bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reimagining Physician Assistant Education
Authors: Hills Karen , VanderMeulen Stephane , Snyder Jennifer A. , Kohlhepp William , Alexander Lisa Mustone , Lane Steven 
Published: August 2020

Abstract
The physician assistant (PA) profession has successfully flourished for over 50 years, demand for graduates remains strong, and there is a wealth of research on the quality of care that PA graduates provide. Nevertheless, health care and education are constantly changing, and we must change with them. We must continually scan the horizon and consider how best to adapt to current issues like the clinical sites crisis, as well as evolutions in technology, pedagogy, and in our students themselves. The Physician Assistant Education Association Presidents Commission, a group of past presidents, sought to stimulate a conversation on “reimagining PA education” through the lens of advances in our knowledge of the neuroscience of learning and changes in technology, including simulation, and a broader focus on innovation and “thinking outside the box.” Through interviews with PA faculty and leaders, we provide some examples of areas of innovation in education, especially on the possibilities presented by a more flexible approach to innovation from the accreditation body than many PA faculty might perceive. One initial conclusion is that PA educators should focus more on helping students to “think like clinicians” from the start of their education. This paper is primarily intended to stimulate dialog, and we encourage all PA educators to form—and more importantly, share—their own thoughts and questions, through the PAEA professional learning communities and Digital Learning Hub (PAEAlearning.org/learn/digital-learning-hub/).
Intraoperative Electrocochleography of Posterior Fossa Tumors Producing Menière's Syndrome
Authors: Varadarajan Varun V. , Riggs Willian J. , Hiss Meghan M. , Moberly Aaron C. , Dodson Edward E. , Adunka Oliver F. , Mattingly Jameson K. 
Published: August 2020

Objectives:
Intraoperative electrocochleography (ECochG) has provided insight regarding inner ear pathophysiology during neurotologic procedures. In this study, intraoperative ECochG findings are reported in patients who presented with episodic aural and vestibular symptoms during resection of posterior fossa neoplasms.

Patients:
Three patients with episodic vertigo who underwent resection of posterior fossa tumors.

Intervention:
Intraoperative ECochG was performed before and after tumor resection with the active electrode at the round window. Acoustic stimuli consisted of click and tone bursts presented in alternating polarity.

Main Outcome Measure:
ECochG responses including summation potential (SP), action potential (AP), and SP:AP ratio values to evaluate for endolymphatic hydrops.

Results:
All subjects presented with asymmetric sensorineural hearing loss (SNHL), episodic vertigo, and tinnitus. Subject 1 was a 63-year-old woman who underwent left translabyrinthine excision of an endolymphatic sac (ELS) tumor and demonstrated no measurable responses until fenestration of the lateral semicircular canal, suggesting severe hydrops relieved by labyrinthotomy. Subject 2 was a 44-year-old woman who underwent right ELS tumor resection and exhibited an elevated SP:AP ratio. Subject 3 was a 55-year-old woman who underwent right retrolabyrinthine resection of a meningioma and exhibited robust responses without hydrops.

Conclusions:
Endolymphatic hydrops secondary to mechanical obstruction by a posterior fossa neoplasm may be demonstrated using intraoperative ECochG. Immediate improvement of hydrops may not be demonstrated after tumor resection.
Noise Damage Accelerates Auditory Aging and Tinnitus: A Canadian Population-Based Study
Authors: Jafari Zahra , Copps Thomas , Hole Glenn , Kolb Bryan E. , Mohajerani Majid H. 
Published: August 2020

Objective:
Age-related hearing loss (ARHL) is the third most challenging disability in older adults. Noise is a known modifiable risk factor of ARHL, which can drive adverse health effects. Few large-scale studies, however, have shown how chronic noise exposure (CNE) impacts the progression of ARHL and tinnitus.

Study Design:
Retrospective large-scale study.

Setting:
Audiology clinical practice.

Patients:
In this study, 928 individuals aged 30-100 years without (n=497) or with the experience of CNE (n=431) were compared in their hearing assessments and tinnitus. In order to only investigate the impact of CNE on ARHL and tinnitus, people with other risk factors of hearing loss were excluded from the study.

Intervention:
Diagnostic.

Main Outcome Measures:
Noise damage was associated with a greater ARHL per age decades (pure-tone average(PTA)0.5-4kHz alterations 19.6-70.8 dB vs. 8.0-63.2 dB, ≤0.001), an acceleration of developing a significant ARHL at least by two decades (PTA0.5-4kHz 33.4 dB at 50-59yr vs. 28.2 dB at 30-39yr, ≤0.001), and an increased loss of word recognition scores (total average 84.7% vs. 80.0%, ≤0.001). Significant noise-associated growth in the prevalence of tinnitus also was shown, including more than a triple prevalence for constant tinnitus (28.10% vs. 8.85%, ≤0.001) and near to a double prevalence for intermittent tinnitus (19.10% vs. 11.10%, ≤0.001). Noise also resulted in the elevation of the static compliance of the tympanic membrane throughout age (total average 0.61 vs. 0.85 mmho, ≤0.001).

Conclusions:
Our findings emphasize the significant contribution of CNE in auditory aging and the precipitation of both ARHL and tinnitus.
Clinical Nurse Specialists' Perceptions of Transitioning Into a Rural Community-Based Transitional Care Role
Authors: Cross Kristi L. , Johnson Paula , Allard Billie Lynn , Shuman Clayton J. 
Published: August 2020

OBJECTIVE
The aim of this study was to understand the experiences of nurses making the role transition from clinical nurse specialists (CNSs) (hospital based) into transitional care nurse (TCN) roles (community based).

BACKGROUND
The shift from fee-for-service to value-based care has led to the development of transitional care programs. However, little is known about the perceptions of nurses transitioning from a hospital- to a community-based position. Their perceptions can inform training and future recommendations for the TCN role.

METHODS
Five of 6 eligible TCNs from a community rural hospital in Vermont who transitioned from a CNS role to a TCN role participated in individual, face-to-face interviews using a semistructured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the constant comparative method.

RESULTS
Seven major themes were identified: enhanced patient-centered care, collaboration among the other TCNs, transitioning from expert to novice, recommendations for navigating and negotiating systems, discomfort with the role transition, a level of altruism and autonomy, and recommendations for improving the TCN role. Minor themes supported the major themes.

CONCLUSIONS
Our findings provide implications to improve the transitions of CNSs into a TCN role. Transitional care nurse programs are essential in transitioning individuals from hospital to home. To achieve maximum benefit from TCN programs and ensure their sustainability, nursing leaders must address gaps in both community resources and TCN training.
Connecting Patients' Perceptions of Nurses' Daily Care Actions, Organizational Human Caring Culture, and Overall Hospital Rating in Hospital Consumer Assessment of Healthcare Providers and Systems Surveys
Authors: Wei Holly , Oehlert Julie Kennedy , Hofler Linda , Hill Kevin N. 
Published: August 2020

OBJECTIVE
The aim of this study was to connect patients' perceptions of nurses' daily care actions with patients' overall ratings of their hospital experience and hospitals' human caring culture.

BACKGROUND
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey measuring patients' hospital experience. Current literature lacks the connections between patients' perceptions of nurses' daily care actions and their overall hospital experience measured by the HCAHPS survey.

METHODS
This is a correlational study based on the HCAHPS surveys from patients discharged from a hospital in the United States. Correlations were conducted between patients' perceptions of nurses' daily care actions and overall hospital experience.

RESULTS
A total of 3,258 (16.6%) patients returned the HCAHPS survey between January and May 2019. Significant relationships were found among patients' perceptions of nurses' daily care actions, hospitals' caring culture, and overall experience.

CONCLUSION
Nurses' daily care actions significantly contribute to favorable patients' overall hospital ratings on HCAHPS.
Can Machine Learning Help Identify Patients at Risk for Recurrent Sexually Transmitted Infections?
Authors: Elder Heather R. , Gruber Susan , Willis Sarah J. , Cocoros Noelle , Callahan Myfanwy , Flagg Elaine W. , Klompas Michael , Hsu Katherine K. 
Published: August 2020

Background
A substantial fraction of sexually transmitted infections (STIs) occur in patients who have previously been treated for an STI. We assessed whether routine electronic health record (EHR) data can predict which patients presenting with an incident STI are at greatest risk for additional STIs in the next 1 to 2 years.

Methods
We used structured EHR data on patients 15 years or older who acquired an incident STI diagnosis in 2008 to 2015 in eastern Massachusetts. We applied machine learning algorithms to model risk of acquiring ≥1 or ≥2 additional STIs diagnoses within 365 or 730 days after the initial diagnosis using more than 180 different EHR variables. We performed sensitivity analysis incorporating state health department surveillance data to assess whether improving the accuracy of identifying STI cases improved algorithm performance.

Results
We identified 8723 incident episodes of laboratory-confirmed gonorrhea, chlamydia, or syphilis. Bayesian Additive Regression Trees, the best-performing algorithm of any single method, had a cross-validated area under the receiver operating curve of 0.75. Receiver operating curves for this algorithm showed a poor balance between sensitivity and positive predictive value (PPV). A predictive probability threshold with a sensitivity of 91.5% had a corresponding PPV of 3.9%. A higher threshold with a PPV of 29.5% had a sensitivity of 11.7%. Attempting to improve the classification of patients with and without repeat STIs diagnoses by incorporating health department surveillance data had minimal impact on cross-validated area under the receiver operating curve.

Conclusions
Machine algorithms using structured EHR data did not differentiate well between patients with and without repeat STIs diagnosis. Alternative strategies, able to account for sociobehavioral characteristics, could be explored.
Evaluation of Training Gaps Among Public Health Practitioners in Washington State
Authors: Sainkhuu Solongo , Cunha-Cruz Joana , Rogers Megan , Knerr Sarah , Bekemeier Betty 
Published: August 2020

Context:
Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce.

Objective:
Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics.

Design:
We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016.

Respondents and Setting:
Employees from governmental local, state, and nonjurisdictional public health departments in Washington State.

Main Outcome Measures:
Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their “training confidence” and “training need.” For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%.

Results:
The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services.

Conclusions:
We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.
The Effectiveness of Community-based Outreach Events for the Promotion of African American Research Participation
Authors: Bardach Shoshana H. , Barber Justin M. , Schmitt Frederick A. , Van Eldik Linda J. , Boggess Morgan B. , Yarbrough Markeda , Jones Keisha C. , Jicha Gregory A. 
Published: August 2020

Introduction:
African Americans (AA) are disproportionately affected by Alzheimer’s disease and related dementias yet are under-represented in clinical research. Outreach events for AA are offered to encourage research participation; however, this approach’s effectiveness remains largely unexplored.

Methods:
To explore the effectiveness of AA-focused versus general audience events, the authors examined attendance data over 5 years, encompassing 10 general audience events and 4 events focused on AA. For each individual, the authors searched center records for recruitment contacts and research enrollment. Summary scores for attendance at AA-focused events, general audience events, and total events were compared between those with and without research involvement.

Results:
Out of 773 unique AA that attended ≥1 event, 88 became or were involved in research (11.4% engagement). AA-focused events achieved greater AA attendance than general audience events. Although research-engaged individuals were more likely to have ever attended an AA-focused event than a general audience event, attendance at AA-focused events did not statistically relate to research engagement. In contrast, attendance at events focused on the general public was related to an increased likelihood of research participation.

Discussion:
These findings have important implications for designing and implementing community events to encourage AA research participation.
Optical Flow Estimation Improves Automated Seizure Detection in Neonatal EEG
Authors: Martin Joel R. , Gabriel Paolo G. , Gold Jeffrey J. , Haas Richard , Davis Suzanne L. , Gonda David D. , Sharpe Cynthia , Wilson Scott B. , Nierenberg Nicolas C. , Scheuer Mark L. , Wang Sonya G. 
Published: August 2020

Purpose:
Existing automated seizure detection algorithms report sensitivities between 43% and 77% and specificities between 56% and 90%. The algorithms suffer from false alarms when applied to neonatal EEG because of the high degree of nurse handling and rhythmic patting used to soothe neonates. Computer vision technology that quantifies movement in real time could distinguish artifactual motion and improve automated neonatal seizure detection algorithms.

Methods:
The authors used video EEG recordings from 43 neonates undergoing monitoring for seizures as part of the NEOLEV2 clinical trial. The Persyst neonatal automated seizure detection algorithm ran in real time during study EEG acquisitions. Computer vision algorithms were applied to extract detailed accounts of artifactual movement of the neonate or people near the neonate though dense optical flow estimation.

Results:
Using the methods mentioned above, 197 periods of patting activity were identified and quantified, of which 45 generated false-positive automated seizure detection events. A binary patting detection algorithm was trained with a subset of 470 event videos. This supervised detection algorithm was applied to a testing subset of 187 event videos with 8 false-positive events, which resulted in a 24% reduction in false-positive automated seizure detections and a 50% reduction in false-positive events caused by neonatal care patting, while maintaining 11 of 12 true-positive seizure detection events.

Conclusions:
This work presents a novel approach to improving automated seizure detection algorithms used during neonatal video EEG monitoring. This artifact detection mechanism can improve the ability of a seizure detector algorithm to distinguish between artifact and true seizure activity.
DNA methylation signatures of C-reactive protein associations with structural neuroimaging measures and major depressive disorder
Authors: Green Claire , Shen Xueyi , Stevenson Anna J. , Conole Eleanor L.S. , Harris Mathew A. , Barbu Miruna C. , Hawkins Emma L. , Adams Mark J. , Lawrie Stephen M. , Evans Kathryn L. , Walker Rosie M. , Morris Stewart W. , Porteous David J. , Wardlaw Joanna M. , Steele J Douglas , Waiter Gordon D. , Sandu Anca-Larisa , Campbell Archie , Marioni Riccardo E. , Cox Simon R. , Cavanagh Jonathan , McIntosh Andrew M. , Whalley Heather C. 
Published: August 2020

AbstractBackgroundInflammatory processes are implicated in the aetiology of Major Depressive Disorder (MDD); however, the relationship between peripheral inflammation, brain structure and depression remains unclear. This study investigates associations between depression, structural neuroimaging measures and two measures of inflammation: serum-based C-reactive protein (CRP) and a methylation-based score for CRP (DNAm CRP) in a large community-based sample.MethodsSerum CRP and DNAm CRP were assessed for participants in Generation Scotland (NMDD cases = 240, Ncontrols = 558) alongside structural brain scans (T1 and diffusion MRI). Linear regression was used to investigate associations between (i) both CRP measures and depressive symptoms, (ii) both CRP measures and structural imaging variables and (iii) inflammation x MDD interaction effects (for both CRP measures) with imaging measures.ResultsIncreased serum CRP was significantly associated with overall MDD symptom severity and specifically with somatic symptoms-general interest (β= 0.145, PFDR = 6×10-4) and energy levels (β= 0.101, PFDR = 0.027) and also reduced entorhinal cortex thickness (β= – 0.095, PFDR = 0.037). DNAm CRP was significantly associated with reduced global grey matter/cortical volume and reduced integrity of 16 white matter tracts and showed larger effect sizes (βaverage = −0.15) compared to serum CRP across all measures (βaverage = 0.01).ConclusionsAcute measures of CRP were related to current depression symptoms, specifically somatic symptoms, whereas methylation signatures of inflammation demonstrated greater differences in global and regional brain structure. This study highlights the utility of combining serological and methylation markers to study chronic inflammation effects on the brain in psychiatric disorders.
Investigation into Quality of Life and Psychological Status of Different Populations during COVID-19: A study concerning Surrounding Areas of Wuhan
Authors: Liu Zheng , Mu Jingsong , Fan Wenxiang 
Published: August 2020

ObjectiveTo investigate different populations’ quality of life and psychological status in surrounding areas of Wuhan during COVID-19 pandemic.MethodsThe data of 248 residents living in Anhui from February 4 to 6 of 2020 were collected through network surveys including age, gender, occupation, the World Health Organization Quality of Life measurement Scale short form (World Health Organization Quality of Life instrument brief, WHOQOL BREF), Zung Self-rating Anxiety Scale (Self-rating Anxiety Scale, SAS and Zung Self-Rating Depression Scale (SDS). Those surveyed, divided into two groups: medical staff (129 cases) and nonmedical staff (119 cases), were made statistic analysis according to the factors mentioned above.ResultsThe WHOQOL-BREF of medical staff in this region was lower than that of nonmedical staff in the fields of physiology, psychology, social relations, and environment, among whom female medical staff scored significantly lower than that of male medical staff in four fields. There was no significant statistical difference in SAS and SDS scores between the two groups, and gender had no significant influence on SAS and SDS scores of medical staff.ConclusionDuring the COVID-19 pandemic, medical staff enjoyed a lower quality of life in surrounding areas of Wuhan than that of nonmedical staff, and female medical staff even lower, which should arouse social concerns.
COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis
Authors: Chang Raymond , Elhusseiny Khaled Mossad , Yeh Yu-Chang , Sun Wei-Zen 
Published: August 2020

ABSTRACTBackgroundInsight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning.Methods and FindingsElectronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12-0.34] and 69% of cases needed IMV [95% CI 0.61-0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25-0.32], 43% [95% CI 0.29-0.58] and ICU, IMV duration was 7.78 [95% CI 6.99-8.63] and 10.12 [95% CI 7.08-13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37-61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52-102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66-16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes.ConclusionsThis is the most comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes to date and the only analysis to implicate IMV’s associtaion with COVID-19 ICU mortality. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as research into optimal ventilation strategies for patients. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.