bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographics and Career Intentions of Graduates of Combined Baccalaureate–MD Programs, 2010–2017: An Analysis of AAMC Graduation Questionnaire Data
Authors: Merritt Rory , Baird Janette , Clyne Brian 
Published: July 2020

Purpose
Combined baccalaureate–MD programs exist to fulfill a variety of educational missions, including to promote the development of physician–scientists, increase workforce diversity, promote primary care careers, and meet the needs of underserved patients. The authors sought to determine the demographics of combined program graduates, as well as their intention to practice in primary care (IPPC) and intention to work with the medically underserved (IWMU), as compared with graduates of traditional MD programs.

Method
Data from the 2010–2017 Association of American Medical Colleges Graduation Questionnaire, a national survey of graduating medical students, were recategorized (e.g., as combined program or traditional program) before analysis. Logistic regression models on the 2 primary outcomes (IPPC and IWMU) were conducted to estimate odds ratios for the effects of covariates and predictors (e.g., gender, underrepresented in medicine [URM] group member, type of medical degree program).

Results
Data from a total of 109,028 respondents were included (3,182 from combined and 105,846 from traditional programs). Compared with students in traditional programs, those in combined programs were more likely to be younger (age at graduation ≤ 29: 3,143, 98.8% vs 89,688, 84.7%) and female (1,813, 57.0% vs 52,013, 49.1%) but less likely to identify as a URM group member (276, 8.7% vs 14,757, 13.9%). In an adjusted logistic regression model, graduating from a combined program, identifying as female, and IWMU predicted significantly greater odds of IPPC, while identifying as a URM, identifying as female, and having debt predicted significantly greater odds of IWMU. Graduating medical students who indicated family medicine as a career specialty were more likely to indicate an IWMU.

Conclusions
Medical students graduating from combined programs were more likely to indicate an IPPC but were no more likely to indicate an IWMU than traditional program graduates.
Influence of local anesthesia on the outcomes of non-surgical periodontal treatment
Authors: Shi Shu-Wen , Jiao Jian , Zhang Li , Lu Rui-Fang , Meng Huan-Xin , Cao Zhan-Qiang , Shi Dong , Song Yi 
Published: July 2020

Abstract

Background
There is limited evidence of the effects of local anesthesia (LA) on outcomes of non-surgical periodontal treatment (NSPT), in particular among the Chinese. This retrospective cohort study aimed to evaluate the effects of LA on short-term treatment outcomes of NSPT and to determine under what circumstances LA should be prescribed to improve these outcomes.

Methods
Data from periodontal examinations of 3980 patients were used. The data were from 3-month re-evaluation records of an electronic periodontal charting record system in the Department of Periodontology of Peking University School and Hospital of Stomatology from June 2008 to January 2015. Descriptive analyses included changes in probing depth (PD) and the Mazza bleeding index (BI). Two-level (patient and tooth) logistic regression models and three-level (patient, tooth, and site) linear regression models were constructed to analyze the influence of LA on PD for all teeth/sites and teeth/sites with an initial PD ≥ 5 mm. Decreases in PD and BI at sites under LA using the initial PD were also compared.

Results
A significantly higher mean decrease in PD after NSPT was found in the LA group than in the no local anesthesia (NLA) group (0.98 vs. 0.54 mm, t = 24.12, P < 0.001). A significantly higher probability of decreases was found in the LA group in BI (percentages of teeth with BI > 1 and BI > 2) for all teeth (16.7% vs. 13.8%, t = 3.75, P < 0.001; 34.7% vs. 28.1%, t = 6.73, P < 0.001) and PD for teeth with PD ≥ 5 mm (32.3% vs. 17.3%, t = 28.48, P < 0.001). The difference in PD between the LA and NLA groups increased as the initial PD increased. The difference between the two groups was 0.12 to 0.22 mm for sites with a baseline PD < 7 mm; however, it increased to 0.41 to 1.37 mm for sites with a baseline PD ≥ 7 mm.

Conclusions
LA improved the decrease in PD after NSPT. Root debridement at sites with initial PD ≥ 7 mm should be performed under routine LA.
Single-nucleotide polymorphism biomarkers of adjuvant anastrozole-induced estrogen suppression in early breast cancer
Authors: Ingle James N. , Kalari Krishna R. , Barman Poulami , Shepherd Lois E. , Ellis Matthew J. , Goss Paul E. , Buzdar Aman U. , Robson Mark E. , Cairns Junmei , Carlson Erin E. , Eyman Casey Abraham , Hoskin Tanya L. , Goodnature Barbara A. , Haddad Tufia C. , Goetz Matthew P. , Weinshilboum Richard M. , Wang Liewei 
Published: July 2020

Objectives
Based on our previous findings that postmenopausal women with estrone (E1) and estradiol (E2) concentrations at or above 1.3 pg/ml and 0.5 pg/ml, respectively, after 6 months of adjuvant anastrozole therapy had a three-fold risk of recurrence, we aimed to identify a single-nucleotide polymorphism (SNP)-based model that would predict elevated E1 and E2 and then validate it in an independent dataset.

Patients and methods
The test set consisted of 322 women from the M3 study and the validation set consisted of 152 patients from MA.27. All patients were treated with adjuvant anastrozole, had on-anastrozole E1 and E2 concentrations and genome-wide genotyping.

Results
SNPs were identified from the M3 genome-wide association study. The best model to predict the E1-E2 phenotype with high balanced accuracy was a support vector machine model using clinical factors plus 46 SNPs. We did not have an independent cohort that is similar to the M3 study with clinical, E1-E2 phenotypes and genotype data to test our model. Hence, we chose a nested matched case-control cohort (MA.27 study) for testing. Our E1-E2 model was not validated but we found the MA.27 validation cohort was both clinically and genomically different.

Conclusions
We identified a SNP-based model that had excellent performance characteristics for predicting the phenotype of elevated E1 and E2 in women treated with anastrozole. This model was not validated in an independent dataset but that dataset was clinically and genomically substantially different. The model will need validation in a prospective study.
The COMPASS trial: practical considerations for application after coronary artery bypass surgery
Authors: Eikelboom Rachel , Muller Moran Hellmuth R. , Lodewyks Carly , Yan Weiang , Zelentsov Ivan , Arora Rakesh C. 
Published: July 2020

Purpose of review
We review the cardiovascular outcomes for people using anticoagulation strategies (COMPASS) trial with particular emphasis on patients with a history of remote coronary artery bypass grafting (CABG) and those who were enrolled 4–14 days after CABG. We provide practical guidance for selecting patients with the greatest potential to benefit who have acceptable bleeding risk. In particular, we address concerns about postoperative bleeding and discuss the relative merits of rivaroxaban and aspirin versus P2Y12 inhibition and aspirin.

Recent findings
The COMPASS trial demonstrated that rivaroxaban and aspirin reduce myocardial infarction, stroke, and cardiovascular death in patients with coronary artery disease, without a demonstrated effect on bypass graft patency in the first postoperative year.

Summary
After CABG, cardiac surgeons should consider using the COMPASS regimen in patients at high risk of thrombosis whose risk of bleeding is acceptable. If used, the COMPASS regimen should be continued indefinitely in conjunction with other pharmacological risk reduction therapies to prevent long-term atherothrombotic events.
Positive relationship of hypertensive retinopathy with carotid intima--media thickness in hypertensive patients
Authors: Zhang Wenbo , Li Jun , Zhao Liang , Zhang Jing , She Haicheng , Meng Ying , Peng Yuan , Shang Kun , Zhang Yadi , Gu Xiaopeng , Chen Xuling , Zhang Yan , Yang Ying , Sun Pengfei , Qin Xianhui , Wang Binyan , Xu Xiping , Hou Fanfan , Tang Genfu , Liao Rongfeng , Lin Tengfei , Jiang Chongfei , Huo Yong , Yang Liu 
Published: July 2020

Objectives:
We aimed to explore the relationship of hypertensive retinopathy with carotid intima--media thickness (CIMT), and to examine the possible effect modifiers in Chinese adults with hypertension.

Methods:
We conducted a cross-sectional study of 12 342 hypertensive patients with complete exit site visit data from the China Stroke Primary Prevention Trial. CIMT was measured by carotid ultrasonography. Hypertensive retinopathy was diagnosed according to the Keith--Wagener--Barker classification.

Results:
The mean (SD) CIMT among study participants was 739.9 (111.4) μm. Compared with patients with grade 1 hypertensive retinopathy or without hypertensive retinopathy, a significantly higher CIMT level (β, 7.63, 95% CI: 2.54--12.73) was observed in patients with grade 2–4 hypertensive retinopathy. Moreover, the association between hypertensive retinopathy (grade 2–4 versus grade 1 or normal) and CIMT was stronger in participants of younger age (<60 years; β, 13.70, 95% CI: 5.65--21.75; versus ≥60 years; β, 1.03, 95% CI: −5.58 to 7.63; P interaction = 0.006); or with lower total homocysteine levels [<12.1 μmol/l (median); β, 12.70, 95% CI: 5.98--19.42; versus ≥12.1 μmol/l; β, 2.07, 95% CI: −5.63 to 9.78; P interaction = 0.030). None of the other variables, including sex, BMI, study centers, treatment group, SBP, triglycerides, total cholesterol, fasting blood glucose, folate, serum creatinine, current smoking and alcohol drinking, significantly modified the relation of hypertensive retinopathy with CIMT levels.

Conclusion:
Hypertensive retinopathy (grade 2 and higher) was significantly associated with increased CIMT in hypertensive patients. The association was stronger in those of younger age or with lower total homocysteine levels.
Guidelines for hypertension management in primary care: is local adaptation possible?
Authors: Leite-Santos Nathália C. , de Melo Daniela O. , Mantovani-Silva Rafael A. , Gabriel Franciele C. , Fornasari Guido S. , Dórea Egídio L. , Molino Caroline de G.R.C. , Ribeiro Eliane 
Published: July 2020

Objective:Hypertension affects more than one billion people worldwide. There has been much discussion about clinical practice guidelines (CPGs) following the proposal of lower thresholds for starting pharmacological treatment. Some smaller groups or institutions could benefit from adapting CPGs to their local context, a process that requires high-quality CPGs with few points of conflict in their recommendations. To address this issue, we have compared high-quality hypertension CPGs and highlighted conflicting recommendations.Methods:CPGs were searched in MEDLINE, Embase, the Cochrane Library, as well as specific websites. Only CPGs published between 2016 and 2019 were included. We defined CPGs as high-quality if the ‘rigor of development’ and ‘editorial independence’ AGREE II domains were scored at least 60%. We compared recommendations made by high-quality CPGs and highlighted areas of conflict (defined as disagreements between more than two CPGs).Results:Nineteen CPGs were identified. The highest scoring domain was ‘scope and purpose’ (74.3%) and the lowest scoring was ‘applicability’ (40.0%). Eight CPGs were rated as high quality. Most CPG recommendations on the management of hypertension were consistent. Conflicting recommendations were regarding blood pressure (BP) levels to initiate pharmacotherapy and therapeutic goals, particularly in patients with low cardiovascular risk and older patients.Conclusion:It is possible to adapt hypertension CPGs once high-quality documents have been identified with agreement between most recommendations. Guideline developers can focus on the adaption process and concentrate efforts on implementation.
Time point of blood pressure drop in patients with orthostatic hypotension in the emergency department
Authors: Jang Kyeongmin , Park Miri , Kim Hack-Lyoung 
Published: July 2020

Objective:
The purpose of this study was to identify the time of blood pressure (BP) drop in the orthostatic hypotension test, and to propose a realistic and appropriate duration in the orthostatic hypotension test.

Methods:
A total of 879 consecutive patients (61-year-old and 44% women) with positive on the orthostatic hypotension test in the emergency department were retrospectively reviewed. Orthostatic hypotension was defined as drop in standing SBP of at least 20 mmHg or standing DBP of at least 10 mmHg from their supine values after standing for 5 min. BP measurements was made at 1, 3, and 5 min after standing.

Results:
Six hundred and eighty-four (77.8%), 152 (17.3%) and 43 (4.9%) patients had BP drop meeting orthostatic hypotension criteria at 1, 3, and 5 min, respectively. In multivariable analysis, older age (≥60 years) and higher blood urea nitrogen (BUN) (≥15.5 mg/dl) were independently associated with early BP drop at 1 min, and younger age (<40 years) was independently associated with later BP drop at 5 min even after controlling for potential confounders.

Conclusion:
To measure orthostatic BP for orthostatic hypotension diagnosis at emergency department, older patients (≥60 years) with high BUN (≥15.5 mg/dl) should be monitored carefully as BP can drop quickly within 1 min. On the contrary, in younger people (<40 years), BP drop occurred slowly after 3 min, suggesting that clinicians measure BP for a longer time.
Home sweet home? How home health aide compensation, benefits and employment security influence the quality of care delivered by home health organizations
Authors: Ranucci Rebecca , Berry Daphne 
Published: July 2020

Background
The number of home health care organizations has grown, and the number of home health aide jobs is among the fastest growing, drawing attention to the home health care industry. Despite increased transparency into the quality of care delivered by home health care organizations, less is known about how organizational work practices directed at home health aides, who work remotely on the frontlines of providing caring home health services, impact quality.

Purpose
We examine how an organization’s benefits and compensation practices for home health aides, as well as changes to home health aide employment security within the organization, impact the quality of care delivered by home health care organizations.

Methodology
We conduct a large-scale longitudinal archival study of Medicare-certified home health organizations using a fixed-effects specification to test the effects of home health aide benefits equality and compensation on the quality of patient outcomes within home health organizations. In addition, we use the proportion of contract home health aides to test moderating effects of employment insecurity.

Results
Benefits equality positively impacts quality, whereas compensation has a negative relationship with quality. However, when an organization increasingly utilizes contract aides, the positive effect of benefits equality on quality is weaker, whereas under these same conditions, compensation has a positive relationship with quality.

Conclusion
Compensation and benefits practices impact quality, and the effect these practices have on quality varies under conditions of employment insecurity created by the organization’s use of contract home health aides.

Practice Implications
Home health organizations should employ a nuanced approach to improving quality, increasing compensation to permanent home health aides when the organization increases their use of contract home health aides and equally distributing benefits to home health aides when the organization does not rely as heavily on contract home health aides.
Influence of preoperative breast cancer localization techniques on rates of sentinel lymph node visualization with preoperative lymphoscintigraphy
Authors: Verma Shipra , Taylor Donna , Al-Ogaili Zeyad 
Published: July 2020

Objectives
The use of preoperative image-guided lesion localization for impalpable breast cancer may interfere with lymphatic drainage and cause delayed or reduced visualization of sentinel lymph nodes (SLNs) on preoperative lymphoscintigraphy. The goal of this audit was to compare rates of SLN visualization in patients undergoing preoperative breast cancer localization with either Iodine 125 seeds (radio-guided occult lesion localization using Iodine 125 seeds, ROLLIS) or hook wire and those with palpable lesions where no localization was required.

Patients and methods
We reviewed the records of 482 patients, who underwent preoperative lymphoscintigraphy with hook wire, ROLLIS, or no localization, at three major tertiary hospitals from January 2013 to December 2017. Static lymphoscintigraphy images are performed post administration of subcutaneous periareolar 99mTc antimony colloid injection. The rate of SLN visualization in the three groups and time to node visualization were analyzed.

Results
Four hundred and eighty-two patients underwent preoperative lymphoscintigraphy: 102 after no localization, 211 in hook wire, and 169 following ROLLIS. Very high overall rates of SLN visualization on preoperative lymphoscintigraphy were noted in all three groups; no localization group: 99% [95% confidence interval (CI), 94.7–99.8%], hook wire: 98.6% (95% CI, 95.9–99.7%) and ROLLIS: 98.8% (95% CI, 95.8–99.9%). For time to node visualization, a statistically significant difference was found between the no localization versus hook-wire group (P = 0.0015) and no localization versus ROLLIS group (P = 0.00011) but no statistically significant difference between the hook-wire and ROLLIS groups (P = 0.16) was demonstrated.

Conclusion
High rates of SLN visualization on preoperative lymphoscintigraphy were noted in all groups, with no significant reduction when breast lesion localization techniques were used. There was; however, an increased rate of delayed imaging required for SLN visualization in women who had undergone either type of preoperative localization compared with those who had not.
Applicability of 2 Dental Age Estimation Methods to Taiwanese Population
Authors: Shen Checheng , Pan Jing , Yang Zhao , Mou Hungen , Tao Jiang , Ji Fang 
Published: July 2020

AbstractThe aim of this study is to assess the accuracy of Demirjian and Willems dental age estimation methods on a population of 8- to 15-year-old Taiwanese children. A total of 799 digital panoramic radiographs (404 boys, 395 girls) of children aged from 8.00 to 15.99 years are evaluated. All panoramic films are assessed by 2 examiners using Demirjian and Willems methods. We randomly select 48 panoramic films to evaluate the reproducibility of dental age measurements. The intraobserver and interobserver Cohen's kappa values are 0.733 and 0.762, respectively.The difference between chronological age and dental age is calculated for each individual using both methods. The result shows that Demirjian method slightly overestimates the chronological age of children. The mean age difference is 0.12 years for boys (standard deviation [SD], 0.80) and 0.21 years for girls (SD, 0.95). Willems method slightly underestimates the chronological age of children. The mean age difference is −0.22 years for boys (SD, 0.80) and −0.12 years for girls (SD, 0.92).In conclusion, Demirjian and Willems methods are both accurate for assessing dental age in the Taiwan region of China. The mean age differences of both methods are within ±1 year, which is acceptable at forensic odontology level. However, although the discrepancy between chronological age and dental age is frequently observed between −0.5 and 0.5 years in both methods, there is no guarantee it will be accurate for any particular individual, further modifications to both methods are suggested.
The Impact of Anxiety and Upper Limb Disability on Participation Levels in People With Dystonia
Authors: Martínez-Piédrola Rosa M. , Huertas-Hoyas Elisabet , Serrada-Tejeda Sergio , Máximo-Bocanegra Nuria , Sánchez-Herrera-Baeza Patricia , García-Bravo Cristina , Pérez-de-Heredia-Torres Marta , Martínez-Castrillo Juan Carlos 
Published: July 2020

Objective
This study sought to evaluate the level of anxiety in people with dystonia and to examine a possible relationship between the level of participation, anxiety, and functional limitations.

Design
This is an observational, cross-sectional, case-control study with 12 cases of focal dystonia and 12 healthy controls aged between 18 and 75 yrs. The Hamilton Anxiety Rating Scale, the QuickDASH scale, and the Measure of Participation and Activities were used. Differences in scores and effect size were analyzed through the Student t test and Cohen d test. A multiple regression model was performed to determine the relationship between variables.

Results
People with dystonia obtained higher scores in the three subsections of the Hamilton Anxiety Rating Scale (total anxiety, psychiatric anxiety, and somatic anxiety; P < 0.05) and on the QuickDASH scale, together with lower scores in participation in activities of daily living of the Measure of Participation and Activities (P = 0.01). Greater upper limb disability was associated with a greater negative impact on participation in activities of daily living (P < 0.01); however, no significant relationship was found with anxiety (P > 0.05).

Conclusions
This study suggests that the ability of people with dystonia to participate in society is negatively affected by the level of disability of the upper limb, but even when anxiety-age–related differences were controlled for, no relationship was found between variables.
Endoscopic Support and Virtual Surgical Planning as an Alternative to Repair Orbital Wall Fractures
Authors: Gonzalez Luis Vicente , López Juan Pablo 
Published: July 2020

Abstract
The reconstruction of the orbit has been carried out throughout history using different techniques. However, the persistence of high rates of complications mainly associated with the position of the eyeball and the migration of reconstruction implants have generated the need and importance of continuing to study new techniques, including with the help of technology. Virtual planning combined with endoscopic access and 3D models could decrease the number of complications associated with the aforementioned problems. For this, the aim of this observational retrospective study is to show the authors’ experience of 19 cases in different orbital fractures using endoscopic support and virtual planning as great alternative in orbital reconstruction.