J. , Dauvilliers Yves , Dupré Nicolas , Rouleau Guy A. , Hassin-Baer Sharon , Fon Edward A. , Alcalay Roy N. , Gan-Or Ziv 
Published: May 2020

AbstractBackgroundBiallelic PRKN mutation carriers with Parkinson’s disease (PD) typically have an earlier disease onset, slow disease progression and, often, different neuropathology compared to sporadic PD patients. However, the role of heterozygous PRKN variants in the risk of PD is controversial.ObjectivesWe aimed to examine the association between heterozygous PRKN variants, including single nucleotide variants and copy-number variations, and PD.MethodsWe fully sequenced PRKN in 2,809 PD patients and 3,629 healthy controls, including 1,965 late onset (63.97±7.79 years, 63% men) and 553 early onset PD patients (43.33±6.59 years, 68% men). PRKN was sequenced using targeted next-generation sequencing with molecular inversion probes. Copy-number variations were identified using a combination of multiplex ligation-dependent probe amplification and ExomeDepth. To examine whether rare heterozygous single nucleotide variants and copy-number variations in PRKN are associated with PD risk and onset, we used optimized sequence kernel association tests and regression models.ResultsWe did not find any associations between all types of PRKN variants and risk of PD. Pathogenic and likely-pathogenic heterozygous single nucleotide variants and copy-number variations were less common among PD patients (1.52%) than among controls (1.8%, false discovery rate-corrected p=0.55). No associations with age at onset and in stratified analyses were found.ConclusionsHeterozygous single nucleotide variants and copy-number variations in PRKN are not associated with Parkinson’s disease. Molecular inversion probes allow for rapid and cost-effective detection of all types of PRKN variants, which may be useful for pre-trial screening and for clinical and basic science studies specifically targeting PRKN patients.
The relationship between glycaemia, cognitive function, structural brain outcomes and dementia: A Mendelian randomization study in the UK Biobank
Authors: Garfield Victoria , Farmaki Aliki-Eleni , Fatemifar Ghazaleh , Eastwood Sophie V. , Mathur Rohini , Rentsch Christopher T. , Denaxas Spiros , Bhaskaran Krishnan , Smeeth Liam , Chaturvedi Nish 
Published: May 2020

AbstractAimsTo investigate the relationship between glycaemia and cognitive function, brain structure and incident dementia using bidirectional Mendelian randomisation (MR).MethodsUK Biobank (n~500,000) individuals, aged 40-69 years at baseline. Our exposures were genetic instruments for type-2 diabetes (163 variants) and HbA1c (52 variants) and our outcomes were reaction time (RT - milliseconds), visual memory (number of incorrect responses), hippocampal and white matter hyperintensity volumes (both mm3), Alzheimer’s disease (AD). To study potential bidirectional effects, we then investigated the associations between genetic variants for RT (43 variants) and clinical type-2 diabetes and measured HbA1c. We used conventional inverse-variance weighted (IVW) MR, alongside standard MR sensitivity analyses.ResultsUsing IVW, genetic liability to type-2 diabetes was not associated with reaction time (exponentiated ß=1.00, 95%CI=1.00; 1.00), visual memory (expß=1.00, 95%CI=0.99; 1.00), white matter hyperintensity volume (expß=0.98, 95%CI=0.93; 1.03), hippocampal volume (coefficient mm3=0.00, 95%CI=-0.01; 0.01) or risk of AD (OR 0.97, 95%CI=0.89; 1.06). HbA1c was not associated with reaction time (expß=1.01, 95%CI=1.00; 1.01), white matter hyperintensity volume (expß=0.88, 95%CI=0.73; 1.07), hippocampal volume (coefficient=-0.02, 95%CI=-0.10; 0.06), risk of AD (OR 0.94, 95%CI=0.47; 1.86), but HbA1c was associated with visual memory (expß=1.06, 95%CI=1.05; 1.07) using a weighted median approach. IVW showed no evidence that reaction time was associated with diabetes (OR 0.96, 95%CI=0.63; 1.46) or HbA1c (coefficient=-0.08, 95%CI=-0.57; 0.42). MR-Egger intercept p-values indicated no major issues with unbalanced horizontal pleiotropy (all p>0.05).ConclusionsOverall, we observed little evidence of causal associations between glycaemia and cognition, structural brain and dementia phenotypes.AbbreviationsAlzheimer’s dementia (AD)Benjamini-Hochberg false discovery rate (BH-FDR)Genome-wide association study (GWAS)Hippocampal volume (HV)Hospital episode statistics (HES)International Classification of Diseases (ICD)Inverse variance weighted (IVW)Magnetic resonance imaging (MRI)Mendelian randomization (MR)Quality control (QC)Reaction time (RT)Simulation extrapolation (SIMEX)UK Biobank (UKB)Visual memory (VM)Weighted median Estimator (WME)White matter hyperintensity volume (WMHV)
Text Mining Approach to Analyze Coronavirus Impact: Mexico City as Case of Study
Authors: Saire Josimar Edinson Chire , Pineda Briseño Anabel 
Published: May 2020

AbstractThe epidemiological outbreak of a novel coronavirus (2019-nCoV or Covid-19) in China, and its rapid spread, gave rise to the first pandemic in the digital age. Derived from this fact that has surprised humanity, many countries started with different strategies in order to stop the infection. In this context, one of the greatest challenges for the scientific community is monitoring (real time) the global population to get immediate feedback of what is happening with the people during this public health contingency. An alternative interesting and affordable for the materialization of the aforementioned are the social networks. In a social network, the persons can act as sensors/information not only of personal data but also data derived from their behavior. This paper aims to analyze the publications of people in Mexico using a Text Mining approach. Specifically, Mexico City is presented as a case study to help understand the impact on society of the spread of Covid-19.
Early outcomes of tocilizumab in adults hospitalized with severe COVID-19 - The Vall d’Hebron COVID-19 prospective cohort study
Authors: Sánchez-Montalvá Adrián , Sellarés-Nadal Júlia , Espinosa-Pereiro Juan , Fernández-Hidalgo Nuria , Pérez-Hoyos Santiago , Salvador Fernando , Durà Xavier , Miarons Marta , Antón Andrés , Eremiev-Eremiev Simeón , Sempere-González Abiu , Monforte-Pallarés Arnau , Bosch-Nicolau Pau , Augustin Salvador , Sampol Júlia , Guillén-del-Castillo Alfredo , Almirante Benito 
Published: May 2020

ABSTRACTBackgroundModulation of the immune system to prevent lung injury is being widely used against the new coronavirus disease (COVID-19) despite the scarcity of evidence.MethodsWe report the preliminary results from the Vall d’Hebron prospective cohort study at Vall d’Hebron University Hospital, in Barcelona (Spain), including all consecutive patients who had a confirmed infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and who were treated with tocilizumab until March 25th. The primary endpoint was mortality at 7 days after tocilizumab administration. Secondary endpoints were admission to the intensive care unit, development of ARDS and respiratory insufficiency among others.Results82 patients with COVID-19 received at least one dose of tocilizumab. The mean (± SD) age was 59.1 (19.8) years, 63% were male, 22% were of non-Spanish ancestry, and the median (IQR) age-adjusted Charlson index at baseline was 3 (1-4) points. Respiratory failure and ARDS developed in 62 (75.6%) and 45 (54.9%) patients, respectively. Median time from symptom onset to ARDS development was 8 (5-11) days. The median time from symptom onset to the first dose of tocilizumab was 9 (7-11) days. Mortality at 7 days was 26.8%. Hazard ratio for mortality was 3.3; 95% CI, 1.3 to 8.5 (age-adjusted hazard ratio for mortality 2.1; 95% CI, 0.8 to 5.8) if tocilizumab was administered after the onset of ARDS.ConclusionTime from lung injury onset to tocilizumab administration may be critical to patient recovery. Our preliminary data could inform bedside decisions until more data from clinical trials becomes available.Summary of the article’s main pointIn patient with COVID-19 and lung injury, time from lung injury onset to tocilizumab administration may be critical to patient recovery. Early administration of host-directed therapies may improve patient outcome.