bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insomnia in the context of short sleep increases suicide risk
Authors: Anna Karin Hedström , Hössjer Ola , Bellocco Rino , Ye Weimin , Trolle Lagerros Ylva , Åkerstedt Torbjörn 
Published: November 2020

Abstract

Study Objectives
The relationship between insomnia and suicide risk is not completely understood. We aimed to investigate the influence of insomnia on suicide risk, taking both sleep duration and depression into consideration.

Methods
The present study is based on a Swedish prospective cohort study of 38,786 participants with a mean follow-up time of 19.2 years. Cox proportional hazards models with attained age as time-scale were used to estimate hazard ratios (HRs) of death by suicide with 95% confidence intervals (CI) for participants categorized by frequency of insomnia symptoms. Causal mediation analysis was performed to assess to what extent the relationship between insomnia and suicide risk is mediated by depression.

Results
Insomnia was only associated with suicide risk among short sleepers, whereas no significant association was observed among those who slept 7 h/night or more. The total effect of insomnia in the context of short sleep on suicide risk, expressed on the HR scale, was 2.85 (95% CI 1.42–5.74). The direct effect was 2.25 (95% CI 1.12–4.54) and the indirect effect, mediated by depression, was 1.27 (95% CI 1.05–1.53). Of the total effect, 32% was mediated by depression. The association between insomnia and suicide risk became more pronounced with decreasing depressive symptoms (p value for trend &lt;0.05).

Conclusions
Insomnia in the context of short sleep increases suicide risk, both directly and indirectly by affecting the risk of depression. Abnormalities of sleep duration and insomnia symptoms should be evaluated when assessing suicide risk.
Determinants of postpartum sleep duration and sleep efficiency in minority women
Authors: Spaeth Andrea M , Khetarpal Risha , Yu Daohai , Pien Grace W , Herring Sharon J 
Published: November 2020

Abstract

Study Objectives
To examine demographic, psychosocial, and behavioral determinants of postpartum sleep duration and sleep efficiency among a cohort of black and Latina women.

Methods
Data were from 148 women (67% black, 32% Latina) at 5 months postpartum, recruited from an academic medical center in Philadelphia. Relevant demographic, psychosocial and behavioral predictors were assessed via questionnaire. Nocturnal sleep was objectively measured for 1 week using wrist actigraphy. Sleep duration was examined as a continuous variable and in categories (&lt;7 versus ≥7 h per night); sleep efficiency was examined as a continuous variable. Independent multiple linear regression models were built to evaluate significant determinants of sleep.

Results
Adjusted models revealed that breastfeeding, having a bedtime after midnight, and being employed were associated with shorter sleep duration (–25–33 min, all p &lt; 0.05). Multiparity, being unmarried, being employed, breastfeeding, having a bedtime after midnight, bedsharing, and responding to infant awakenings by getting up immediately rather than waiting a few minutes to see if the infant fell back asleep, were all significant determinants of sleeping &lt;7 h per night (OR varying: 2.29–4.59, all p &lt; 0.05). Bedsharing was the only variable identified from the multiple regression model that associated with poorer sleep efficiency (–3.8%, p &lt; 0.05).

Conclusions
Findings may inform interventions for improving postpartum sleep in socioeconomically disadvantaged, racial/ethnic minority postpartum women.
Cross-participant prediction of vigilance stages through the combined use of wPLI and wSMI EEG functional connectivity metrics
Authors: Imperatori Laura Sophie , Cataldi Jacinthe , Betta Monica , Ricciardi Emiliano , Ince Robin A A , Siclari Francesca , Bernardi Giulio 
Published: November 2020

AbstractFunctional connectivity (FC) metrics describe brain inter-regional interactions and may complement information provided by common power-based analyses. Here, we investigated whether the FC-metrics weighted Phase Lag Index (wPLI) and weighted Symbolic Mutual Information (wSMI) may unveil functional differences across four stages of vigilance—wakefulness (W), NREM-N2, NREM-N3, and REM sleep—with respect to each other and to power-based features. Moreover, we explored their possible contribution in identifying differences between stages characterized by distinct levels of consciousness (REM+W vs. N2+N3) or sensory disconnection (REM vs. W). Overnight sleep and resting-state wakefulness recordings from 24 healthy participants (27 ± 6 years, 13F) were analyzed to extract power and FC-based features in six classical frequency bands. Cross-validated linear discriminant analyses (LDA) were applied to investigate the ability of extracted features to discriminate (1) the four vigilance stages, (2) W+REM vs. N2+N3, and (3) W vs. REM. For the four-way vigilance stages classification, combining features based on power and both connectivity metrics significantly increased accuracy relative to considering only power, wPLI, or wSMI features. Delta-power and connectivity (0.5–4 Hz) represented the most relevant features for all the tested classifications, in line with a possible involvement of slow waves in consciousness and sensory disconnection. Sigma-FC, but not sigma-power (12–16 Hz), was found to strongly contribute to the differentiation between states characterized by higher (W+REM) and lower (N2+N3) probabilities of conscious experiences. Finally, alpha-FC resulted as the most relevant FC-feature for distinguishing among wakefulness and REM sleep and may thus reflect the level of disconnection from the external environment.
Mapping Africa’s Biodiversity: More of the Same Is Just Not Good Enough
Authors: Farooq Harith , Azevedo Josué A R , Soares Amadeu , Antonelli Alexandre , Faurby Søren 
Published: November 2020

AbstractSpecies distribution data are fundamental to the understanding of biodiversity patterns and processes. Yet, such data are strongly affected by sampling biases, mostly related to site accessibility. The understanding of these biases is therefore crucial in systematics, biogeography, and conservation. Here we present a novel approach for quantifying sampling effort and its impact on biodiversity knowledge, focusing on Africa. In contrast to previous studies assessing sampling completeness (percentage of species recorded in relation to predicted), we investigate whether the lack of knowledge of a site attracts scientists to visit these areas and collect samples of species. We then estimate the time required to sample 90% of the continent under a Weibull distributed biodiversity sampling rate and the number of sampling events required to record $ \ge $50% of the species. Using linear and spatial regression models, we show that previous sampling has been strongly influencing the resampling of areas, attracting repeated visits. This bias has existed for over two centuries, has increased in recent decades, and is most pronounced among mammals. It may take between 172 and 274 years, depending on the group, to achieve at least one sampling event per grid cell in the entire continent. Just one visit will, however, not be enough: in order to record $ \ge $50% of the current diversity, it will require at least 12 sampling events for amphibians, 13 for mammals, and 27 for birds. Our results demonstrate the importance of sampling areas that lack primary biodiversity data and the urgency with which this needs to be done. Current practice is insufficient to adequately classify and map African biodiversity; it can lead to incorrect conclusions being drawn from biogeographic analyses and can result in misleading and self-reinforcing conservation priorities. [Amphibians; birds; mammals; sampling bias; sampling gaps; Wallacean shortfall.]
Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema
Authors: Sibbald R. Gary , Elliott James A. , Coutts Patricia , Persaud-Jaimangal Reneeka 
Published: November 2020

ABSTRACT

BACKGROUND
Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control.

METHODS
Two systems were evaluated for control of bilateral or unilateral lower limb edema: an elasticized longitudinal stockinette (ELS; EdemaWear; Compression Dynamics, Omaha, Nebraska) and an elasticized tubular bandage (ETB; Tubigrip; Mölnlycke Health Care, Norcross, Georgia). Twenty-five patients were recruited; patients with bilateral edema (n = 12) wore the ELS on one limb, and the ETB on the other. Patients with unilateral edema (n = 13) were randomized to wear either the ELS or ETB. Edema measurements, leg pain, and patient preference were recorded.

RESULTS
There were 14 females (56%) and 11 males (44%); mean age was 66 years (range, 32-88 years); and mean body mass index was 40.4 kg/m2 (range, 26.1–66.9 kg/m2). Patients with bilateral edema wearing ELS had a foot-to-leg circumference between 25.5 and 42.9 cm pre-ELS that remained essentially unchanged at 2 weeks. The five patients with unilateral edema using ELS had a 24.3– to 43.7-cm circumference pre-ELS and 24.2- to 42.6-cm range at 2 weeks. The patients with bilateral edema using ETBs had a foot-to-leg circumference of 25.5 to 43.7 cm before treatment, unchanged 2 weeks later. The eight patients with unilateral edema using ETB had a 25.4- to 45.3-cm circumference pre-ETB and 24.8– to 42.0-cm range post-ETB. Mean pain levels decreased from 1.0 at week 0 to 0.5 at week 2. More patients preferred ELS (17/23, 78.3%) over ETB (5/23, 21.7%).

CONCLUSIONS
Both systems were easy to apply and provided low compression without increased pain. The ELS was preferred by more patients (78.3%) than ETB (21.7%).
Conservative Management of Catastrophic Antiphospholipid Syndrome-Related Skin Necrosis: A Case Report
Authors: Niu Niu , Jiang Qixia , Cheng Dongrui , Wang Zhongling 
Published: November 2020

ABSTRACT
Catastrophic antiphospholipid syndrome is an extremely rare autoimmune disease with complex and diverse clinical manifestations. Cutaneous necrosis is one of its rare clinical features. However, interventions for this manifestation are not standardized and lack evidence, which increases treatment difficulty. Here, study authors report the successful care and follow-up of a 46-year-old female patient with nephrotic syndrome and catastrophic antiphospholipid syndrome complicated by full-thickness cutaneous necrosis of the dorsum of the right hand that lasted more than 4 months and 1 month prior to wound treatment, respectively. Study authors set up an interprofessional team, including a nephrologist, a vascular surgeon, and two specialist wound care nurses to provide holistic wound care and treat her complex systemic conditions. After 84 days of treatment, which involved removing necrotic tissue with autolytic wound debridement, reducing inflammation with hydrofiber dressings containing silver, and promoting re-epithelialization with hydrocolloid paste and systemic medications, the wound healed successfully. Authors followed up with the patient at 1, 4, 6, 11, and 19 months after healing. The quality of scar was monitored, and the function of her right hand recovered normally.
COVID-19
Authors: Rogge Mary Madeline , Gautam Bibha 
Published: November 2020

Abstract:
In 2019, a novel coronavirus infection was detected in humans. As coronavirus disease 2019 (COVID-19) spread around the world, often confusing and contradictory information about the disease proliferated rapidly. This article reviews what is currently known about COVID-19, including transmission, epidemiology, immunologic responses, clinical manifestations, and disease management.
Characteristics of Women of Reproductive Age With Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status—United States, January 22–June 7, 2020
Authors: Ellington Sascha , Strid Penelope , Tong Van T. , Woodworth Kate , Galang Romeo R. , Zambrano Laura D. , Nahabedian John , Anderson Kayla , Gilboa Suzanne M. 
Published: November 2020

(Abstracted from MMWR Morb Mortal Wkly Rep 2020;69:769–775)
Pregnant women are at greater risk of severe respiratory infection due to immunologic and physiologic changes in the setting of several viral infections such as influenza. However, there are limited data among this population to date that determine the prevalence and severity of COVD-19 and whether its signs and symptoms differ between pregnant and nonpregnant women.
Medical Students’ Reflections on the Recent Changes to the USMLE Step Exams
Authors: Cangialosi Peter T. , Chung Brian C. , Thielhelm Torin P. , Camarda Nicholas D. , Eiger Dylan S. 
Published: November 2020

The United States Medical Licensing Examination (USMLE) consists of Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3. To be licensed to practice medicine in the United States, medical students must pass all parts of the USMLE. However, in addition to that pass/fail grade, students are currently given a numerical score for Step 1, Step 2 Clinical Knowledge, and Step 3. Residency program directors have come to use the Step 1 score to efficiently screen a growing number of residency applicants. As a result, a deleterious environment in undergraduate medical education has been created, given the importance of Step 1 to medical students matching to their preferred residency program. It was announced in February 2020 that the score-reporting protocol for Step 1 would be changed from a 3-digit numerical score to pass/fail only, beginning no earlier than January 1, 2022. This decision will undoubtedly impact medical students, medical schools, and residency program directors.
Here, the authors discuss the impact that the change to Step 1 scoring will have on these key stakeholder groups, from their perspective as students at MD-granting medical schools in the United States. They also call attention to outstanding issues with the USMLE that must be addressed to improve undergraduate medical education for all stakeholders, and they offer advice for further improvements to the residency application process.
Evaluation of Biomarkers in Critical Care and Perioperative Medicine
Authors: Soussi Sabri , Collins Gary S. , Jüni Peter , Mebazaa Alexandre , Gayat Etienne , Le Manach Yannick 
Published: November 2020

SUMMARY
Interest in developing and using novel biomarkers in critical care and perioperative medicine is increasing. Biomarkers studies are often presented with flaws in the statistical analysis that preclude them from providing a scientifically valid and clinically relevant message for clinicians. To improve scientific rigor, the proper application and reporting of traditional and emerging statistical methods (e.g., machine learning) of biomarker studies is required. This Readers’ Toolbox article aims to be a starting point to nonexpert readers and investigators to understand traditional and emerging research methods to assess biomarkers in critical care and perioperative medicine.
Accuracy of Posterior Wall Acetabular Fracture Lag Screw Placement: Correlation Between Intraoperative Fluoroscopy and Postoperative Computer Tomography
Authors: Rashidifard Christopher , Boudreau John , Revak Thomas 
Published: November 2020

Objective:
Compare intraoperative “on end” fluoroscopy lag screw position to postoperative computer tomography.

Design:
Retrospective review.

Clinical Setting:
Level 1 trauma center.

Patients:
One hundred sixteen patients sustaining operative acetabular fractures with posterior wall components.

Intervention:
Posterior wall lag screws placed using “on end” fluoroscopic imaging.

Main Outcome Measurements:
The primary outcome was determining correlation between lag screw position, in relation to the acetabular articular margin, using intraoperative fluoroscopy and postoperative computer tomography. Analysis was performed based on location around the acetabulum, including posterior (P), superoposterior (SP), and superior (S) regions, and screws 0–5, 5–10, and >10 mm from the joint.

Results:
Two hundred forty-four lag screws were identified as follows: 51.6% in the P group, 25.4% in SP, and 23.0% in the S group with excellent correlation noted in all groups. For screws pooled based on fluoroscopic distance from the joint, 28.3% were 0–5 mm, 52.9% 5.01–10 mm, and 18.4% >10 mm. Correlation coefficients were 0.60 for 0–5 mm and 0.68 for both groups >5 mm. Subdividing screws based on anatomic region and fluoroscopic location found increasing correlation as screws moved further from the joint in the P region. In the SP group, excellent correlation was noted for screws 0–5 mm with decreasing correlation further from the joint. Within the S group, correlation for screws 0–5 mm did not reach significance, but good correlation was noted for screws >5 mm. Overall incidence of intraarticular screws was 1.2%.

Conclusions:
Intraoperative axial fluoroscopy for posterior wall lag screw placement correlates closely with postoperative computer tomography allowing for reliable posterior wall lag screw placement in all regions around the acetabulum. Care should be taken while placing lag screws within 5 mm of the articular surface, particularly within the posterior region.
Pain During Sex Before and After Surgery for Lumbar Disc Herniation
Authors: Holmberg Siril T. , Salvesen Øyvind O. , Vangen-Lønne Vetle , Hara Sozaburo , Fredheim Olav M. , Solberg Tore K. , Jakola Asgeir S. , Solheim Ole , Nygaard Øystein P. , Gulati Sasha 
Published: November 2020

Study Design.
Observational multicenter study.

Objective.
The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH).

Summary of Background Data.
There are limited data available on sexual function in patients undergoing surgery for LDH.

Methods.
Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain.

Results.
Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors.

Conclusion.
This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year.

Level of Evidence: 2
Use of Inhaled Volatile Anesthetics for Longer Term Critical Care Sedation: A Pilot Randomized Controlled Trial
Authors: Jerath Angela , Wong Kelvin , Wasowicz Marcin , Fowler Tara , Steel Andrew , Grewal Deep , Huszti Ella , Parotto Matteo , Zhang Haibo , Wilcox M. Elizabeth , McDonald Bernard , Overgaard Christopher , Rao Vivek , Ferguson Niall D. 
Published: November 2020

Objectives:
Assess feasibility, barriers to recruitment, and safety of volatile-based sedation in longer term sedation patients in North American ICUs with limited or no experience with volatile sedation.

Design:
Open-label, pilot randomized clinical trial performed between October 2013 and September 2018.

Setting:
Four Canadian ICUs across two academic tertiary and quaternary hospitals.

Patients:
Sixty adults anticipated needing sedation and invasive ventilation beyond 48 hours with tidal volumes greater than 350 mL, expected 6-month mortality risk less than 50%, no evidence of high intracranial pressure, or drug contraindications (malignant hyperthermia, allergy).

Interventions:
2:1 randomization to inhaled volatile sedation using isoflurane or standard midazolam and/or propofol IV sedation.

Measurement and Main Results:
Primary outcome of safety and feasibility was assessed by staff satisfaction scores using a five-point Likert scale and serum fluoride measurements. Secondary clinical outcomes included time to extubation, quality of sedation, opioid use, cardiorespiratory parameters, vasopressor and antipsychotic drug use, and 3-month cognitive outcome measured using telephone interview for cognitive status. From 2,210 screened patients, 308 met eligibility criteria secondary to many not requiring sedation, extubation planned within 48 hours, high risk of death, or low tidal ventilation. Of 308 patients, 60 were randomized to isoflurane (n = 41) or IV (n = 19) sedation secondary to lack of substitute decision-maker or physician consent. Duration of inhaled isoflurane and IV sedation were median of 114 and 88 hours, respectively. Nine isoflurane patients crossed into the IV arm secondary to mainly hypercarbia from low tidal ventilation. Nursing and respiratory therapy staff satisfaction scores were quantitatively similar between both sedation approaches. Serum fluoride levels rose with duration of isoflurane sedation but were not associated with altered kidney function. There were no significant differences in secondary clinical outcomes.

Conclusions:
We showed adequate preliminary safety and acceptability of inhaled volatile anesthetics for long-term sedation.
Penn Medicine Lancaster General Health’s Ambulatory Care Evolution
Authors: Bergen Jan L. , Wynne Susan 
Published: November 2020

SUMMARY
Hospital and health system leaders alike are increasing their efforts to implement an ambulatory care strategy. The move is understandable: Innovative and well-funded competitors are entering their markets, payers are demanding lower-cost options, and patients are seeking affordability and convenience.
Healthcare organizations must consider several imperatives when identifying a long-term ambulatory strategy that is both successful and sustainable. The rise of value-based care and emerging market and competitive trends are among the important considerations that call for a strategy that is affordable, responds to consumer expectations, and ensures that care is coordinated and optimal.
Penn Medicine Lancaster General Health (LG Health) strategically transformed its ambulatory services over three decades. Early on, the system focused on providing services in and around its urban flagship hospital. Increased competition, new technologies, market growth, and other influences eventually led the system to expand its depth and breadth while aggregating many of its ambulatory services in a single suburban location designed to optimize efficiency, prioritize clinical coordination, and enhance patient and physician satisfaction.
The system built on that foundation by creating a network of ambulatory locations featuring four service delivery models. Each features distinct facility sizes, physician types, patient groups, and services. In addition, LG Health continues to build the technological and operational capabilities to deliver telehealth services that have become more established in the wake of the COVID-19 pandemic.
The investments made, experiences studied, and lessons learned by LG Health since 1990 and during the uncertain course of the current pandemic continue to guide its ambulatory strategy.