bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation: Recommendations From Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research (SCEPTER) Recommendation III
Authors: Ward Denham S. , Absalom Anthony R. , Aitken Leanne M. , Balas Michele C. , Brown David L. , Burry Lisa , Colantuoni Elizabeth , Coursin Douglas , Devlin John W. , Dexter Franklin , Dworkin Robert H. , Egan Talmage D. , Elliott Doug , Egerod Ingrid , Flood Pamela , Fraser Gilles L. , Girard Timothy D. , Gozal David , Hopkins Ramona O. , Kress John , Maze Mervyn , Needham Dale M. , Pandharipande Pratik , Riker Richard , Sessler Daniel I. , Shafer Steven L. , Shehabi Yahya , Spies Claudia , Sun Lena S. , Tung Avery , Urman Richard D. 
Published: April 2021

OBJECTIVES:
Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators.

DESIGN:
A 2-day in-person meeting was held in Washington, DC, on March 28–29, 2019, followed by a three-round, online modified Delphi consensus process.

PARTICIPANTS:
Thirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process.

MEASUREMENTS AND MAIN RESULTS:
The final recommendations were iteratively refined based on the survey results, participants’ reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization.

CONCLUSIONS:
These recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.
Improving Team Skills of Health Care Practitioners: Effects of an Interprofessional Education Program
Authors: Cohen Elaine V. , Luce Virge , González Manny J. , Hagestuen Ruth , González-Ramos Gladys , Cohen Hillel W. 
Published: April 2021

Introduction:
Health care practitioners in Parkinson's care need to learn effective interprofessional team skills. This study examines posttraining effects on team skills of health practitioners attending an interprofessional education (IPE) program for team-based Parkinson's care.

Methods:
Using a quasi-experimental pre–post design, practitioners (n = 236) in nine professions (physician, nurse and nurse practitioner, physician assistant, occupational, physical and music therapy, speech-language pathology, and social work) completed the validated, self-report Team Skills Scale, before and after the training. Associations of Team Skills Scale change with intention to change practice, measured at end of each training day, and with improved attitudes toward team, knowledge, confidence, and amount of new information were examined.

Results:
All professions, except physician assistant, significantly improved perceived team skills, as did those showing greatest intention to change practice, with no meaningful differences in magnitude of change across profession groups. Team skills change was significantly associated with improved attitudes toward health care teams, increased knowledge about team and the role of other professions, and new knowledge gained. Confidence in Parkinson's care showed modest, statistically significant association with team skills improvement.

Discussion:
The Allied Team Training for Parkinson-IPE program significantly improved perceived team skills of health care practitioners, effectively teaching about skills for collaborative teamwork. Future IPE research should explore whether similar programs in other settings achieve the enhanced team skills competencies with postlicensure practitioners observed here and validate our findings from self-developed measures using larger samples, additional professions, and follow-up of transfer of learning effects through direct observation of skills of actual teams.
The Ontological Choreography of Continuing Professional Development: A Mixed-Methods Study of Continuing Professional Development Leaders and Program Directors
Authors: Paton Morag , Rowland Paula , Tavares Walter , Schneeweiss Suzan , Ginsburg Shiphra 
Published: April 2021

Introduction:
Reports have forecast significant changes ahead for Continuing Professional Development (CPD). With new models on the horizon, CPD developers will require additional knowledge and training. Our objective was to learn how CPD leaders and developers came into their roles, if they are engaged in scholarship and the challenges and opportunities in pursuing scholarship.

Methods:
We conducted a mixed grounded theory study, inviting CPD leaders within our institution for interviews focused on career paths, CPD and scholarly activities, networks, and supports and challenges. We invited 405 program/conference directors from our institution to participate in a survey focused on similar themes. We used the framework of ontological choreography in our final analysis.

Results:
We conducted 13 interviews and had a survey response rate of 28.6% (n = 116). We identified three themes: (1) the pathway to becoming an expert in CPD planning and delivery is often unplanned, unclear, and uncredentialed; (2) CPD is undervalued as a field, with inadequate time and funding allocated; and (3) engagement with scholarship is variable while identifying resources to support scholarship is difficult.

Discussion:
Beyond the usual calls for CPD to be more appropriately recognized and valued, this article offers another way to explore why past visions of the future have not been fully realized; CPD means different things to different people; it is ontologically different even across a single network in a single faculty.
Evaluation of a High Stakes Physician Competency Assessment: Lessons for Assessor Training, Program Accountability, and Continuous Improvement
Authors: Wenghofer Elizabeth F. , Steele Robert S. , Christiansen Richard G. , Carter Misti H. 
Published: April 2021

Introduction:
There is a dearth of evidence evaluating postlicensure high-stakes physician competency assessment programs. Our purpose was to contribute to this evidence by evaluating a high-stakes assessment for assessor inter-rater reliability and the relationship between performance on individual assessment components and overall performance. We did so to determine if the assessment tools identify specific competency needs of the assessed physicians and contribute to our understanding of physician dyscompetence more broadly.

Method:
Four assessors independently reviewed 102 video-recorded assessments and scored physicians on seven assessment components and overall performance. Inter-rater reliability was measured using intraclass correlation coefficients using a multiple rater, consistency, two-way random effect model. Analysis of variance with least-significant difference post-hoc analyses examined if the mean component scores differed significantly by quartile ranges of overall performance. Linear regression analysis determined the extent to which each component score was associated with overall performance.

Results:
Intraclass correlation coefficients ranged between 0.756 and 0.876 for all components scored and was highest for overall performance. Regression indicated that individual component scores were positively associated with overall performance. Levels of variation in component scores were significantly different across quartile ranges with higher variability in poorer performers.

Discussion:
High-stake assessments can be conducted reliably and identify performance gaps of potentially dyscompetent physicians. Physicians who performed well tended to do so in all aspects evaluated, whereas those who performed poorly demonstrated areas of strength and weakness. Understanding that dyscompetence rarely means a complete or catastrophic lapse competence is vital to understanding how educational needs change through a physician's career.
Knowledge of Infant Development and Parent Well-Being: Cross-Sectional Analysis of Toddlers
Authors: Sullivan Jacqueline A. , Zvara Bharathi J. , Keim Sarah A. , Andridge Rebecca , Anderson Sarah E. 
Published: April 2021

ABSTRACT:

Objective:
Knowledge about child development is associated with parenting and children's outcomes. Parents with less accurate knowledge about developmental milestones may have unrealistic expectations for their child's behavior, which may affect parent well-being. Limited research has examined this topic relative to depression, but other aspects of parent well-being (e.g., parenting stress) are unexplored.

Methods:
Cross-sectional analysis of an ongoing prospective cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation.) Primary caregivers (93% mothers) completed the 20-item Knowledge of Infant Development Index (KIDI) and questionnaires for child temperament and 3 aspects of parent well-being (depressive and anxious symptoms, parenting stress, and general health). Covariate-adjusted regression models assessed relationships between the KIDI score and each well-being outcome. We hypothesized that parents with less knowledge would have more symptoms of depression and anxiety, greater parenting stress, and poorer health. Whether associations were stronger for parents of children born preterm or who had high negative affect was explored.

Results:
Knowledge of Infant Development Index scores were associated with sociodemographic characteristics, child temperament, and gestational age (more knowledge: higher socioeconomic position, less child negative affect, and full-term birth). KIDI scores did not predict any aspect of parent well-being, and there was no evidence that child temperament or preterm birth altered these findings.

Conclusion:
In this sample of parents of toddlers assessed in 2018/19, greater knowledge of infant development was not associated with parent well-being.
Clinical performance of a machine-learning algorithm to predict intra-operative hypotension with noninvasive arterial pressure waveforms
Authors: Wijnberge Marije , van der Ster Björn J.P. , Geerts Bart F. , de Beer Friso , Beurskens Charlotte , Emal Dina , Hollmann Markus W. , Vlaar Alexander P.J. , Veelo Denise P. 
Published: April 2021

BACKGROUND
Intra-operative hypotension is associated with adverse postoperative outcomes. A machine-learning-derived algorithm developed to predict hypotension based on arterial blood pressure (ABP) waveforms significantly reduced intra-operative hypotension. The algorithm calculates the likelihood of hypotension occurring within minutes, expressed as the Hypotension Prediction Index (HPI) which ranges from 0 to 100. Currently, HPI is only available for patients monitored with invasive ABP, which is restricted to high-risk procedures and patients. In this study, the performance of HPI, employing noninvasive continuous ABP measurements, is assessed.

OBJECTIVES
The first aim was to compare the performance of the HPI algorithm, using noninvasive versus invasive ABP measurements, at a mathematically optimal HPI alarm threshold (Youden index). The second aim was to assess the performance of the algorithm using a HPI alarm threshold of 85 that is currently used in clinical trials. Hypotension was defined as a mean arterial pressure (MAP) below 65 mmHg for at least 1 min. The predictive performance of the algorithm at different HPI alarm thresholds (75 and 95) was studied.

DESIGN
Observational cohort study.

SETTING
Tertiary academic medical centre.

PATIENTS
Five hundred and seven adult patients undergoing general surgery.

RESULTS
The performance of the algorithm with invasive and noninvasive ABP input was similar. A HPI alarm threshold of 85 showed a median [IQR] time from alarm to hypotension of 2.7 [1.0 to 7.0] min with a sensitivity of 92.7 (95% confidence interval [CI], 91.2 to 94.3), specificity of 87.6 (95% CI, 86.2 to 89.0), positive predictive value of 79.9 (95% CI, 77.7 to 82.1) and negative predictive value of 95.8 (95% CI, 94.9 to 96.7). A HPI alarm threshold of 75 provided a lower positive predictive value but a prolonged time from prediction to actual hypotension.

CONCLUSION
This study demonstrated that the algorithm can be employed using continuous noninvasive ABP waveforms. This opens up the potential to predict and prevent hypotension in a larger patient population.

TRIAL REGISTRATION
Clinical trials registration number NCT03533205.
Swallowing ability and intra-oral water-retaining ability during moderate propofol sedation in healthy human volunteers
Authors: Hanamoto Hiroshi , Togawa Eriko , Yokoe Chizuko , Niwa Hitoshi 
Published: April 2021

BACKGROUND
The cough reflex or aspiration under monitored anaesthesia care might be associated with sedative-induced changes in swallowing and intra-oral water-retaining abilities.

OBJECTIVES
To investigate the effects of moderate propofol sedation on swallowing and intra-oral water-retaining ability.

DESIGN
Prospective observational study.

SETTING
Single tertiary care centre during 2017.

PARTICIPANTS
A total of 13 healthy adult volunteers.

INTERVENTION
Volunteers in the supine position were asked to retain 10 ml of orally injected water for 5 min. After 5 minutes or when the water was spontaneously swallowed, the retention time and residual intra-oral water volume were measured. Subjects then voluntarily swallowed a further 10 ml of injected water and the residual water volume was measured. This whole process was repeated under sedation with propofol at effect-site concentrations of 0.5, 1.0 and 1.5 μg ml−1.

MAIN OUTCOME MEASURES
The primary outcome was the estimated volume swallowed (swallowing volume); the secondary outcome was water retention time.

RESULTS
Median water retention time decreased from 300 to 11 s (P < 0.001), and greater spontaneous swallowing was induced with increased propofol effect-site concentrations measuring up to 1.5 μg ml−1 (P < 0.001). The median of the estimated swallowing volumes with voluntary swallowing while awake and with all three concentrations of propofol were 9.5, 9.6, 9.6 and 9.4 ml, respectively (P = 0.805); more water remained after spontaneous swallowing than after voluntary swallowing at all concentrations. Differences in mean estimated swallowing volumes between voluntary and spontaneous swallowing were 3.4 ml (95% CI, 0.9 to 6.0, P = 0.016) for 0.5 μg ml−1, 4.1 ml (95% CI, 1.8 to 6.3, P = 0.002) for 1.0 μg ml−1 and 5.1 ml (95% CI, 3.4 to 6.8, P < 0.001) for 1.5 μg ml−1.

CONCLUSIONS
Moderate propofol sedation decreases water-retaining ability but has no effect on voluntary swallowing. Ensuring that patients can respond under sedation may effectively prevent the unexpected cough reflex and aspiration by enabling occasional voluntary swallowing.

TRIAL REGISTRATION
UMIN Clinical Trials Registry identifier: UMIN000027517.
PDSS2 Inhibits the Ferroptosis of Vascular Endothelial Cells in Atherosclerosis by Activating Nrf2
Authors: Yang Kai , Song Hejian , Yin Delu 
Published: April 2021

Abstract:
Cardiovascular disease ranks the leading cause of mortality worldwide. Prenyldiphosphate synthase subunits collectively participate in the formation and development of atherosclerosis (AS). This study aimed to investigate the role of PDSS2 in AS and its underlying mechanisms. Human coronary artery endothelial cells (HCAECs) were treated with oxidized low-density lipoprotein to establish the AS model. The gene expression levels were determined by qRT-PCR, Western blot, and ELISA. CCK-8, colony formation was applied to determine the proliferation of HCAECs. Chromatin immunoprecipitation assay and luciferase assay were applied to verify the interaction between PDSS2 and Nrf2. The results showed that the serum levels of PDSS2 and Nrf2 were decreased in patients with AS. Overexpression of PDSS2 suppressed the release of reactive oxygen species, iron content and ferroptosis of HCAECs, and promoted the proliferation of HCAECs. Moreover, PDSS2 activated antioxidant Nrf2. PDSS2 interacted with Nrf2 to alleviate the ferroptosis of HCAECs. However, knockdown of Nrf2 alleviated the effects of PDSS2 on the proliferation and ferroptosis of HCAECs. In vivo assays, overexpression of PDSS2 and Nrf2 suppressed the progression of AS. In conclusion, overexpression of PDSS2 suppressed the ferroptosis of HCAECs by promoting the activation of Nrf2 pathways. Thence PDSS2 may play a cardio-protective role in AS.
Fatal and Nonfatal Injury Patterns of Stranded Motorists
Authors: Drake Stacy A. , Yang Yijiong , Gao Si , Mora Stephen , Garza Robin , Moore Laura , Todd S. Rob , Wilson Chad , Wolf Dwayne A. 
Published: April 2021

ABSTRACT
Because nonfatal and fatal incidents for stranded motorists are not separated from vehicular accidents, little data are available on incident characteristics. To close this gap, data fields were inserted into databases at a medical examiner's office and two trauma centers to collect injury-related information. Forensic nurses and pathologists aided in forming a collaboration among the agencies involved and supported data collection efforts. Data collected over a 5-year period were examined for injury patterns to determine risk factors affecting these patterns. Of the total sample (N = 219), 24.7% had spinal injuries resulting in fatal injuries for 46 of 54 individuals. The odds were stranded motorists with spine-related injuries (C1–C7) had 9.13 times higher risk for a fatal outcome compared with those without spine-related injuries. Severe injuries (Abbreviated Injury Scale scores ≥ 4) noted for head/neck (29.7%) and chest (24.2%) were significantly associated with fatality. Of the 219 cases, 22.8% were inside of a stopped vehicle, and 77.2% were outside a vehicle at the time of injury. Outcomes illustrated the success of the interprofessional collaboration between trauma centers and a medicolegal death investigation agency that resulted in data useful for forensic nurses and pathologists documenting evidence, emergency and trauma responding personnel in patient priority stabilization, and injury prevention specialists for highway safety programs.
Difference and Disdain as Indicators of the Public Stigma of Mental Illness
Authors: Corrigan Patrick W. , Talluri Sai Snigdha , Qin Sang 
Published: April 2021

Abstract
Viewing a stigmatized group as different from everyone else is believed to be a contentless stigma that leads to disdain. This study tests whether three emotions—intergroup anxiety, anger, and empathy—mediate the path between difference and disdain. Six hundred thirty-eight research participants from MTurk provided valid responses to an online survey via Qualtrics. The survey used standardized measures of difference, disdain, intergroup anxiety, anger, and empathy. The hypothesized path model was tested using structural equation modeling (SEM). Fit indicators from SEM and corresponding betas supported a two-mediator model. Specifically, difference was found to be significantly associated with disdain. The path between the two was positively mediated by anger and negatively mediated by empathy. Difference and disdain may become important constructs in predicting and assessing stigma change. Perspective-taking that enhances empathy may prove especially useful for decreasing difference and disdain perceptions about people with mental illness.
Relationship of Vitamin D Deficiency and Fatty Liver in Children as Defined by Multiple Imaging and Histologic Endpoints
Authors: Rudolph Bryan , Selig Tyler , Li Yingjie , Ovchinsky Nadia , Kogan-Liberman Debora , Liszewski Mark C. , Levin Terry L. , Ewart Michelle , Liu Qiang , Viswanathan Shankar , Lin Juan , Xue Xiaonan , Burk Robert D. , Strickler Howard D. 
Published: April 2021

Objectives:
The relationship between vitamin D deficiency (VDD) and pediatric nonalcoholic fatty liver disease (NAFLD) remains uncertain due to conflicting results and few studies with histologic endpoints. We therefore used multiple imaging and histologic NAFLD endpoints to more comprehensively assess the association between VDD and NAFLD in a large pediatric population.

Methods:
Data were obtained from an ongoing pediatric NAFLD study in Bronx, NY. Briefly, overweight and obese children aged 2 to 18 years with alanine aminotransferase levels ≥35 U/L were serially enrolled. Liver biopsy was obtained in accordance with clinical guidelines. All participants had liver imaging, namely, controlled attenuation parameter to assess steatosis and, to assess fibrosis, vibration controlled transient elastography (FibroScan), and acoustic radiation force impulse imaging. Levels of 25-hydroxyvitamin D were measured serologically.

Results:
N = 276 (88%) of 315 participants had 25-OH vitamin D results, of whom 241 (87%) were Hispanic, 199 (72%) were male, and 92 (33%) underwent liver biopsy. VDD was univariately associated with high waist circumference (P = 0.004), high-density lipoprotein level (P = 0.01), season (P = 0.009), and controlled attenuation parameter score (P = 0.01). In multivariate analysis, only waist circumference (P = .0002) and biopsy inflammation grade (P = 0.03) were associated with VDD, though the latter had not approximated statistical significance in univariate analysis (P = 0.56). There was no association between VDD and hepatic steatosis, ballooning, NAFLD activity score, and acoustic radiation force impulse or vibration controlled transient elastography elasticity scores.

Conclusions:
VDD was not associated with NAFLD defined by imaging and histologic endpoints, except for a possible relation with histologic inflammation grade.