bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impairment in Quantitative Microvascular Function in Non-Ischemic Cardiomyopathy as Demonstrated Using Cardiovascular Magnetic Resonance
Authors: Slivnick Jeremy A. , Zareba Karolina M. , Truong Vien T. , Liu Ellen , Barnes Alexis , Mazur Wojciech , Binkley Philip 
Published: May 2021

Abstract
Purpose

Microvascular dysfunction (MVD)—defined as impaired augmentation of the microcirculation in response to stress—is present in various cardiovascular diseases and portends worse outcomes. We aimed to evaluate the relationship between MVD and non-ischemic cardiomyopathy (NICM) utilizing stress cardiovascular magnetic resonance (CMR) as compared to a cohort of control patients.
Methods

We retrospectively studied 41 consecutive patients with NICM (mean age 51 ± 14, 59% male) and 58 controls with preserved systolic function (mean age 51 ± 13, 31% male) who underwent adenosine stress CMR exams between 2011–2016. Microvascular function was assessed visually and with myocardial perfusion reserve index (MPRI), quantified using first pass perfusion imaging by comparing perfusion slopes of myocardium and blood pool at rest/stress. MVD was defined visually as presence of subendocardial stress perfusion defect and quantitatively by MPRI < 1.51. MPRI was compared between NICM and controls using univariate analysis and multivariable linear regression.
Results

Impaired MPRI was noted in 37 patients (23 in NICM and 14 in control cohorts). In patients with NICM, 23 (56%) had MVD by quantitative assessment, while 11 (27%) by visual evaluation. No differences in comorbidities were noted between cohorts. Compared with controls, NICM patients had lower rest perfusion slope (3.9 vs 4.9, p = 0.05), stress perfusion slope (8.8 vs 11.7, p < 0.001), and MPRI (1.41 vs 1.74, p = 0.02). MPRI remained associated with NICM after controlling for age, gender, hypertension, diabetes, and late gadolinium enhancement (log MPR, β coefficient = -0.17, p = 0.009).
Conclusions

MVD assessed with stress CMR is highly prevalent in NICM as compared to control patients with preserved systolic function. Quantitative MPRI assessment identities more NICM patients with MVD as compared to visual evaluation. NICM remains independently associated with an impaired MPRI after controlling for covariates. Further studies are needed to determine whether targeted therapies to treat MVD are beneficial in NICM.
Clinical Outcomes of Non-diabetic COVID-19 Patients with Different Blood Glucose Levels: A Nationwide Turkish Study (TurCoGlycemia)
Authors: Haymana Cem , Demirci Ibrahim , Tasci Ilker , Cakal Erman , Salman Serpil , Ertugrul Derun , Ata Naim , Unluturk Ugur , Dagdelen Selcuk , Atmaca Aysegul , Sahin Mustafa , Celik Osman , Demir Tevfik , Emral Rifat , Sahin Ibrahim , Caglayan Murat , Satman Ilhan , Sonmez Alper 
Published: May 2021

Abstract
Purpose New coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients. Methods A nationwide retrospective cohort of non-diabetic patients with conﬁrmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were <100 mg/dL in group-1, in the range of 100-139 mg/dl in group-2, and the range of 140-199 mg/dl in group-3. Clinical characteristics and outcomes were compared among the groups. The primary outcome was mortality. Results A total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140-199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation. ConclusionHyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.
Challenges in Current Nursing Home Care in Rural Germany and How They Can Be Reduced by Telehealth - an Exploratory Pre-post Study
Authors: May Susann , Jonas Kai , Zahn Thomas , Heinze Martin , Mühlensiepen Felix 
Published: May 2021

Abstract
BackgroundTelemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. ObjectiveThe goal was to assess the effect of implement medical video consultations into nursing home care addressing the following research questions:- How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? - How can video consultations be used to reduce difficulties arising in everyday care? - How does implementation of video consultations impact day-to-day nursing home care delivery?MethodsTwenty-one guided interviews (pre-implementation n=13; post-implementation n=8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis.ResultsChallenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly.ConclusionsTelehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.
An Embedded Multiple Case Study: Facilitating Uptake of Food Insecurity Screening Initiatives in Low Resource Primary Care Settings
Authors: Taher Sabira , Muramatsu Naoko , Odoms-Young Angela , Peacock Nadine , Fagen Michael C. , Suh Courtney K. 
Published: May 2021

Abstract
Background

Food insecurity (FI), limited access to healthy food, is a social determinant of health linked to poor dietary health and difficulty with disease management. Healthcare experts support the adoption of validated screening tools within primary care clinics to identify and connect FI patients to food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that can guide wide-scale program implementation.
Methods

This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 clinical staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis.
Findings:

Programs outcomes included: the number of patients screened and identified as FI; the number of patients referred to and participated in the onsite food assistance program. Overall, neither case achieved intended reach or participation. Limited financial, human and infrastructure support were implementation barriers. Existing community collaborations and clinic-level autonomy were critical facilitators during implementation that contributed to the flexibility of program activities. Programs were tailored to each context to assist in implementation feasibility, but contributed to low program fidelity.
Conclusions

Programs were highly adaptable and each context enhanced implementation feasibility across settings. These characteristics have the potential to support program uptake in other settings, but should be used with caution to preserve program fidelity and to achieve intended outcomes. A foundational model for the development and testing of standard clinical practice was the product of this study.
Effect of Gd doping on Structural, Morphological and Magnetic Properties of Mn-Zn Soft Ferrites Nanoparticles
Authors: Shrivastava Anjali , Shrivastava Ashwani Kumar 
Published: May 2021

Abstract
Co-precipitation technique was adopted to synthesize gadolinium doped manganese-zinc ferrite nano particles with varying concentration 0, 0.1, 0.2 and 0.3. XRD patterns authenticated the ferrite innovate in the as-prepared samples. The lattice parameter, crystallite size, lattice strain and x-ray density has been calculated. The crystallite size is comes bent on be around 5 nm. The FTIR spectra reveal that every one the functional groups are present within the material. SEM images are accustomed to indicate the morphological characteristics of the as-prepared samples. Magnetic properties show the decrease in saturation magnetization from 37.57emu/g to 30.15emu/g with reference to increase in gadolinium doping from 0.1 to 0.3.
Fatal rhinocerebral mucormycosis in diabetic patients: report of two cases
Authors: Gomes Guilherme Borsato , Correia Leticia Sassaki , de Freitas Fernanda Schimidt , Carvalho Vinicius Almeida , Stabile Cecília Luiz Pereira , Stabile Glaykon Alex Vitti 
Published: May 2021

Abstract
Mucormycosis is a potentially serious and quite rare fungal infection, caused by the Saprophytic fungus, of the order Mucorales, Absidia, Mucor, Rhizomucor and Rhizopus. These agents are commonly isolated from decomposing soil and plant material and remain dormant in healthy individuals in the respiratory and digestive tubes when inhaling or ingesting contaminated food. It becomes pathogenic when the individual gets immunocompromised and debilitated, progressing to an aggressive and often lethal clinical picture, which requires accurate diagnosis and prompt treatment. There are reports in the literature of its gastrointestinal, pulmonary, cutaneous, rhino-orbital-cerebral, endocardial and osteoarticular forms. Regardless of its location, treatment necessarily includes early clinical diagnosis, stabilization of systemic comorbidities and aggressive drug and surgical therapy, resulting in a mortality rate of up to 40% of cases. It is a relevant topic in tertiary care hospitals in terms of contamination, being a matter of concern if present in premature newborns and burn therapy units. The purpose of this article is to report a case of rhino-orbital-cerebral Mucormycosis acquired in the community by a decompensated diabetic patient who evolved with invasion of the hard palate, paranasal sinuses, orbits and cavernous sinus, spreading to the central nervous system and leading to thrombosis the cavernous sinus.
Shifts in outdoor activity patterns in the time of COVID-19 and its implications for exposure to vector-borne diseases in the United States.
Authors: Fernandez Maria , Bron Gebbiena , Kache Pallavi , Tsao Jean , Bartholomay Lyric , Hayden Mary , Ernst Kacey , Berry Kevin , Diuk-Wasser Maria 
Published: May 2021

Abstract
Unintended consequences of human behavioral changes induced by governmental and individual responses to COVID-19 risk are yet to be fully realized. Herein, we evaluated changes in outdoor activity patterns during the spring and summer of 2020 vs. 2019 in the Northeast and Midwest United States. We used self-reported data from daily surveys available through a smartphone application, The Tick App. We simultaneously assessed changes in exposure to tick vectors in relation to changes in outdoor recreation. Outdoor activities and particularly peridomestic activities, increased by two-fold between years, while recreational activities in green spaces decreased by 70%. Tick encounters increased by 30%, and were mainly associated with outdoor activities and living in a rural county. Changes in outdoor recreation were associated with statewide stay-at-home orders in 2020 and persisted as out-of-home mobility increased. Our findings suggest that public health response should also address competing hazards from COVID-19 related outdoor exposure.
Prevalence of narcolepsy in patients with H63D syndrome
Authors: Diamandis Carolina , Seideman David , Balaskas  , Papadopoulos Anastasios , Honda Riku 
Published: May 2021

Abstract
H63D syndrome is a phenotype of a homozygous mutation of the HFE gene H63D, which is otherwise known to cause at most mild classical hemochromatosis. H63D syndrome leads to an iron overload in the body (especially in the brain, heart, liver, skin and male gonads) in the form of non-transferrin bound iron (NTBI) poisoning. Hallmark symptoms and causal factor for H63D syndrome is a mild hypotransferrinemia with transferrin saturation values >50%. H63D syndrome is an incurable multi-organ disease, leading to permanent disability. Our objective was to detect the prevalence of narcolepsy and narcolepsy with cataplexy in patients with H63D syndrome.
Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A qualitative study
Authors: Abrahams Zulfa , Boisits Sonet , Schneider Marguerite , Honikman Simone , Lund Crick 
Published: May 2021

Abstract

Background
In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems. We investigated facilitators and barriers of service-providers and -users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence.
Methods
Service-provider perspectives were informed by qualitative interviews with 37 healthcare workers providing care to pregnant women attending four midwife obstetric units (MOUs) in Cape Town. Qualitative interviews with 38 pregnant women attending the same MOUs for their first antenatal care visit provided service-user perspectives.
Results
Facilitators identified included the availability of a mental health screening questionnaire and the perceived importance of detection and treatment. Barriers included service providers’ heavy workload and discomfort with discussing mental health issues; lack of standardised referral pathways and poor uptake of referrals; lack of confidentiality and feelings of shame related to experiences of domestic violence.
Limitations:
Difficulty in linking perceptions of care with specific healthcare providers; social desirability bias - pregnant women’s responses to questions on domestic violence, and service providers’ responses to their role in providing care.
Conclusion
The facilitators and barriers identified indicate the need to strengthen health systems by training antenatal care nurses to detect symptoms of CMDs and experiences of domestic violence in pregnant women, developing standardised referral pathways and training lay healthcare workers to provide treatment for mild symptoms of depression and anxiety.
Should nurses be given the rights to autonomously initiate medications for adult patients’ experiencing acute pain at triage prior to a physicians’ consult in Singapore’s Emergency Departments? A Systematic Review
Authors: Charles Gerard 
Published: May 2021

Abstract
Background: Globally, in most countries, nurses are restricted from independent prescribing however, seven countries have achieved legislation to implement prescriptive authority to nurses with more countries in bid to follow suit. Since the inception of nurse-initiated medications in the 1990s, the increase in prescribing authority has shown a positive impact on the measured metrics with evidence improving patient care with timeliness to analgesia and greater pain control. Objectives: The objectives of this review is to rationalise the use of nurse-initiated medications at triage for patients’ presenting with acute pain in the emergency department, to critically analyse the risks and benefits of NIM and to generate ideas and make recommendations about practice implications regarding NIM at triage.Methods: A literature review using a systematic approach was undertaken. Multiple keyword combinations were incorporated, and an inclusion and exclusion criteria were set. All studies chosen were critically appraised using four different toolkits based on research design for rigour & quality. Ten studies were selected for this review. Thematic analysis was conducted, stitching the similarities identified within the studies and a discussion of the results with a conclusion was written. Results: Nurses who were given prescriptive authority significantly decreased time to analgesia in nine studies with the initiation of NIM at triage. There were no complaints or mentions of medication errors, special events or adverse reactions reported in the selected research papers. Thematic analysis identified pain assessment as a key indicator for nurses to initiate medications for patients upon triage. The introduction of NIM has attained clinically significant pain reduction scores and increased patient satisfaction. There was, however, little effect between NIM and ED length of stay. Safety concerns, anxiety, and overwhelming workload were identified as barriers for nurse prescribing with measures set in place to combat these issues.Conclusion: This review has found that nurse-initiated medications are beneficial as it does increase timeliness to analgesia and improve pain control for patients. It also highlights compelling evidence with an increase in timeliness to analgesia and that authority should be given to nurses in Singapore for the rights to autonomously prescribe analgesia for patients’ experiencing acute pain at triage prior to a physicians’ consultation. Prescriptive authority for nurses will be a step forward in contemporary emergency medicine. Further exploration and research should be undertaken about the concept and impact of NIM on safety issues, ED length of stay with randomised studies to solidify this initiation.
Emergency Gastrointestinal Surgery in Patients Undergoing Antithrombotic Therapy in a Single General Hospital: a Propensity Score-matched Analysis
Authors: Abe Shinya , Ami Katsunori , Katsuno Akira , Tamura Noriyasu , Harada Toshiko , Hamasaki Shunsuke , Kitagawa Yusuke , Machida Taku , Umetani Naoyuki 
Published: May 2021

Abstract
Background: This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. Methods: We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) were assessed. The optimal value of EBL was determined using the receiver operating characteristic curve. Results: Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 ml; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 113 ml) occurred 3 in 146 patients. Multivariate analysis using the full cohort revealed that anticoagulant drug use was an independent risk factor for severe bleeding (odds ratio, 6.50; 95% CI 1.4-36; p = 0.015). Conclusions: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery, although patients taking anticoagulant drugs or multiple antithrombotic drugs should undergo careful surgical performances and postoperative management.