bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-level costs in intensive care: a case report of a standardized and scalable approach
Authors: Bezerra I , Rodrigues M , Sousa EM , Malicia J , Prestes R , Rêgo RC , Mendes A , Sousa A , Nassar Junior AP , Pereira AJ 
Published: October 2021

Abstract

Background
Intensive care units (ICU) costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs (Value-Based Healthcare).

Methods
Case report of a costing methodology implementation, in a 15-bed ICU, in a public, teaching hospital at Teresina/Piauí-Brazil (as part of a broader initiative, with 10 hospitals from all Brazilian regions). All costs incurred during ICU stay were measured from the hospital perspective, applying absorption costing method, by using a standardized approach and a specific central IT system. The study was carried out from Oct/19-Sep/20, including 613 patients, and a team of 10 researchers working with 4 teams of the local hospital (costs, IT, ICU and managers).

Results
ICU fixed costs (personnel, overheads, energy/water, depreciation, non-tracked drugs/medical materials), were divided by service capacity (total bed-hours) for calculation of the costs/minute. Costs were then allocated in the patient level multiplying costs/minute by the ICU length of stay. Variable costs (lab/image tests, transfusions, hemodialysis, and traceable medical materials/drugs) were directly allocated, multiplying the unit cost by the volume consumed per patient. A mini-survey applied 1-year after showed that both cost researchers and hospital staff agreed on the main challenges in measuring patient-level costs (fragmented process; fixed costs available only at the hospital level; lack of control on cost-drivers; indirect costs not considered; any reference for lab/image costs) and that the approach was sufficient to overcome them. The local team also reported increased awareness about the importance of patient-level costs after the experience.

Conclusions
The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.

Key messages
ICU costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs. The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
Klebsiella pneumoniae in vegetable products: antimicrobial resistance and consumer health risk
Authors: Centorotola G , Cornacchia A , Marfoglia C , Saletti MA , Ciarrocchi A , Del Matto I , Galante D , Rodrigues C , Brisse S , Pomilio F 
Published: October 2021

Abstract

Background
Klebsiella pneumoniae (Kp) is considered one of the major causes of human hospital infections. Moreover, Kp is often present in several food products and it could be a potential health hazard for the consumers through the increase of Kp antimicrobial resistance (AMR) to the main routinely used antibiotics classes. The aim of this study was to evaluate the AMR profile of Kp strains isolated from vegetable food products.

Methods
The whole genome sequences of 10 Kp strains, previously isolated from carrots (n. 4), salads (n. 3), tomatoes (n. 2) and pumpkin (n. 1) samples, were obtained by next generation sequencing technique, using Illumina platform. Phenotypic and genotypic AMR profiles, with particular attention to β-lactams, quinolones and aminoglycosides resistances, were acquired by both agar diffusion and micro-dilution susceptibility testing and uploading the Kp sequences to Institut Pasteur platform (https://bigsdb.pasteur.fr/), respectively.

Results
Most of Kp strains (9 of 10) resulted susceptible to the main antibiotics tested and few AMR genes were detected in silico besides the native blaSHV, blaOKP and blaLEN. Only one Kp harboured blaAMPC and blaCMY, showing resistance to 5 β-lactams (amoxicillin/clavulanate, cefoxitin, cefpodoxime, cefpodoxime/clavulanate, ceftobiprole). Regarding the quinolone resistances, all the Kp strains carried gyr and par genes. No aminoglycoside resistance genes were highlighted in the 10 Kp strains studied.

Conclusions
These preliminary results showed the presence, in vegetable foods, mainly in ready to eat raw products, of Kp strains, harbouring no or few AMR genes. Good hygiene practices should be properly applied during the entire food processing chain, to avoid hazardous implications for the consumer. Further studies are needed in order to: analyse more vegetable samples, deeply evaluate the phenotypic and genotypic AMR profile of the Kp strains and their possible transmission from food products to consumer.

Key messages
Klebsiella pneumoniae is often isolated in food, as ready to eat vegetables, and it could be a potential public health risk due to the antimicrobial resistance increase to main antibiotics. The presence of Klebsiella pneumoniae in food implies the correct application of good hygiene practices in the entire food processing chain, in order to avoid dangerous effects for consumers.
Occupational exposure to formaldehyde and oxidative stress in Italian workers
Authors: Squillacioti G , Bellisario V , Ghelli F , Bono R 
Published: October 2021

Abstract

Background
Formaldehyde (FA) is an environmental pollutant widely used in several occupational settings. Beyond its carcinogenic effect, FA can trigger inflammation by promoting reactive oxygen species formation in exposed subjects. The current study aims to investigate the association between air-FA exposure and systemic oxidative stress induction in specific working environments.

Methods
We accounted for three different scenarios of air-FA exposure by including a sample of pathologists and nurses from operating theatres (n = 185), traffic police officers (n = 154) and wood-workers (n = 127), who participated as volunteers. Exposure to air-FA was assessed by passive air-samplers (Radiello®) and oxidative stress was quantified by 15-F2t-IsoP urinary biomarker (ELISA). A piecewise linear regression model was performed to analyse oxidative stress variation in response to air-FA exposure.

Results
Overall, 466 subjects (45 ± 9 years) were included in the study, 53% were females. None significant changes of ln(15-F2t-IsoP) were observed before a specific exposure breakpoint of 4.729 (air-FA = 113 µg/m3). Beyond the breakpoint, ln(15-F2t-IsoP) showed a 1.5 increase (p &lt; 0.0001), independently from age and sex. Interestingly, while age did not affect oxidative stress levels nor before neither beyond the breakpoint, sex determined an increase of ln(15-F2t-IsoP) only before the breakpoint (+0.62, p &lt; 0.0001).

Conclusions
Currently, the most precautionary regulatory limit of air-FA exposure in occupational settings is 0.1 ppm (TLW-TVA, i.e. 120 µg/m3). This limit is recommended to protect for eyes and upper respiratory tract irritation. However, our results highlighted that slightly lower exposures can induce a biological effect, which should deserve consideration from Primary Prevention perspective. Since oxidative stress may evolve in future diseases, it would be advisable considering to tailor the regulatory limits to such a pre-pathological condition rather symptoms onset.

Key messages
Occupational exposure to air-FA is able to induce systemic oxidative stress even below the regulatory limit, independently from age and sex. Future updates of the regulatory limits in force may consider pre-pathological conditions, such as oxidative stress, rather symptoms onset.
Risk Management Assessments of Adverse Drug Reactions: A Systematic Review of the Literature
Authors: Traore B , Tsoumbou-Bakana G , Nani S , Hassoune S 
Published: October 2021

Abstract

Background
Improving the quality of life of patients is a key concern in public health. In the context of improving therapeutic compliance, quality of life of patients undergoing anti-tuberculosis treatment, and prevention of antibiotic resistance, we conducted this systematic review to support risk minimization actions.

Methods
A literature review of risk management strategies targeting adverse drug reactions to anti-tuberculosis drugs was conducted, including published observational studies. Two independent reviewers identified studies through Medline, Scopus, and Web of Science. The methodological quality of the included studies was assessed using criteria defined by the Newcastle Ottawa Scale.

Results
Seven studies were included in this review, which identified four risk management strategies (psychological intervention, reduction of drug dose with or without prescription of adjunctive medications, change of medication, permanent or temporary discontinuation of medication). The strategies adopted were dependent on the nature and severity of the adverse events. All drugs responsible for serious adverse events were changed or discontinued. Three studies had a moderate risk of methodological bias.

Conclusions
Strategies to minimize the risk of adverse drug reactions and improve adherence to therapy have a strong potential to improve adherence to therapy, improve patient quality of life, and reduce antibiotic resistance. However, high-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.

Key messages
Strategies to manage the risk of adverse drug reactions have a strong potential benefit for TB patients on treatment; and improve adherence to treatment. High-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.
How the health-related quality of life in geriatric patients is influenced?
Authors: Nante N , Rivieri C , Cuccaro C , Diodati D , Abinova A , Gentile G 
Published: October 2021

Abstract

Background
Health requires a multi-dimensional approach and not just a cure for illness. Health can be assessed from the point of view of the objective state, but also from its perception which influences the quality of life (QoL). Several tools have been used to measure QoL in many clinical contexts such as five-level EuroQol-5 dimension questionnaire (EQ-5D-5L). The aim of the study is to evaluate the perceived QoL in geriatric patients.

Methods
We conducted a cross-sectional study, using EQ-5D-5L from January to December 2019. EQ-5D-5L was self-administered to a sample of 187 geriatric patients from a private clinical (100 beds). We performed a descriptive and statistical analyses using the five dimensions: mobility (M), self-care (SC), usual activities (UA), pain/discomfort (PD), anxiety/depression (AD) in association with BMI, age, sex, length of stay (LoS). The analyses (Spearman correlation coefficient) was carried out with STATA software.

Results
In our sample the 66,8% was female, the mean age was 78,35 ±10,9, the LoS had an average of 22,37 ± 37,72. Only 170 patients responded to EQ-5D-5L. The mean score of the five dimension of EQ-5D-5L was 3 excepted for the AD that was 2. The mean of EQ index was 0.44 ± 0.29, and it is realted to LoS (p = 0,01; Rho=-0,18). Only UA was associated to BMI (p &lt; 0.05; Rho= -0,21). The age and LoS were associated to M, SC and UA (p &lt; 0,03 Rho&lt;0,25). The gender appeared related to the M (p &lt; 0,02) with a worse perception in the female.

Conclusions
Our sample perceived a low quality of life that appeared to be related to the length of stay. Among the 5 dimensions mobility, self-care and usual activities were more influenced by our variables. A higher BMI doesn't appear as a limit to the habitual daily activities.

Key messages
Health requires a multi-dimensional approach and not just a cure for illness beacause it could influence the quality of life. The length of the stay seems to condition the quality of life of patiens and also a higher BMI seems not impacted the habitual daily activities.
BSAC Vanguard Series: the future of ADVOCACY on AMR
Authors: Osterholm Michael T 
Published: October 2021

Abstract
The COVID public health emergency has brought home how vulnerable we are to forces beyond our control. We are losing our ability to treat infectious diseases for a number of reasons, including antimicrobial resistance (AMR). AMR is a ‘slow-moving’ threat, which makes it harder to recognize and address. The situation has not been helped by the difficulty we have had in seeing the actions and health of everyone on this planet as interconnected. The COVID pandemic has changed this. Despite the dire predictions of the effect of AMR in the future, we still have time to change course. Advocacy by scientists and health professionals is a powerful tool in this process, but there are pitfalls and it must be used wisely. In this article I suggest a number of ways in which this can be achieved.
Predictors of Incident Severe Acute Respiratory Syndrome Coronavirus 2 Positivity in a Veteran Population
Authors: Smith Jeremy , Aboumrad Maya , Reyes Carolina , Satram Sacha , Young-Xu Yinong 
Published: October 2021

ABSTRACT

Objectives
We explored factors related to testing positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) to identify populations most at risk for this airborne pathogen.

Methods
Data were abstracted from the medical record database of the U.S. Department of Veterans Affairs and from public sources. Veterans testing positive were matched in a 1:4 ratio to those at a similar timepoint and local disease burden who remained negative between March 1, 2020, and December 31, 2020. Multivariable logistic regression was used to calculate odds ratios for the association of each potential risk factor with a positive test result.

Results
A total of 24,843 veterans who tested positive for SARS-CoV-2 were matched with 99,324 controls. Cases and controls were similar in age, sex, ethnicity, and rurality, but cases were more likely to be Black, reside in low-income counties, and suffer from dementia. Multivariable analysis demonstrated highest risk for Black veterans, those with dementia or diabetes, and those living in nursing homes or high-poverty areas. Veterans living in counties likely to be more adherent to public health guidelines were at the lowest risk.

Conclusions
Our results are similar to those from studies of other populations and add to that work by accounting for several important proxies for risk. In particular, this work has implications for the value of infection control measures at the population level in helping to stem widespread outbreaks of this type.
EUA for Regen-Cov Now Includes COVID-19 Postexposure Prophylaxis
Authors: Aschenbrenner Diane S. 
Published: October 2021

The emergency use authorization for REGEN-COV (a combination of two monoclonal antibodies, casirivimab and imdevimab) has been revised to include postexposure prophylaxis of COVID-19 in adults and children 12 years of age and older who, if they become COVID-19 positive, are at high risk for severe disease.Prophylaxis with REGEN-COV is not a substitute for vaccination against COVID-19.
The Flu Pandemic of 1918: A Nurse's Story
Authors: Johnson Deborah 
Published: October 2021

ABSTRACT
In the spring of 1918, a virus swept across the world, killing approximately 50 million people by the summer of 1919. My grandmother, Kathryn (“Katie”) Ann Darmody—an Irish immigrant who settled in New York State in 1904—was among the nurses who responded to this pandemic, which became known as the 1918 influenza pandemic (or, erroneously, the Spanish flu). Today, as the world contends with the COVID-19 pandemic, my grandmother's experiences resonate with new meaning—a reminder of how, then as now, nurses have been at the forefront of public health. Her story, transmitted across generations, is one I now share with a new generation of nurses.
Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review
Authors: Albuquerque Andreia , Stockdale Colleen K. , Heller Debra , Bornstein Jacob , Roberts Jennifer M. , Preti Mario , Poynten I. Mary , Vieira-Baptista Pedro 
Published: October 2021

Objectives
Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women.

Materials and Methods
A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC.

Results
The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method.

Conclusions
Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.
Clinical Application of the Musculoperiosteal Iliac Flap for Osteonecrosis of the Femoral Head
Authors: Li Bo-Rui , Qin Kai-Rong , Liu Bao-Yi , Wang Ben-Jie , Qiu Xing , Li Zhi-Gang , Lineaweaver William C. , Zhang Feng , Zhao Dewei 
Published: October 2021

Background
Osteonecrosis of the femoral head (ONFH) often affects young, active patients, and the femoral head’s preservation is the primary goal of treatment for this disease. Vascularized iliac crest bone grafting is one of the many vascularized procedures used in treating ONHF. In some cases, we selectively performed this procedure using the musculoperiosteal iliac flap with the ascending branch of the lateral femoral circumflex artery for ONFH treatment.

Methods
Twelve patients (12 hips) with nontraumatic femoral head necrosis underwent musculoperiosteal iliac flap transfer with the ascending branch of the lateral femoral circumflex artery. The Harris Hip Score (HHS), visual analog scale score, and double-hip X-ray findings were used to analyze hip function changes within 10 days preoperatively and 6 and 12 months postoperatively.

Results
The mean HHS increased from 52.33 ± 3.34 preoperatively to 65.92 ± 5.04 6 months postoperatively and 79.75 ± 3.84 12 months postoperatively, and the data showed a statistical significance difference between preoperative and postoperative (F = 131.90, P < 0.01). The HHS at 6 and 12 months after surgery were significantly different (P < 0.01). The visual analog scale score showed the same trend. The x-ray of hip joints at 6 and 12 months after surgery showed that the femoral heads' shape and contour were good, femoral heads did not collapse, and the transferred bone flaps healed well.

Conclusions
Musculoperiosteal iliac flap transfer with the ascending branch of the lateral femoral circumflex artery may be an effective method with a high clinical success rate for treating young patients with early to midstage ONFH.
A Systematic Stepwise Method to Perform a Supermicrosurgical Lymphovenous Anastomosis
Authors: Rodriguez Jose R. , Yamamoto Takumi 
Published: October 2021

Background
Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with extremity lymphedema. In this article, we present our current strategy for patient selection, preoperative planning, and a series of intraoperative clues that may help to perform a supermicrosurgical LVA. Technical considerations are presented using a systematic step-by-step method to make this procedure more reproducible and straightforward.

Patients and Methods
We conducted a review of patients operated between January 2015 and June 2018 using the aforementioned approach. Data were collected prospectively, and all procedures were performed by the senior author. Preoperative assessment included lymphoscintigraphy, indocyanine green lymphography, noncontrast magnetic resonance lymphography and high-frequency ultrasonography. Lymphovenous anastomosis was decomposed into a sequential 6-step approach considering the main aspects that determine a successful anastomosis.

Results
Lymphovenous anastomosis was performed in 229 patients, including 677 anastomoses. Median follow-up was 33 months (range, 13–51 months). A median of 3.1 (range, 1–7) LVA were performed on 2.7 (range, 1–6) incision sites per patient. Median time for dissection of lymphatic(s) and vein(s) was 8.7 minutes (1–18 minutes) with a median time of 27.2 minutes (range, 13–51 minutes) for a complete LVA. Lymphatic detection rate was 100% (677 of 677) and vein detection rate was 99.7% (675 of 677), with 31.0% (210 of 677) of reflux-free veins. For upper-extremity lymphedema (47 of 229; 20.6%), volume reduction was achieved in 100% (47 of 47) of the cases, with a median volume reduction rate of 67% (range, 7–93%). In lower-extremity lymphedema (182 of 229; 79.4%), volume reduction was achieved in 86.8% (158 of 182) of the cases, with a median volume reduction rate of 41% (range, 7–81%). Cellulitis episodes decreased from 2.1 to 0.2 episodes/year after LVA (P < 0.05).

Conclusions
Acceptable success rates were obtained using a sequential strategy for planning and execution of supermicrosurgical LVA for secondary extremity lymphedema. We believe including a stepwise approach may help to simplify this procedure, especially for surgeons in their early practice.
Nutritional dependence of sperm mitochondrial metabolism and small RNA biogenesis
Authors: Ramesh Rashmi , Skog Signe , Nätt Daniel , Kugelberg Unn , Örkenby Lovisa , Öst Anita 
Published: October 2021

SummaryA wide spectrum of exogenous factors, including diet, environmental pollutants, stress, and seasonal changes have major impact on sperm quality and function. The molecular basis, however, that explains this susceptibility remains largely unknown. Using a combination of proteomics and small RNA (sRNA) sequencing, we show thatDrosophilasperm display rapid molecular changes in response to dietary sugar, both in terms of metabolic/redox proteins and sRNA content, particularly miRNA and mitochondria derived sRNA (mt-sRNA). Thus, results from two independent omics point at the dynamics of mitochondria as the central aspect in rapid metabolic adjustments in sperm. Using specific stains andin vivoredox reporter flies, we show that diet indeed rapidly alters the production of mitochondrial derived reactive oxygen species (ROS). Quenching ROS via supplementation of N acetyl cysteine reduces diet-upregulated miRNA, but not mitochondrial-sRNA. Together, these results open new territories in our search for the mechanistic understanding of sperm health and disease.HighlightsDiet rapidly changes the proteomic and sRNA profiles in spermDiet sensitive sperm proteins are found in human infertility studiesSperm mitochondrial ROS levels are modulated by dietdme-miR-10 regulation is secondary to diet-induced ROSDiet, but not diet-induced ROS, alters the expression of mitochondrial small RNA, especially tsRNA