bluuebunny/crossref_metadata_2025_split huggingface dataset:
Matched-pair Analysis for Survival Endpoints Between Women With Early-stage Uterine Carcinosarcoma and Uterine Serous Carcinoma
Authors: Yahya Jehan B. , Zhu Simeng , Burmeister Charlotte , Hijaz Miriana Y. , Elshaikh Mohamed A. 
Published: July 2021

Objective:
The objective of this study was to compare survival endpoints between women with uterine carcinosarcoma and those with uterine serous carcinoma utilizing matching analysis.

Methods:
Patients with stages I to II who underwent hysterectomy at our institution were included in this analysis. Patients with carcinosarcoma were then matched to patients with serous carcinoma based on stage, and adjuvant management received (observation, radiation treatment alone, chemotherapy alone, or combined modality with radiotherapy and chemotherapy. Recurrence-free survival, disease-specific survival, and overall survival were calculated for the 2 groups.

Results:
A total of 134 women were included (67 women with carcinosarcoma and 67 with serous carcinoma, matched 1:1). There was no statistically significant difference between the 2 groups regarding 5-year recurrence-free survival (59% vs. 62%), disease-specific survival (66% vs. 67%), or overall survival (53% vs. 57%), respectively. The only independent predictor of shorter recurrence-free survival for the entire cohort was the lack of adjuvant combined modality therapy, while lower uterine segment involvement was the only independent predictor for shorter disease-specific survival. Lack of lymph node dissection and lack of adjuvant combined modality therapy were independent predictors of shorter overall survival.

Discussion:
When matched based on stage and adjuvant treatment, our study suggests that there is no statistically significant difference in survival endpoints between women with early-stage carcinosarcoma and serous carcinoma. Adjuvant combined modality treatment is an independent predictor of longer recurrence-free survival and overall survival.
A New Approach for Classifying Fetal Growth Restriction
Authors: Hutcheon Jennifer A. , Riddell Corinne A. , Himes Katherine P. 
Published: July 2021

Background:
Fetal growth restriction is commonly defined using small for gestational age (SGA) birth (birthweight < 10th percentile) as a proxy, but this approach is problematic because most SGA infants are small but healthy. In this proof-of-concept study, we sought to develop a new approach for identifying fetal growth restriction at birth that combines information on multiple, imperfect measures of fetal growth restriction in a probabilistic manner.

Methods:
We combined information on birthweight, placental weight, placental malperfusion lesions, maternal disease, and fetal acidemia using latent profile analysis to classify fetal growth in births at the Royal Victoria Hospital in Montreal, Canada, 2001–2009. We examined the clinical characteristics and health outcomes of infants classified as growth-restricted and nongrowth-restricted by our model, and among the subgroup of growth-restricted infants who had a birthweight ≥10th percentile (i.e., would have been missed by the conventional SGA proxy).

Results:
Among 26,077 births, 345 (1.3%) were classified as growth-restricted by our latent profile model. Growth-restricted infants were more likely than nongrowth-restricted infants to have an Apgar score <7 (10% vs. 2%), have hypoglycemia at birth (17% vs. 3%), require neonatal intensive care unit admission (59% vs. 6%), die in the perinatal period (3.8% vs. 0.2%), and require an emergency cesarean delivery (42% vs. 15%). Risks remained elevated in growth-restricted infants who were not SGA, suggesting our model identified at-risk infants not detected using the SGA proxy.

Conclusions:
Latent profile analysis is a promising strategy for classifying growth restriction at birth in fetal growth restriction research.
Can We Reach a Consensus on the Appropriate Use of Before and After Photos in Breast Surgery?
Authors: Valiquette Chantal R. , Forrest Christopher R. , Kasrai Leila , Wanzel Kyle R. , Martou Glykeria , Beber Brett A. , Semple John L. , Constantine Thomas , Ho Emily S. , Somogyi Ron B. 
Published: July 2021

Background:
Breast surgery is an area of practice where patients value before and after photographs (BAPs). Consensus is needed to develop guidelines to address the deficit in the literature regarding appropriate use of BAPs, as these may ultimately play a significant role in the breast surgery consent process.

Methods:
Expert breast reconstructive surgeons participated in a modified nominal group technique (NGT) to establish expert consensus on categories and criteria to be used when evaluating appropriate use of BAPs as part of informed consent. Endorsement rate of 75% and coefficients of variance within and between rounds were conducted to determine validity of each criteria item’s rank order.

Results:
Eight experts participated in the NGT in-person meeting and subsequent online survey. five of seven categories were endorsed for discussion: purpose, image type, anatomy, results, and photographic integrity. Overall consensus was obtained for six of 11 criteria. Criteria items found to have consensus were: patients considering surgery being the intended photograph audience (100% endorsement, CV1 – CV2 = 0.01), use of photographic images (75% endorsement, CV1 – CV2 = 0.04), defining the standard clinical photograph by having patients in the same body position (100% endorsement, CV1 – CV2 = 0.14), anonymizing images by removing all digital tags (88% endorsement, CV1 – CV2 = 0.03) and patient identifiers (75% endorsement, CV1 – CV2 = 0.00), not limiting the number of photograph sets needed for sufficient representation (100% endorsement, CV1 – CV2 = 0.07), and representing average outcomes (100%, CV1 – CV2 = 0.06).

Conclusions:
Early use of this validated and effective technique helps identify potential consensus categories and criteria that surgeons recommend for the use of BAPs in the informed consent process. Further study is required.
Effect of Face Mask on Tear Film Stability in Eyes With Moderate-to-Severe Dry Eye Disease
Authors: Arriola-Villalobos Pedro , Burgos-Blasco Barbara , Vidal-Villegas Beatriz , Oribio-Quinto Carlos , Ariño-Gutiérrez Mayte , Diaz-Valle David , Benitez-del-Castillo Jose Manuel 
Published: July 2021

Purpose:
The purpose of this study was to evaluate whether tear film stability worsens with the use of masks in patients with dry eye disease, objectively analyzing the tear film stability using noninvasive tear film breakup time (NITBUT) with and without a face mask.

Methods:
A cross-sectional study including patients with moderate or severe dry eye disease was conducted. Tear stability was measured using an Oculus Keratograph 5M (Oculus, Wetzlar, Germany), which records NITBUT, both first and average NITBUT. Two measurements were taken: an initial measurement with a mask and a second measurement after 10 minutes without wearing the face mask.

Results:
Thirty-one patients were included with a mean age of 57.6 ± 11.7 years (range 31–80) and 30 being female (97%). Mean first NITBUT with face mask was 6.2 ± 3.8 seconds (range 2.0–19.8), which increased to 7.8 ± 5.6 seconds (range 2.3–24.0) without the use of mask (P = 0.029), differences being −1.6 ± 0.7 seconds (CI 95% −3.1075 to −0.1770). Mean average NITBUT with a face mask was 12.3 ± 4.8 seconds (range 4.0–19.4) and increased to 13.8 ± 5 seconds (range 5.5–24.0) without the use of mask (P = 0.006), mean difference being −1.5 ± 0.5 seconds (CI 95% −2.5290 to −0.4458).

Conclusions:
Face mask use decreases tear film stability in patients with moderate-to-severe dry eye.
Clinical Outcomes of a New Type of Continuous Intrastromal Corneal Ring for Treatment of Keratoconus
Authors: Jabbarvand Mahmoud , Ahmadzadeh Hooman , Khodaparast Mehdi , Jamali Alireza , Aghamirsalim Mohamadreza 
Published: July 2021

Purpose:
The purpose of this study was to evaluate the efficacy and safety of implantation of a new continuous corneal ring in keratoconic corneas of an Iranian population.

Methods:
This study was conducted on 95 contact lens–intolerant keratoconic eyes with clear central corneas. A continuous corneal ring, annular intrastromal corneal inlay (AICI), was inserted using femtosecond laser in all cases. Patients were followed up for 1, 3, and 12 months postsurgery. Visual and subjective refractive outcomes were evaluated in each examination. Besides, keratometry and aberrometric values were recorded before and 12 months after surgery. Finally, vector analysis of refractive astigmatism was performed using the Alpins method.

Results:
The uncorrected and corrected distance visual acuities improved significantly 12 months after surgery from 0.91 ± 0.39 to 0.38 ± 0.22 (P < 0 0.001) and 0.33 ± 0.21 to 0.13 ± 0.11 logMAR (P < 0.001), respectively. Moreover, spherical and cylindrical refractive components reduced from −2.52 ± 2.62 to −0.76 ± 1.78 D (P < 0.001) and −4.14 ± 1.64 to −1.91 ± 1.18 D (P < 0.001), respectively. The mean anterior keratometry had a significant reduction 12 months after AICI insertion (P< 0.001). Primary coma and spherical aberration values showed a significant increase (both, P < 0.05). Our results showed 100% safety (safety index: 1.8) and 45% efficacy (efficacy index: 1).

Conclusions:
AICI implantation seemed to be a safe and effective procedure for improving visual acuity and refractive outcomes in subjects with keratoconus.
Microsporidial Endotheliitis Mimicking Graft Rejection After Deep Anterior Lamellar Keratoplasty
Authors: Gandhi Neha , Das Sujata , Mittal Ruchi , Barik Manas R. 
Published: July 2021

Purpose:
The purpose of this study was to report a case of microsporidial endotheliitis masquerading as graft rejection after deep anterior lamellar keratoplasty (DALK).

Methods:
A 36-year-old man visited the clinic with complaints of blurred vision, redness, pain, watering, and whitish appearance of the black portion of his left eye. On evaluation, there was diffuse stromal edema with epithelial defect and hypopyon. Microbial keratitis resolved with macular grade scar. He underwent DALK. After 3 years, he presented with complaints of sudden diminution of vision in the same eye for 10 days. His unaided visual acuity was counting finger 1 meter. The clinical findings were circumcorneal congestion, diffuse graft edema, Descemet membrane folds, and diffuse keratic precipitates. A presumptive diagnosis of left eye graft rejection was made. Topical steroids were administered. There was significant improvement within a week. However, at 1 month, there was an increase in graft edema after the steroids were tapered. At this point, a diagnosis of endotheliitis of viral origin was made. He was then administered oral antivirals and steroids. There were 2 such waxing and waning episodes of graft edema before the graft failed. Patient underwent penetrating keratoplasty with cataract extraction with intraocular lens implantation.

Results:
The previous donor and host Descemet endothelium complex was sent for histopathology and polymerase chain reaction. Both histology and polymerase chain reaction were positive for microsporidia.

Conclusions:
Microsporidial endotheliitis may present as graft rejection. There should be a suspicion of microsporidial infection in cases of features mimicking as endothelial rejection after DALK.
Evaluation of Depression and Quality of Life in Patients With Psoriasis
Authors: Sriramoju Sravani , Dunde Shiva , Eggadi Venkateshwarlu , Koppolu Manasa Sowmya , Bandaru Seshagiri Sharavana Bhava 
Published: July 2021

Abstract

Objective:
To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients' quality of life.

Methods:
A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score, presence, and severity of depression using the patient health questionnaire 9, and quality of life using the dermatology life quality index 10. Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95% confidence intervals (CIs); P < 0.00001 was taken to indicate statistical significance.

Results:
The severity of psoriasis was mild in 36.36% of patients, moderate in 25.97%, severe in 32.47%, and very severe in 5.20%. Of the 154 patients, 139 (90.3%) had depression; the severity of depression was mild in most affected patients (46.7%) and severe in 2.6% of patients. Psoriasis had a moderate effect on the quality of life in 37.01% of patients and a very large effect in 33.77% of patients. The severity of psoriasis was positively correlated with depression (Pearson correlation coefficient, r = 0.42, P<0.00001, 95% CI: 0.28-0.54) and quality of life (r = 0.43, P<0.00001, 95% CI: 0.29-0.55).

Conclusion:
Depression is a common comorbidity in patients with psoriasis. The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.
The Impact of Electronic Health Records and Meaningful Use on Inpatient Quality
Authors: Trout Kate E. , Chen Li-Wu , Wilson Fernando A. , Tak Hyo Jung , Palm David 
Published: July 2021

ABSTRACT
It is unclear if national investments of the HITECH Act have resulted in significant improvements in care processes and outcomes by making “Meaningful Use (MU)” of Electronic Health Record (EHR) systems. The objective of this study is to determine the impact of EHRs and MU on inpatient quality. We used inpatient hospitalization data, American Hospital Association annual survey, and the Centers for Medicare and Medicaid Services attestation records to study the impact of EHRs on inpatient quality composite scores. Agency for Healthcare Research and Quality Inpatient Quality Indicator (IQI) software version 5.0 was used to compute the hospital-level risk-adjusted standardized rates for IQI indicators and composite scores. After adjusting for confounding factors, EHRs that attested to MU had a positive impact on IQI 90 and IQI 91 composite scores with an 8% decrease in composites for mortality for selected procedures and 18% decrease in composites for mortality for selected conditions. Meaningful Use attestation may be an important driver related to inpatient quality. Health care leaders may need to focus on quality improvement initiatives and advanced analytics to better leverage their EHRs to improve IQI 90 composite score for mortality for selected procedures, because we observed a lesser impact on IQI 90 compared with IQI 91.
Health Locus of Control and Neurocognitive Function in Latinx and Non-Latinx White People Living With HIV: A Cross-sectional Study
Authors: Aghvinian Maral , Morris Emily P. , Savin Micah J. , Summers Angela C. , Crook Cara L. , Stiver Jordan , Gonzalez Jairo , Byrd Desiree , Rivera Mindt Monica 
Published: July 2021

Abstract
Research suggests that health locus of control (HLOC) is related to important health and neurocognitive outcomes in people living with HIV. However, the role of ethnicity in these relationships remains poorly understood. This study explored the role of HLOC on neurocognition in a diverse sample of 134 people living with HIV (Latinx: n = 96; non-Latinx White: n = 38) who completed comprehensive neurocognitive evaluations and the Multidimensional HLOC Scale-Form C. Results indicate no ethnocultural differences in HLOC beliefs (ps > .05). External HLOC (i.e., chance and powerful others) related to worse neurocognition in the Latinx group and contributed to significant variance in global neurocognition and learning, memory, and verbal fluency, underscoring the role of external HLOC beliefs on neurocognition, particularly for Latinx individuals. Additional research is needed to better characterize the mechanistic relationship between HLOC beliefs and neurocognitive function and to further explore this relationship among other underrepresented populations also disproportionately affected by HIV.
Credentials and Core Clerkships: Who's Training Our Physician Assistant Students (and Does It Matter)?
Authors: Min Elana A. , Bowden W. Patrick , Gerstner Laura R. , Guthrie Jennifer R. 
Published: July 2021

Purpose
Evaluating the effectiveness of supervised clinical practice experiences (SCPEs) is a primary responsibility of the clinical education team. Physician assistant (PA) education is unique because preceptors are not confined to one professional credential. This study evaluated the relationship between students' perceptions of rotation experiences and the professional credentials of the preceptor of record.

Methods
This retrospective data analysis evaluated data from 3 cohorts (2016–2018) across 4 PA programs. Preceptors of record were categorized as MDs/DOs or advanced practice providers (APPs).

Results
Analysis of 209 SCPEs found 91 APP preceptors (43%) and 119 MD/DO preceptors (57%). APP preceptors were most prevalent in family medicine/primary care (57%), internal medicine (50%), and emergency medicine (49%). Students' evaluation scores were higher for APP preceptors compared to MD/DO preceptors, but not statistically significant.

Conclusions
This study showed that a considerable number of APPs are serving as preceptors and were found to have similar student evaluation scores to those of MD/DO preceptors.
Advancing Physician Assistant Faculty Development: A New Model
Authors: Gordes Karen L. , Fleming Shani , Cawley James F. , Kulo Violet 
Published: July 2021

Purpose
The purpose of this article is to describe the development, implementation, and evaluation of an innovative physician assistant (PA) faculty development model.

Methods
The Maryland Physician Assistant Leadership and Learning Academy's (PALLA's) executive team developed a 10-month fellowship designed to build a skilled faculty pipeline. The fellowship framework was grounded in the PA educator competencies, the 3 pillars of academia, and the 5th edition Accreditation Standards for Physician Assistant Education. The self-perceived impact of the fellowship was evaluated through multiple surveys.

Results
Survey results show that all of the learning activities met fellows' expectations, and fellows indicated strong agreement in self-perceived achievement in meeting the fellowship outcome goals.

Conclusion
Study results provide evidence that formal training increases self-perceived competence in clinicians transitioning to academia. PALLA can serve as a model for other states to ensure faculty capacity within PA education.
Unmet needs of hypertension care in Nigeria: results of the community action against non-communicable diseases (COMAAND) project preintervention survey
Authors: Obagha Chijioke Emmanuel , Danladi Benjamin , Kamateeka Moreen , Chori Babangida Sylvester , Ogbonnaya Uche , Maduka Doris , Nguku Patrick , Osunkwo Damaris Amarachukwu , Odili Augustine Nonso 
Published: July 2021

Objective
Assessing the state of hypertension care remains the first step towards planning a robust health system needed to tackle the rising burden of hypertension. Prior to the commencement of the Community Action Against Non-Communicable Disease project, we assessed hypertension care using the hypertension care cascade (HCC). This will serve as a baseline to evaluate project performance upon completion.

Methods
Hypertensive subjects were grouped into a mutually exclusive care cascade of 5 categories including unscreened and undiagnosed; screened but undiagnosed; diagnosed but untreated; treated but uncontrolled and treated with controlled hypertension.

Results
Of the 372 participants, mean age 48.9 years, 161 (43.3%) were hypertensive, of whom only 12.0% had controlled blood pressure (BP). Among the 88.0% with uncontrolled BP,19.0% were unscreened and undiagnosed, 48.5% were screened but undiagnosed, 13.0% were diagnosed but untreated and 7.5% were treated but BP uncontrolled. The HCC demonstrates that 19% of the hypertensive patients were lost at the screening stage, 60% of those who were screened never diagnosed, 40% of those who were diagnosed did not receive treatment and 60% of those who were on treatment did not reach target BP.

Conclusion
Unmet need of hypertension care is substantially high, thus underpinning the need for intervention with a multifaceted approach
Algorithmic prognostication in critical care: a promising but unproven technology for supporting difficult decisions
Authors: Weissman Gary E. , Liu Vincent X. 
Published: July 2021

Purpose of review
Patients, surrogate decision makers, and clinicians face weighty and urgent decisions under uncertainty in the ICU, which could be aided by risk prediction. Although emerging artificial intelligence/machine learning (AI/ML) algorithms could reduce uncertainty surrounding these life and death decisions, certain criteria must be met to ensure their bedside value.

Recent findings
Although ICU severity of illness scores have existed for decades, these tools have not been shown to predict well or to improve outcomes for individual patients. Novel AI/ML tools offer the promise of personalized ICU care but remain untested in clinical trials. Ensuring that these predictive models account for heterogeneity in patient characteristics and treatments, are not only specific to a clinical action but also consider the longitudinal course of critical illness, and address patient-centered outcomes related to equity, transparency, and shared decision-making will increase the likelihood that these tools improve outcomes. Improved clarity around standards and contributions from institutions and critical care departments will be essential.

Summary
Improved ICU prognostication, enabled by advanced ML/AI methods, offer a promising approach to inform difficult and urgent decisions under uncertainty. However, critical knowledge gaps around performance, equity, safety, and effectiveness must be filled and prospective, randomized testing of predictive interventions are still needed.
Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus
Authors: Hart Phil A. , Andersen Dana K. , Petrov Maxim S. , Goodarzi Mark O. 
Published: July 2021

Purpose of review
Diabetes secondary to pancreatic diseases (i.e., acute pancreatitis, chronic pancreatitis, and pancreatic cancer) is increasingly studied, but remains challenging to distinguish from type 2 diabetes (T2DM). We review the clinical significance and potential biomarkers that may help differentiate these types of diabetes.

Recent findings
Recent studies have identified several complications (including nonvascular) that occur more frequently in patients with diabetes secondary to acute and chronic pancreatitis than T2DM, and biomarkers to differentiate these types of diabetes. There have been advances that may enable the enrichment of a population of adults with new onset diabetes to potentially screen for occult pancreatic cancer, but efforts are needed to identify and validate promising diagnostic biomarkers.

Summary
High-quality studies are needed to more precisely understand the risk factors and natural course of diabetes secondary to pancreatic diseases. Mechanistic and interventional studies are awaited to provide insights that will distinguish diabetes secondary to pancreatic diseases and refine the management of hyperglycemia in this patient population.