bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Guarding on the Outcomes of the 6-Minute Walk Test
Authors: Lefebvre Kristin , Wellmon Robert , Bartlo Pamela , Bednarek Melissa , Hoffman Julie , Karnes James , Vandenberg Lyndsey 
Published: April 2020

Introduction:
The American Thoracic Society recommends not walking with the client during the 6-minute walk test (6MWT). This recommendation raises safety concerns for individuals at increased risk of falls. To date, the effects of guarding during the 6MWT have not been investigated.

Purpose:
The purpose of this study was to determine whether guarding during the 6MWT affected gait velocity and distance walked.

Methods:
This multicenter study collected data from healthy younger (n = 103, 24.2 ± 3.4 yr) and older adults (n = 102, 71.1 ± 11.3 yr) who performed 2 consecutive 6MWT trials. Participants were randomized into a “guarded first” versus “guarded second” condition. Data were analyzed using a one-sample t test, intraclass correlation coefficients (ICCs), and Bland–Altman plots.

Results:
Guarding significantly decreased (P < .001) the distance walked (mean difference = 13.5 ± 40.3 m, 95% limits of agreement [LOA] = 65.5 and −92.4 m) and gait velocity (mean difference = 0.04 ± 0.11 m/sec, 95% LOA = 0.26 and −0.18 m/sec). Guarding decreased distance walked and velocity when divided into an older and younger group as well but had a more significant impact in the younger grouping.

Conclusions:
Guarding during the 6MWT influenced walking distance. Findings suggest that the measurements under the 2 walking conditions are not interchangeable.
Anakinra in Recurrent Pericarditis: Current Evidence on Clinical Use, Effectiveness, and Safety
Authors: Correia Eduardo Thadeu de Oliveira , dos Santos Barbetta Letícia Mara , de Almeida João Paulo Chevrand Latini , Mesquita Evandro Tinoco 
Published: April 2020

Abstract:
Anakinra is a recombinant human interleukin 1 receptor antagonist that competes and blocks the biologic effects of interleukin 1, reducing systemic inflammatory responses. In the 2015 guidelines for the diagnosis and management of pericardial diseases of the European Society of Cardiology, anakinra was established as a third-line therapy option for refractory recurrent pericarditis (RP). Recently, important studies that investigates the effect and safety of anakinra in RP were published, such as the AIRTRIP trial and the International Registry of Anakinra for Pericarditis. This article presents the current evidence about the effectiveness and safety of anakinra in RP and discusses its clinical application and mechanisms.
An Individualized Patient-centric Approach and Evolution towards Total Autologous Free Flap Breast Reconstruction in an Academic Setting
Authors: Haddock Nicholas Till , Suszynski Thomas Mark , Teotia Sumeet Sorel 
Published: April 2020

Summary:
Advances with newer perforator flaps and complex microsurgical techniques have enabled creative solutions in autologous breast reconstruction. For patients seeking total autologous breast reconstruction without the use of implants, body regions other than the abdomen have emerged to provide a substitute or additional donor tissue. In cases where abdominal perforator flaps are not possible (as with prior abdominoplasty), flaps taken from the lower back or thigh can be used. In situations of inadequate donor tissue in 1 body area, stacked multiple flap reconstruction is possible using donor tissue from multiple areas. In this article, we present our approach for individualizing treatment for breast reconstructive patients seeking to avoid permanent implants. We highlight how free perforator flap selection can not only serve to provide adequate tissue for body-appropriate breast reconstruction but may also be secondarily tailored to provide patient-specific aesthetic body contouring. Our preoperative patient counseling has evolved to involve flap selection based on clinical examination as well as advanced computed tomographic imaging of abdomen, thighs, and lower back. Decision to use 1 or more flaps is based on an assessment of whether the targeted body region(s) provide enough skin and fat for breast reconstruction, if the requisite perforator anatomy is available, and whether the effect of tissue procurement on their individualized aesthetic body contour is optimal.
8.5/8.6-mm Excimer Laser–Assisted Penetrating Keratoplasties in a Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes
Authors: Alfaro Rangel Raul , Szentmáry Nóra , Lepper Sabine , Daas Loay , Langenbucher Achim , Seitz Berthold 
Published: April 2020

Purpose:
To report the indications and outcomes of 8.5/8.6-mm excimer laser–assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center.

Methods:
This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal.

Results:
The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5–1.0), and surface asymmetry index (2.59–1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up.

Conclusions:
In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser–assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.
Update on Idiopathic Canalicular Inflammatory Disease (ICID): Outcomes With Addition of Topical Cyclosporine and the Modified Treatment Protocol
Authors: Ali Mohammad Javed , Bothra Nandini 
Published: April 2020

Purpose:
The objective of this study is to present clinical outcomes with addition of topical cyclosporine while managing cases of “idiopathic canalicular inflammatory disease” and to propose a modified treatment protocol.

Methods:
Prospective case series of 88 canaliculi of 44 eyes of 22 patients diagnosed as “idiopathic canalicular inflammatory disease” at a tertiary care Dacryology service over a period of 2 years. All the patients were diagnosed based on the published major and minor criteria and each of the canaliculus was clinically staged. All patients were treated initially with a combination of topical cyclosporine (0.05%) and rapidly tapering topical steroids followed by punctal dilatation and placement of mini-monoka stents after control of inflammation. Monoka stents were extubated at 6 weeks and the cyclosporine was continued for at least up to 3 months beyond the extubation of stents. Patient demographics, investigations, response to cyclosporine, management modalities, recurrence of inflammation, anatomical and functional outcomes were analyzed.

Results:
Eighty-eight canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (77%, 17/22) and the mean age at presentation was 51 years. All patients presented with bilateral epiphora (mean duration 4.5 months) without any discharge. Staging revealed 18, 27, 24, and 19 canaliculi were involved with stages 1–4, respectively. The mean duration of cyclosporine use was 5.7 months. All patients except 3 (19/22) underwent monoka dilatation. Complete anatomical and functional resolution were noted in 62% (55/88), of which 12 puncta and canaliculi, all stage 1 (13.6%, 12/88) showed complete resolution with cyclosporine alone. Relentless disease progression to stage 5 was noted in 30% (26/88) of the puncta and canaliculi. All the younger patients (<30 years, 13.6%, 3/22) demonstrated poor outcomes.

Conclusions:
The addition of topical cyclosporine is beneficial in controlling inflammation and disease downstaging in patients with idiopathic canalicular inflammatory disease. The current modified treatment protocol salvages majority of the canaliculi.
Unintentional Manganese Delivery in Neonatal Parenteral Nutrition
Authors: Sauberan Jason B. , Katheria Anup C. 
Published: April 2020

ABSTRACTIatrogenic manganese (Mn) neurotoxicity is a safety concern in neonates receiving parenteral nutrition (PN). Prior studies suggest Mn contamination of PN ingredients represents an unintended source of Mn delivery. In order to determine the relative contribution of unsourced Mn to total Mn exposure in neonatal PN, this study measured Mn concentrations in neonatal PN solutions using inductively coupled plasma mass spectrometry. Solutions prepared using a standard fixed dose neonatal multiple trace element product were compared with test solutions prepared using individual trace element ingredients not including Mn. The standard solutions (n = 6) contained a mean (SD) Mn concentration of 56.63 μg/L (0.94), compared with 6.04 μg/L (0.39) in the test solutions without added Mn (n = 6). This study suggests that neonatal PN contains significant quantities of Mn not intentionally added during PN preparation. Further studies are needed to identify individual ingredient sources of unintentional Mn, and the feasibility of Mn omission strategies.
Cultivable Bacteria in Urine of Women With Interstitial Cystitis: (Not) What We Expected
Authors: Jacobs Kristin M. , Price Travis K. , Thomas-White Krystal , Halverson Thomas , Davies Abigail , Myers Deborah L. , Wolfe Alan J. 
Published: April 2020

Objective
Multiple studies show cultivatable bacteria in urine of most women. The existence of these bacteria challenges interstitial cystitis (IC)/painful bladder syndrome (PBS) diagnosis, which presumes a sterile bladder. The aims of this study were (1) to compare the female bladder microbiomes in women with IC/PBS and unaffected controls and (2) to correlate baseline bladder microbiome composition with symptoms.

Methods
This cross-sectional study enrolled 49 IC/PBS and 40 controls. All provided catheterized urine samples and completed validated questionnaires. A subset of the IC/PBS cohort provided voided and catheterized urine samples. All samples from both cohorts were assessed by the expanded quantitative urine culture (EQUC) protocol; a subset was assessed by 16S rRNA gene sequencing.

Results
Of the IC/PBS cohort, 49.0% (24/49) were EQUC positive; in these EQUC-positive samples, the most common urotypes were Lactobacillus (45.8%) and Streptococcus (33.3%). Of the controls, 40.0% were EQUC positive; of these EQUC-positive samples, the most common urotype was Lactobacillus (50.0%). The urotype distribution was significantly different (P < 0.05), as 16% of the IC/PBS cohort, but 0% of controls, were Streptococcus urotype (P < 0.01). Symptom-free IC/PBS participants were less likely to be EQUC positive (12.5%) than IC/PBS participants with moderate or severe symptoms (68.8% and 46.2%) and the control cohort (60%; P < 0.05).

Conclusion

Lactobacillus was the most common urotype. However, the presence of Lactobacillus did not differ between cohorts, and it did not impact IC/PBS symptom severity. Bacteria were not isolated from most participants with active IC/PBS symptoms. These findings suggest that bacteria may not be an etiology for IC/PBS.
United States Special Operations Command fatality study of subcommands, units, and trends
Authors: Kotwal Russ S. , Mazuchowski Edward L. , Howard Jeffrey T. , Janak Jud C. , Harcke Howard T. , Montgomery Harold R. , Butler Frank K. , Holcomb John B. , Eastridge Brian J. , Gurney Jennifer M. , Shackelford Stacy A. 
Published: April 2020

BACKGROUND
Death from injury occurs predominantly in prehospital settings. Injury prevention and prehospital care of military forces is the responsibility of combatant commanders. Medical examiner and trauma systems should routinely study fatalities and inform commanders of mortality trends.

METHODS
Data reported on US Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001, to September 10, 2018, were reevaluated to compare subcommands, units, and trends. Injury was assessed by mechanism, severity, operational posture, and survivability. Death was assessed by manner, cause, classification, mechanism, and preventability.

RESULTS
Of 614 USSOCOM fatalities (median age, 30 years; male, 98.5%), 67.6% occurred in the Army command, of which 49.2% occurred in the Special Forces command. Battle injury accounted for 60.1% of USSOCOM fatalities. Most battle-injured fatalities in each subcommand had nonsurvivable injuries and nonpreventable deaths. For each subcommand except Marine Corps, fatalities with nonsurvivable injuries sustained injuries primarily while mounted. By subcommand, the primary cause of death for fatalities with nonsurvivable injuries was blast for Army (57.6%), multiple/blunt force for Navy (60.0%), gunshot wound for Air Force (55.6%), and split between blast (50.0%) and gunshot wound (50.0%) for Marine Corps. For each subcommand except Air Force, fatalities with potentially survivable-survivable injuries sustained injuries primarily while dismounted, and the mechanism of death was primarily hemorrhage plus other mechanism or hemorrhage alone. Hemorrhage only mechanism of death was surpassed over time by complex multimechanism death. Potential for injury survivability and death preventability was greatest during early and later years of conflict.

CONCLUSION
Organizational differences in mortality characteristics and trends were identified from which commanders can refine efforts to prevent and treat injury and improve survival. Fatality analyses inform operational risk matrices and advance casualty prevention and response efforts. Prevention, assessment, and treatment strategies must evolve to reduce death from hemorrhage plus coexisting mechanisms.

LEVEL OF EVIDENCE
Performance Improvement and Epidemiological, level IV.
Tranexamic acid in pediatric combat trauma requiring massive transfusions and mortality
Authors: Hamele Mitchell , Aden James K. , Borgman Matthew A. 
Published: April 2020

BACKGROUND
Tranexamic acid (TXA) has been demonstrated to decrease mortality in adult trauma, particularly in those with massive transfusions needs sustained in combat injury. Limited data are available for the efficacy of TXA in pediatric trauma patients outside of a single combat support hospital in Afghanistan.

METHODS
The Department of Defense Trauma Registry was queried for trauma patients younger than 18 years from Iraq and Afghanistan requiring 40 mL/kg or greater of blood product within 24 hours of injury. Burns and fatal head traumas were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were hospital, ventilator, and intensive care unit–free days, as well as total blood product volume.

RESULTS
Among those pediatric patients receiving massive transfusions, those who received TXA were less likely to die in hospital (8.5% vs. 18.3%). Patients who received TXA and those who did not have similar hospital-free days (19 vs. 20), ventilator-free days (27 vs. 27), and intensive care unit–free days (25 vs. 24). Those who received TXA had higher 24-hour blood product administration (100 mL/kg vs. 75 mL/kg). None of our results rose to the level of statistical significance. The TXA administration significantly reduced odds of death on logistic regression (odds ratio, 0.35; 95% confidence interval, 0.123–0.995; p = 0.0488).

CONCLUSION
Use of TXA in pediatric patients with combat trauma requiring massive transfusions trended toward a significant improvement in in-hospital mortality (p = 0.055). This mortality benefit is similar to that seen in adult studies and a less well characterized cohort in another pediatric study suggesting TXA administration confers mortality benefit in massively transfused pediatric combat trauma victims.

LEVEL OF EVIDENCE
Evidence (retrospective cohort), Level IV
Disparity in Accessibility to and Prognosis of Kidney Transplantation According to Economic Inequality in South Korea: A Widening Gap After Expansion of Insurance Coverage
Authors: Park Sehoon , Park Gi Chan , Park Jina , Kim Ji Eun , Yu Mi-yeon , Kim Kwangsoo , Park Minsu , Kim Yong Chul , Kim Dong Ki , Joo Kwon Wook , Kim Yon Su , Lee Hajeong 
Published: April 2020

Background.
Nationwide studies on the effects of wealth inequality on kidney transplantation are rare, particularly in a country with an expanded National Health Insurance Service and in Asian countries.

Methods.
In this nationwide, population-based cohort study, we reviewed the national claims database of Korea in which details of nationwide health insurance are provided. From 2007 to 2015, 9 annual cohorts of end-stage renal disease patients were included. The annual financial statuses were collected and stratified into 5 subgroups in each year: the aided group in which insurance fee was waived and the 4 other groups divided by quartiles of their medical insurance fee. Time trends of incidence proportion of kidney transplantation among end-stage renal disease patients in each year were initially assessed. The risk of graft failure, both including death-censored graft failure and death with a functioning graft, was analyzed as a prognostic outcome within the transplant recipients.

Results.
Significant disparity in the accessibility of kidney transplantation was present, and it was further widening, particularly from 2009 in which the National Health Insurance Service started to cover desensitized kidney transplantation. Desensitized or preemptive transplantation was less common in the poorest group who were more frequently receiving transplantation after 5 years of dialysis in the latter years. The prognosis of kidney transplantation was significantly worse in the poorer people, and this disparity also worsened during the study period.

Conclusions.
Prominent disparity regarding accessibility to and prognosis of kidney transplantation was observed in Korea according to wealth inequality, and this disparity was worsening.
Can N95 respirators be reused after disinfection? And for how many times?
Authors: Liao Lei , Xiao Wang , Zhao Mervin , Yu Xuanze , Wang Haotian , Wang Qiqi , Chu Steven , Cui Yi 
Published: April 2020

AbstractThe Coronavirus Disease 2019 (COVID-19) pandemic has led to a major shortage of N95 respirators, which are essential to protecting healthcare professionals and the general public who may come into contact with the virus. Thus, it is essential to determine how we can reuse respirators and other personal protection in these urgent times. We investigated multiple commonly used and easily deployable, scalable disinfection schemes on media with particle filtration efficiency of 95%. Among these, heating (≤85 °C) under various humidities (≤100% RH) was the most promising, nondestructive method for the preservation of filtration properties in meltblown fabrics as well as N95-grade respirators. Heating can be applied up to 50 cycles (85 °C, 30% RH) without observation in the degradation of meltblown filtration performance. Ultraviolet (UV) irradiation was a secondary choice which was able to withstand 10 cycles of treatment and showed small degradation by 20 cycles. However, UV can also potentially impact the material strength and fit of respirators. Finally, treatments involving liquids and vapors require caution, as steam, alcohol, and household bleach may all lead to degradation of the filtration efficiency, leaving the user vulnerable to the viral aerosols.
Trading accuracy for speed over the course of a decision
Authors: Derosiere Gerard , Thura David , Cisek Paul , Duque Julie 
Published: April 2020

AbstractHumans and other animals often need to balance the desire to gather sensory information (to make the best choice) with the urgency to act, facing a speed-accuracy tradeoff (SAT). Given the ubiquity of SAT across species, extensive research has been devoted to understanding the computational mechanisms allowing its regulation at different timescales, including from one context to another, and from one decision to another. However, animals must frequently change their SAT on even shorter timescales –i.e., over the course of an ongoing decision – and little is known about the mechanisms that allow such rapid adaptations. The present study aimed at addressing this issue. Human subjects performed a decision task with changing evidence. In this task, subjects received rewards for correct answers but incurred penalties for mistakes. An increase or a decrease in penalty occurring halfway through the trial promoted rapid SAT shifts, favoring speeded decisions either in the early or in the late stage of the trial. Importantly, these shifts were associated with stage-specific adjustments in the accuracy criterion exploited for committing to a choice. Those subjects who decreased the most their accuracy criterion at a given decision stage exhibited the highest gain in speed, but also the highest cost in terms of performance accuracy at that time. Altogether, the current findings offer a unique extension of previous work, by suggesting that dynamic changes in accuracy criterion allow the regulation of the SAT within the timescale of a single decision.New and noteworthyExtensive research has been devoted to understanding the mechanisms allowing the regulation of the speed-accuracy tradeoff (SAT) from one context to another and from one decision to another. Here, we show that humans can voluntarily change their SAT on even shorter timescales –i.e., over the course of a decision. These rapid SAT shifts are associated with dynamic adjustments in the accuracy criterion exploited for committing to a choice.