bluuebunny/crossref_metadata_2025_split huggingface dataset:
Research Letter: Sleep Mediates the Association Between Prior Concussion and Depressive Symptoms
Authors: Brett Benjamin L. , Meier Timothy B. , Savitz Jonathan , Guskiewicz Kevin M. , McCrea Michael A. 
Published: March 2021

Objective:
To test sleep quality as one mechanistic pathway through which repeated concussion increases risk of depression later in life among former contact sport athletes.

Setting:
Multicenter study enrolled former American collegiate football players from 16 different National Collegiate Athletic Association member institutions.

Participants:
Fifty-eight former American collegiate football players approximately 15 years following sport discontinuation.

Design:
Participants completed in-person evaluations including comprehensive semistructured interviews with detailed concussion history and sport history, as well as self-reported measures of depression symptom severity (Beck Depression Inventory-II) and sleep quality (Pittsburgh Sleep Quality Index). Years of football participation were included as a covariate. Mediation modeling examined the degree to which sleep quality accounted for the association between repeated concussion and depression symptoms.

Results:
Within the mediation model, concussion history significantly predicted sleep quality (B = 1.03; 95% CI, 0.37 to 1.65; P = .002) and sleep quality significantly predicted depressive symptom severity (controlling for the effects of concussion history; B = 0.15; 95% CI, 0.06 to 0.24; P = .001). The association between prior concussion and depressive symptom severity was fully mediated by sleep quality. With inclusion of the indirect effects, concussion history did not predict depressive symptom severity (direct effect: B = 0.14; 95% CI, −0.09 to 0.41; P = .249; indirect effect: 0.15; 95% CI, 0.03 to 0.29; P = .016).

Conclusions:
Current findings raise the possibility that the greater risk of depression reported in those with a history of mTBI/concussion is mediated by sleep quality, a common sequela of mTBI. These findings highlight potential opportunities for prophylactic sleep-related intervention among individuals with multiple prior concussions to mitigate the risk of depression.
The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy
Authors: Lo Flora M. W. , Wong Eliza M. L. , Hong Felix K. W. 
Published: March 2021

Background
Education is considered a crucial element in anticoagulation management for patients with atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism. However, the effects of education on the patients prescribed warfarin are seldom investigated.

Objectives
This integrative review was conducted to explore the effects of educational programs on patients prescribed warfarin for the aforementioned cardiovascular diseases and to identify the components of effective programs.

Methods
A systematic search of clinical trials was performed in 8 databases from inception to August 2020. Two reviewers performed the eligibility assessment, methodological evaluation, and data extraction. A total of 9 studies were included and analyzed via narrative synthesis.

Results
Nine studies involving a combined total of 1335 patients were included in the review. The findings suggest that educational programs have potential benefits related to international normalized ratio control and warfarin knowledge. However, their effects on major bleeding and thromboembolic events are unremarkable. Stronger evidence is recommended to confirm these findings, and the limited evidence examining the effects of education on warfarin adherence, minor bleeding, abnormal international normalized ratio, readmission rate, and warfarin-related mortality requires further exploration. Verbal education supported by written materials was the main educational delivery mode. A lecture length of approximately 45 minutes was likely appropriate. Notably, the integration of educational strategies, application of follow-up interventions and monitoring measures, adoption of psychological theories in program development, and inclusion of nurses or pharmacists in program conduction seemed to be effective program components.

Conclusions
The effects of educational programs on patients prescribed warfarin mainly for atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism remain inconclusive. Further research using randomized controlled trials is warranted.
Effectiveness and safety of warm needle acupuncture on lumbar muscles strain
Authors: Huang Yashuang , Cheng Cheng , Xie Li , Zhu Xinghui , Chen Dongmei , Cheng Cisong 
Published: March 2021

Abstract

Background:
Lumbar muscle strain (LMS) is the most common orthopedic syndrome, with high incidence globally and lingering disease, which seriously affects patients’ work efficiency and quality of life. Warm needle acupuncture (WNA) is a treatment method combining acupuncture technology with warm and medicinal effect of moxibustion. It has outstanding curative effect and wide range of treatment, especially in the treatment of pain diseases. We aim to collect clinical evidence and demonstrate the efficacy and safety of WNA on LMS.

Methods/design:
We will search the following database sources for the randomized controlled trials: PubMed, Cochrane Library, Excerpta Medica Database (EMBASE), Web of Science, WHO International Clinical Trials Registry Platform (TCTRP), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Database (VIP), and the Wanfang Database.
All randomized controlled trials of WNA for lumbar muscle strain (LMS) in the above database will be considered for inclusion, and high-quality articles will be screened for data extraction and analysis, to summarize the therapeutic effect of WNA on LMS patients.

Result:
This study will provide a rational synthesis of current evidences for warm needle acupuncture on lumbar muscle strain.

Conclusion:
The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on LMS.

Trial registration:
INPLASY2020120100 (DOI number: 10.37766/inplasy2020.12.0100).
Effectiveness and safety of Yufeng Ningxin for the treatment of essential hypertension
Authors: Huang Mingyan , Long Linzi , Deng Mi , Yu Zikai , Qu Hua , Tan Ling , Peng Yuxuan , Fu Changgeng 
Published: March 2021

Abstract

Background:
Essential hypertension is the primary cause of death and disability and it has become a major public health problem globally. Yufeng Ningxin (YFNX) is a commonly used Chinese patent medicine in treating essential hypertension. The objective of this protocol is to evaluate the effectiveness and safety of YFNX for the treatment of essential hypertension.

Methods:
Randomized controlled trials (RCTs) in relation to the effectiveness and safety of YFNX in the treatment of essential hypertension will be systematically searched and collected from the following databases: PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database from the database inception to January 1, 2021. The data screening and extraction will be carried out by 2 different reviewers. The quality of randomized controlled trials will be assessed based on the version 2 of the risk-of-bias tool for randomized trials (RoB 2) in the Cochrane Handbook. The reduction of systolic blood pressure (SBP) and diastolic blood pressure (DBP) will be served as the primary outcome. The secondary outcomes will include average SBP and average DBP during the day and the night measured by 24 hours ambulatory blood pressure monitoring, the clinical effectiveness rate, scores of traditional Chinese medicine syndrome, clinical symptoms, the quality of life and adverse events. Statistical analysis will be conducted with Review Manager 5.3 and STATA 14.0 software.

Conclusion:
This systematic review will provide strong evidence to assess the effectiveness and safety of YFNX in the treatment of essential hypertension.

Trial registration number:
INPLASY202110059.
Is Hospital Nurse Staffing Legislation in the Public’s Interest?
Authors: Lasater Karen B. , Aiken Linda H. , Sloane Douglas M. , French Rachel , Anusiewicz Colleen V. , Martin Brendan , Reneau Kyrani , Alexander Maryann , McHugh Matthew D. 
Published: March 2021

Background:
The Safe Staffing for Quality Care Act under consideration in the New York (NY) state assembly would require hospitals to staff enough nurses to safely care for patients. The impact of regulated minimum patient-to-nurse staffing ratios in acute care hospitals in NY is unknown.

Objectives:
To examine variation in patient-to-nurse staffing in NY hospitals and its association with adverse outcomes (ie, mortality and avoidable costs).

Research Design:
Cross-sectional data on nurse staffing in 116 acute care general hospitals in NY are linked with Medicare claims data.

Subjects:
A total of 417,861 Medicare medical and surgical patients.

Measures:
Patient-to-nurse staffing is the primary predictor variable. Outcomes include in-hospital mortality, length of stay, 30-day readmission, and estimated costs using Medicare-specific cost-to-charge ratios.

Results:
Hospital staffing ranged from 4.3 to 10.5 patients per nurse (P/N), and averaged 6.3 P/N. After adjusting for potential confounders each additional patient per nurse, for surgical and medical patients, respectively, was associated with higher odds of in-hospital mortality [odds ratio (OR)=1.13, P=0.0262; OR=1.13, P=0.0019], longer lengths of stay (incidence rate ratio=1.09, P=0.0008; incidence rate ratio=1.05, P=0.0023), and higher odds of 30-day readmission (OR=1.08, P=0.0002; OR=1.06, P=0.0003). Were hospitals staffed at the 4:1 P/N ratio proposed in the legislation, we conservatively estimated 4370 lives saved and $720 million saved over the 2-year study period in shorter lengths of stay and avoided readmissions.

Conclusions:
Patient-to-nurse staffing varies substantially across NY hospitals and higher ratios adversely affect patients. Our estimates of potential lives and costs saved substantially underestimate potential benefits of improved hospital nurse staffing.
Current Trends in Pediatric Physical Therapy Practice for Children With Down Syndrome
Authors: Johnson Rebekah , Looper Julia , Fiss Alyssa 
Published: March 2021

Background:
Physical therapists (PTs) have a broad range of approaches to the management of Down syndrome (DS).

Purpose:
To examine the breadth of physical therapy practice for children with DS.

Methods:
A survey was distributed to 1000 randomly selected members of the Academy of Pediatric Physical Therapy.

Data Analysis:
Responses were categorized into 13 thematic subcategories and 3 International Classification of Functioning, Disability and Health (ICF) subcategories.

Results and Discussion:
One hundred eight PTs participated. Joint stability and alignment were the most common physical therapy–related problem. Functional movement was the most common physical therapy intervention. Most clinicians identified and treated at the ICF level of body functions and structure. Multiple assessment tools were used and tended to include norm-referenced tests. There was diversity of interventions with varying amounts of supporting evidence.

Conclusions:
PTs manage children with DS for a wide variety of needs with a variety of interventions.
Mindfulness-Based Stress Reduction Buffers Glucocorticoid Resistance Among Older Adults: A Randomized Controlled Trial
Authors: Lindsay Emily K. , Creswell J. David , Stern Harrison J. , Greco Carol M. , Dutcher Janine M. , Lipitz Sarah , Walsh Catherine P. , Wright Aidan G.C. , Brown Kirk Warren , Marsland Anna L. 
Published: March 2021

ABSTRACT

Objective
Mindfulness interventions have been effective for improving a range of health outcomes; however, pathways underlying these effects remain unclear. Inflammatory processes may play a role, possibly through increased resistance of immune cells to the anti-inflammatory effects of glucocorticoids (i.e., glucocorticoid resistance, or GCR). Here, we conducted an initial examination of whether mindfulness training mitigates GCR among lonely older adults.

Methods
Lonely older adults (65–85 years; n = 190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or a matched Health Enhancement Program (HEP). Whole blood drawn before and after the intervention and at 3-month follow-up was incubated with endotoxin and varying concentrations of dexamethasone, and interleukin-6 production was assessed using enzyme-linked immunosorbent assay. GCR was assessed as the concentration of dexamethasone required to decrease the stimulated interleukin-6 response by 50% (half maximal inhibitory concentration), with higher concentrations indicating greater GCR. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR versus HEP) effects.

Results
There was no overall time by condition effect on GCR across all time points. However, a significant time by condition effect was observed from preintervention to postintervention (d = 0.29), such that MBSR buffered increases in GCR observed in the HEP group. Although MBSR showed small, nonsignificant reductions in GCR from preintervention to 3-month follow-up, group differences were not maintained at the 3-month follow-up (d = 0.10).

Conclusions
Results suggest that MBSR may protect against declines in the sensitivity of immune cells to the anti-inflammatory effects of glucocorticoids among at-risk lonely older adults and show value in studying this biological mechanism in future trials.

Trial Registration: Clinical Trials identifier NCT02888600.
Dental Topics for Plastic Surgeons, Part Four: Common Cysts and Tumors of the Jaw
Authors: Zambetti Luke , Agarwal Ravi , Obeid George , Mantilla-Rivas Esperanza , Manrique Monica , Rogers Gary F. , Oh Albert K. 
Published: March 2021

Abstract
Conditions that affect dental and periodontal structures receive sparse coverage in the plastic surgery literature, yet a working knowledge of this subject matter is important in certain areas of clinical practice and a fundamental understanding is part of plastic surgery competency tested on the in-service and written board examinations. This 4-part series was written to provide plastic surgeons with a working knowledge of dental topics that may be relevant to their clinical practice. This section, Part IV, covers common dental cyst and tumors of the jaw.
Schizophrenia during pregnancy
Authors: Dazzan Paola 
Published: March 2021

Purpose of review
A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues.

Recent findings
Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.
Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.
Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women.

Summary
There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children.
Genomics and epidemiology of a novel SARS-CoV-2 lineage in Manaus, Brazil
Authors: Faria Nuno R. , Mellan Thomas A. , Whittaker Charles , Claro Ingra M. , Candido Darlan da S. , Mishra Swapnil , Crispim Myuki A. E. , Sales Flavia C. , Hawryluk Iwona , McCrone John T. , Hulswit Ruben J. G. , Franco Lucas A. M. , Ramundo Mariana S. , de Jesus Jaqueline G. , Andrade Pamela S. , Coletti Thais M. , Ferreira Giulia M. , Silva Camila A. M. , Manuli Erika R. , Pereira Rafael H. M. , Peixoto Pedro S. , Kraemer Moritz U. , Gaburo Nelson , Camilo Cecilia da C. , Hoeltgebaum Henrique , Souza William M. , Rocha Esmenia C. , de Souza Leandro M. , de Pinho Mariana C. , Araujo Leonardo J. T , Malta Frederico S. V. , de Lima Aline B. , Silva Joice do P. , Zauli Danielle A. G. , Ferreira Alessandro C. de S. , Schnekenberg Ricardo P , Laydon Daniel J. , Walker Patrick G. T. , Schlüter Hannah M. , dos Santos Ana L. P. , Vidal Maria S. , Del Caro Valentina S. , Filho Rosinaldo M. F. , dos Santos Helem M. , Aguiar Renato S. , Modena José L. P. , Nelson Bruce , Hay James A. , Monod Melodie , Miscouridou Xenia , Coupland Helen , Sonabend Raphael , Vollmer Michaela , Gandy Axel , Suchard Marc A. , Bowden Thomas A. , Pond Sergei L. K. , Wu Chieh-Hsi , Ratmann Oliver , Ferguson Neil M. , Dye Christopher , Loman Nick J. , Lemey Philippe , Rambaut Andrew , Fraiji Nelson A. , Carvalho Maria do P. S. S. , Pybus Oliver G. , Flaxman Seth , Bhatt Samir , Sabino Ester C. 
Published: March 2021

AbstractCases of SARS-CoV-2 infection in Manaus, Brazil, resurged in late 2020, despite high levels of previous infection there. Through genome sequencing of viruses sampled in Manaus between November 2020 and January 2021, we identified the emergence and circulation of a novel SARS-CoV-2 variant of concern, lineage P.1, that acquired 17 mutations, including a trio in the spike protein (K417T, E484K and N501Y) associated with increased binding to the human ACE2 receptor. Molecular clock analysis shows that P.1 emergence occurred around early November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.4–2.2 times more transmissible and 25-61% more likely to evade protective immunity elicited by previous infection with non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.One-Sentence SummaryWe report the evolution and emergence of a SARS-CoV-2 lineage of concern associated with rapid transmission in Manaus.
A comprehensive digital phenotype for postpartum hemorrhage
Authors: Zheutlin Amanda B , Vieira Luciana , Li Shilong , Wang Zichen , Schadt Emilio , Gross Susan , Stone Joanne , Schadt Eric , Li Li 
Published: March 2021

ABSTRACTObjectiveWe aimed to establish a comprehensive digital phenotype for postpartum hemorrhage (PPH). Current guidelines rely primarily on estimates of blood loss, which can be inaccurate and biased, and ignore a suite of complementary information readily available in electronic medical records (EMR). Inaccurate and incomplete phenotyping contribute to ongoing challenges to track PPH outcomes, develop more accurate risk assessments, and identify novel interventions.MethodsWe constructed a cohort of 71,944 deliveries from the Mount Sinai Health System, 2011-2019. Estimates of postpartum blood loss, shifts in hematocrit intra- and postpartum, administration of uterotonics, surgical treatments, and associated diagnostic codes were combined to identify PPH retrospectively. All clinical features were extracted from structured EMR data and mapped to common data models for maximum interoperability across hospitals. Blinded chart review was done on a randomly selected subset of cases and controls for validation and performance was compared to alternate PPH phenotypes.ResultsWe identified 6,639 cases (9% prevalence) using our phenotype – more than three times as many as using blood loss alone (N=1,747), supporting the need to incorporate other diagnostic and treatment data. Blinded chart review revealed our phenotype had 96% sensitivity, 89% precision, 77% specificity, and 89% accuracy to detect PPH. Alternate phenotypes were less accurate, including a common blood loss-based definition (67%) and a previously published digital phenotype (74%).ConclusionWe have developed a scalable, accurate, and valid digital phenotype that may be of significant use for tracking outcomes and ongoing clinical research to deliver better preventative interventions for PPH.
Closed-loop automated reaching apparatus (CLARA) for interrogating motor systems
Authors: Bowles S , Williamson WR , Nettles D , Hickman J , Welle CG 
Published: March 2021

ABSTRACTObjective: Personalized neurostimulation is a rapidly expanding category of therapeutics for a broad range of indications. Development of these innovative neurological devices requires high-throughput systems for closed-loop stimulation of model organisms, while monitoring physiological signals and complex, naturalistic behaviors. To address this need, we developed CLARA, a closed-loop automated reaching apparatus.Approach:Using breakthroughs in computer vision, CLARA integrates fully-automated, markerless kinematic tracking of multiple features we use to classify animal behavior and precisely deliver neural stimulation based on behavioral outcomes. CLARA is compatible with advanced neurophysiological tools, enabling the testing of neurostimulation devices and identification of novel neurological biomarkers.Results: The CLARA system tracks unconstrained skilled reach behavior in 3D at 150hz without physical markers. The system fully automates trial initiation and pellet delivery and is capable of accurately delivering stimulation in response to trial outcome with sub-quarter second latency. Mice perform the skilled reach task in the CLARA system at a proficiency similar to manually trained animals. Kinematic data from the CLARA system provided novel insights into the dynamics of reach consistency over the course of learning, suggesting that changes are driven entirely by unsuccessful reach accuracy. Additionally, using the closed-loop capabilities of CLARA, we demonstrate that vagus nerve stimulation (VNS) delivered on reach success improves skilled reach performance and increases reach trajectory consistency in healthy animals.Significance:The CLARA system is the first mouse behavior apparatus that uses markerless pose tracking to provide real-time closed-loop stimulation in response to the outcome of an unconstrained motor task. Additionally, we demonstrate that the CLARA system was essential for our finding that VNS given after successful completion of a motor task improves performance in healthy animals. This approach has high translational relevance for developing neurostimulation technology based on complex human behavior.