bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Predictive Modeling to Tailor Molecular Testing Utilization for Thyroid Nodules
Authors: Ahmed Sadia T. , Fernandes Stevyn , Gao Qi , Ow Thomas J. , Smith Richard V. , Schiff Bradley A. , Mehta Vikas 
Published: March 2021

ObjectiveVarious risk stratification systems for cytologically indeterminate thyroid nodules are available. However, malignancy risk assessment data, such as ultrasound features, are not always used when the decision is to order molecular testing or not. Our aim was to investigate the utility of molecular testing after incorporating an algorithm with ultrasound‐based risk of malignancy (ROM) estimation.Study DesignDiagnostic/prognostic study.SettingSingle‐institution urban tertiary care center.MethodsWe performed a single‐institution retrospective chart review of all thyroid nodules that had undergone molecular testing. A web‐based Malignancy Risk Estimation System for Thyroid Nodules was utilized with ultrasound findings to stratify malignancy risk according to the Korean Thyroid Imaging Reporting and Data System (TI‐RADS), French TI‐RADS, American Association of Clinical Endocrinology guideline, and American Thyroid Association guideline. A novel algorithm for utilizing molecular testing at our institution was developed with the Korean TI‐RADS and with recommendations from the American Thyroid Association and National Comprehensive Cancer Network.ResultsThe Korean TI‐RADS performed best in our population (area under the curve = 0.83). A positive molecular test result had a positive association with a higher ROM according to all 4 models (P <. 05). Use of our algorithm prior to molecular testing would have prevented 38% of benign/low‐ROM negative nodules (n = 28) from being tested.ConclusionIn patients with indeterminate thyroid nodules, an algorithm built on pre‐ and posttest probability to guide molecular testing might reduce unnecessary testing of benign and low‐risk nodules.
Management of Pulmonary Hypertension in Term Infants—A Review
Authors: Kumaran Uthaya , Shenoi Arvind 
Published: March 2021

Abstract Pulmonary hypertension (PH) in the term newborn is associated with roughly one-fifth higher mortality and morbidity. The diagnosis of PH is confirmed by echocardiogram based on established criteria, including assessment of cardiac function, size of the shunts, and presence of hypovolemia. The elementary steps in the management of PH are supportive measures followed by oxygenation, ventilation including possibly high frequency ventilation; lung recruitment and surfactant therapy. Ventilation strategies are based on the etiology of persistent pulmonary hypertension of the newborn (PPHN)-like lung parenchymal disease, or hypoplasia. Oxygenation index (OI) or oxygen saturation index (OSI) are the parameters used for monitoring the disease progression and treatment. Surfactant is given if OI >5 in PPHN due to underlying lung disease, and pulmonary vasodilators such as sildenafil are contemplated if OI <15 and inhaled nitric oxide (iNO) if OI >15. If iNO and sildenafil fail, the options available are milrinone, bosentan, adenosine, and prostaglandins. Extra corporeal membrane oxygenation is the final option available with OI >40. A structured algorithmic approach for the management of PH in term infants is discussed in this review. Novel therapies targeting specific pathways in the pulmonary vasculature are under investigation.
Harm Perceptions of Tobacco/Nicotine Products and Child Exposure: Differences between Non-Users, Cigarette-Exclusive, and Electronic Cigarette-Exclusive Users
Authors: Tackett Alayna P , Wallace Samantha W , Smith Caitlin E , Turner Elise , Fedele David A , Stepanov Irina , Lechner William V , Hale Jessica J , Wagener Theodore L 
Published: March 2021

Objective: This study examined caregiver perception of harm and child secondhand exposure to nicotine in a sample of e-cigarette-exclusive, cigarette-exclusive, and non-tobacco/nicotine users (non-users). Methods: Cigarette-exclusive (n = 19), e-cigarette-exclusive (n = 12), and non-users (n = 20) and their children (N = 51, Mage = 10.47) completed self-report questionnaires about perceptions of harm, child secondhand exposure, and provided urine to assess child nicotine exposure (cotinine). ANOVAs examined differences between caregiver use status on tobacco harm perceptions and child cotinine levels. Independent samples t-test compared differences in caregiver-reported child secondhand exposure in the home and car. Results: All 3 caregiver groups rated cigarettes as highly harmful ( P = .14), but e-cigarette users rated all 3 types of e-cigarette products (Cartridge-based: P < .001; Tank: P < .001; Box Mod: P < .001) as less harmful than cigarette users and non-users. Caregivers from the e-cigarette user group reported greater child secondhand exposure than caregivers using cigarettes (past 7-day in-home exposure ( P = .03); past 7-day exposure in-home + in-car exposure ( P = .02); in-home exposure by caregivers and other people exposure ( P = .02)). Children from the cigarette user group had significantly higher levels of cotinine ( M = 16.6, SD = 21.7) compared to children from the Non-User group ( M = .43, SD = .95; P = .001), but no significant difference when compared to children from the E-Cigarette User group ( M = 6.5, SD = 13.5). Discussion: In this sample, caregivers who used e-cigarettes perceived them as less harmful, reported using them more frequently at home and in the car, even when their children were present, compared to cigarette users. As a result, children appear to be exposed to nicotine at levels similar to children living with cigarette users. Future caregiver prevention and intervention efforts should target education around the potential harms of secondhand e-cigarette aerosol to children.
‘Have you ever traded sex for money or drugs?’ Health care providers’ perspectives on sex trafficking risk assessments in clinics
Authors: Gerassi Lara , Pederson Anna 
Published: March 2021

Objective The United States’ Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization. Methods This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity). Results Although staff routinely screened by asking ‘Have you ever traded sex for money or drugs?’, participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else’s job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location). Conclusions There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients’ needs. Implications for practice, policy, and future research are discussed.
Efficacy and safety of copanlisib in patients with relapsed or refractory marginal zone lymphoma
Authors: Panayiotidis Panayiotis , Follows George A. , Mollica Luigina , Nagler Arnon , Özcan Muhit , Santoro Armando , Stevens Don , Trevarthen David , Hiemeyer Florian , Garcia-Vargas Jose , Childs Barrett H. , Zinzani Pier Luigi , Dreyling Martin 
Published: March 2021

Abstract
Marginal zone lymphoma (MZL) is challenging to treat, with many patients relapsing following initial treatment. We report the long-term efficacy and safety of copanlisib, a pan-class I phosphoinositide 3-kinase (PI3K) inhibitor, in the subset of 23 patients with relapsed/refractory MZL treated in the phase 2 CHRONOS-1 study (#NCT01660451, Part B; www.clinicaltrials.gov). Patients had a median of 3 prior lines of therapy, including rituximab and alkylating agents, and received IV copanlisib 60 mg on days 1, 8, and 15 of 28-day cycles for a median of 23 weeks. The objective response rate was 78.3% (18/23; 3 complete responses and 15 partial responses). The median duration of response was 17.4 months (median follow-up, 9.4 months), and median time to response was 2.1 months. Median progression-free survival was 24.1 months (median follow-up, 10.3 months), and median overall survival was not reached (median follow-up, 28.4 months). The most common all-grade treatment-emergent adverse events (TEAEs) included fatigue (52.2%, 12/23), diarrhea, and transient, infusion-related hyperglycemia (each 47.8%, 11/23). Nineteen patients (82.6%) had grade 3/4 TEAEs, most commonly transient, infusion-related hyperglycemia and hypertension (each 39.1%, 9/23). TEAEs led to dose reduction or dose interruptions /delays in 9 patients (39.1%) and 18 patients (78.3%), respectively. Patients with activated PI3K/B-cell antigen receptor signaling had improved response rates. Overall, copanlisib demonstrated strong efficacy, with a short time to objective response, improved objective response rate with longer treatment duration, durable responses, and manageable safety, in line with previous reports. These data provide rationale for long-term treatment with copanlisib in patients with relapsed/refractory MZL.
Association of the lymphocyte-to-monocyte ratio, mean diameter of coronary arteries, and uric acid level with coronary slow flow in isolated coronary artery ectasia
Authors: Yang Zhuoxuan , Yuan Jiansong , Cui JinGang , Guan Hao , Qiao Shubin 
Published: March 2021

Abstract
Background
The pathophysiology of isolated coronary artery ectasia (CAE) with the coronary slow flow (CSF) phenomenon is still unclear. The purpose of this study was to investigate the risk factors for isolated CAE complicated with CSF.

Methods
A total of 126 patients with isolated CAE were selected retrospectively. The patients were grouped into the no CSF (NCSF) group (n = 55) and the CSF group (n = 71) according to the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Data on demographics, laboratory measurements, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), CTFC and diameters of three coronary arteries were collected.

Results
The proportions of males (84.5% vs. 61.8%, p = 0.004) and patients with a smoking history (63.4% vs. 43.6%, p = 0.021) were higher in the CSF group than in the NCSF group. The neutrophil-to-lymphocyte ratio (NLR) (2.08(1.68–3.21) vs. 1.89 ± 0.58, p = 0.001), mean diameter of coronary arteries (mean D) (5.50 ± 0.85 vs. 5.18 ± 0.91, p < 0.001), and uric acid (URIC) level (370.78 ± 109.79 vs. 329.15 ± 79.71, p = 0.019) were significantly higher in the CSF group, while the lymphocyte-to-monocyte ratio (LMR) (4.81 ± 1.66 vs. 5.96 ± 1.75, p < 0.001) and albumin (ALB) level (44.13 ± 4.10 vs. 45.69 ± 4.11, p = 0.036) were lower. Multivariable logistic analysis showed that the LMR (odds ratio: 0.614, 95% CI: 0.464–0.814, p = 0.001), mean D (odds ratio: 2.643, 95% CI: 1.54–4.51, p < 0.001) and URIC level (odds ratio: 1.006, 95% CI: 1.001–1.012, p = 0.018) were independent predictors of CSF in CAE.

Conclusions
The LMR was a negative independent predictor of CSF in isolated CAE, while URIC level and mean D were positive independent predictors.
Quinolone resistant Salmonella species isolated from pediatric patients with diarrhea in central Iran
Authors: Abbasi Elnaz , Ghaznavi-Rad Ehsanollah 
Published: March 2021

AbstractBackgroundThis study aimed to investigate the frequency and the antibiotic resistance patterns ofSalmonellaspecies that were isolated from infectious diarrhea samples taken from pediatric patients in central Iran.MethodsThe study analyzed 230 stool specimens that were cultured on XLD, MacConkey agar and GN broth. Polymerase chain reaction (PCR) assay was used to identify theSalmonellagenus. The antibiotic resistance profiles and the frequency of quinolone and integron genes were obtained.ResultsOut of 230 samples of infectious diarrhea, 21 (9.1%) cases ofSalmonellaspp. were identified using culture methods. Another 28 (12.1%) samples had positive PCR results, withS.serovar Paratyphi B and C (9/21; 42.8%) andS.Typhi (3/21; 14.3%) being the most recognized. The highest antibiotic resistance rates were found for nalidixic acid (15/21; 71.4%), tetracycline (9/21; 42.8%). However, six (28.5%) of isolates were found resistant to cotrimoxazole, ampicillin and chloramphenicol. Among the plasmid-mediated quinolone resistance (PMQR) determinants,qnrS,qnrA, andqnrBwere positive in (9/15; 60%), (6/15; 40%) and (3/15; 20%) of the isolates, respectively. Class 1 and 2 integrons were identified in 15 (71.4%) and 3 (14.3%) isolates, respectively.ConclusionHigh rates of quinolone resistant and low frequency of MDRSalmonellaspp. isolates were identified in central Iran, similar to findings in other parts of Asia. To prevent the spread of these resistant strains, the antimicrobial resistance ofSalmonellaspp. isolates should be under constant surveillance, and empiric antibiotic therapy should be adapted appropriately.
Exploring the extent of digital food and beverage related content associated with a family-friendly event: a case study
Authors: Amson Ashley , Remedios Lauren , Pinto Adena , Potvin Kent Monique 
Published: March 2021

Abstract
Background
Exposure to unhealthy food and beverage content is a contributing factor to the obesity epidemic. Youth are susceptible to unhealthy digital food marketing including content shared by their peers, which can be as influential as commercial marketing. Current Canadian regulations do not consider the threat digital food marketing poses to health. No research to date has examined the prevalence of food related posts on social media surrounding family-friendly events. The aim of this study was to explore the frequency of food related content (including food marketing) and the marketing techniques employed in social media posts related to a family-friendly event in Canada.

Methods
In this case study, a content analysis of social media posts related to a family-friendly event on Facebook, Twitter, and Instagram was conducted between January to February 2019. Each post containing food related content was identified and categorized by source and food category using a coding manual. Marketing techniques found in each food related post were also assessed.

Results
A total of 732 food and beverage related posts were assessed. These posts were most commonly promoted through Instagram (n = 561, 76.6%) with significantly more individual users (61.5%; p < 0.05) generating food and beverage related content (n = 198, 27%) than other post sources. The top most featured food category was fast food (n = 328, 44.8%) followed by dine-in restaurants (n = 126, 17.2%). The most frequently observed marketing techniques included predominantly featuring a child in the post (n = 124, 16.9%; p < 0.0001), followed by products intended for children (n = 118, 16.1%; p < 0.05), and the presence of family (n = 57, 7.8%; p < 0.0001).

Conclusions
The present study highlights the proliferation of unhealthy food and beverage content by individuals at a family-friendly event as well as the presence of food marketing. Due to the unfettered advertising found in digital spaces, and that they are largely unregulated, it is important for future policies looking to combat childhood obesity to consider incorporating social media into their regulations to safeguard family-friendly events. General awareness on the implications of peer to peer sharing of unhealthy food and beverage posts should also be considered.
Do-not-attempt-resuscitation orders: attitudes, perceptions and practices of Swedish physicians and nurses
Authors: Bremer Anders , Årestedt Kristofer , Rosengren Ewa , Carlsson Jörg , Sandboge Samuel 
Published: March 2021

Abstract
Background
The values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt-resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation.

Methods
This was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional hospitals and one county hospital.

Results
210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the discussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made.

Conclusions
Swedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions.
Influence of COVID-19 on lifestyle behaviors in the Middle East and North Africa Region: a survey of 5896 individuals
Authors:   EARG Collaborators, Abouzid Mohamed , El-Sherif Dina M. , Eltewacy Nael Kamel , Dahman Nesrine Ben Hadj , Okasha Salah A. , Ghozy Sherief , Islam Sheikh Mohammed Shariful 
Published: March 2021

Abstract
Background
Coronavirus disease (COVID-19) pandemic has affected health and lifestyle behaviors of people globally. This project aims to identify the impact of COVID-19 on lifestyle behavior of individuals in the Middle East and North Africa (MENA) region during confinement.

Methods
We conducted an online survey in 17 countries (Egypt, Jordan, United Arab Emirates, Kuwait, Bahrain, Saudi Arabia, Oman, Qatar, Yemen, Syria, Palestine, Algeria, Morocco, Libya, Tunisia, Iraq, and Sudan) from the MENA region on August and September 2020. The questionnaire included self-reported information on lifestyle behaviors, including physical activity, eating habits, smoking, watching television, social media use and sleep before and during the pandemic. Logistic regression was performed to analyze the impact of COVID-19 on lifestyle behaviors.

Results
A total of 5896 participants were included in the final analysis and 62.8% were females. The BMI of the participants was 25.4 ± 5.8 kg/m2. Around 38.4% of the participants stopped practicing any physical activities during the confinement (P < 0.001), and 57.1% reported spending more than 2 h on social media (P < 0.001). There were no significant changes in smoking habits. Also, 30.9% reported an improvement in their eating habits compared with 24.8% reported worsening of their eating habits. Fast-food consumption decreased significantly in 48.8% of the study population. This direct/indirect exposure to COVID-19 was associated with an increased consumption of carbohydrates (OR = 1.09; 95% CI = 1.02–1.17; P = 0.01), egg (OR = 1.08; 95% CI = 1.02–1.16; P = 0.01), sugar (OR = 1.09; 95% CI = 1.02–1.16; P = 0.02), meat, and poultry (OR = 1.13; 95% CI = 1.06–1.20; P < 0.01). There was also associated increase in hours spent on watching television (OR = 1.07; 95% CI = 1.02–1.12; P < 0.01) and social media (OR = 1.09; 95% CI = 1.01–1.18; P = 0.03). However, our results showed a reduction in sleeping hours among those exposed to COVID-19 infection (OR = 0.85; 95% CI = 0.77–0.94; P < 0.01).

Conclusions
The COVID-19 pandemic was associated with an increase in food consumption and sedentary life. Being exposed to COVID-19 by direct infection or through an infected household is a significant predictor of amplifying these changes. Public health interventions are needed to address healthy lifestyle behaviors during and after the COVID-19 pandemic.
Microbiome meta-analysis and cross-disease comparison enabled by the SIAMCAT machine learning toolbox
Authors: Wirbel Jakob , Zych Konrad , Essex Morgan , Karcher Nicolai , Kartal Ece , Salazar Guillem , Bork Peer , Sunagawa Shinichi , Zeller Georg 
Published: March 2021

AbstractThe human microbiome is increasingly mined for diagnostic and therapeutic biomarkers using machine learning (ML). However, metagenomics-specific software is scarce, and overoptimistic evaluation and limited cross-study generalization are prevailing issues. To address these, we developed SIAMCAT, a versatile R toolbox for ML-based comparative metagenomics. We demonstrate its capabilities in a meta-analysis of fecal metagenomic studies (10,803 samples). When naively transferred across studies, ML models lost accuracy and disease specificity, which could however be resolved by a novel training set augmentation strategy. This reveals some biomarkers to be disease-specific, with others shared across multiple conditions. SIAMCAT is freely available fromsiamcat.embl.de.
The global dissemination of hospital clones of Enterococcus faecium
Authors:   Enterococcal Group, van Hal Sebastiaan J. , Willems Rob J. L. , Gouliouris Theodore , Ballard Susan A. , Coque Teresa M. , Hammerum Anette M. , Hegstad Kristin , Westh Hendrik T. , Howden Benjamin P. , Malhotra-Kumar Surbhi , Werner Guido , Yanagihara Katsunori , Earl Ashlee M. , Raven Katherine E. , Corander Jukka , Bowden Rory 
Published: March 2021

AbstractBackgroundThe hospital-adapted A1 group ofEnterococcus faeciumremains an organism of significant concern in the context of drug-resistant hospital-associated infections. How this pathogen evolves and disseminates remains poorly understood.MethodsA large, globally representative collection of short-read genomic data from the hospital-associated A1 group ofEnterococcus faeciumwas assembled (n = 973). We analysed, using a novel analysis approach, global diversity in terms of both the dynamics of the accessory genome and homologous recombination among conserved genes.ResultsTwo main modes of genomic evolution continue to shapeE. faecium: the acquisition and loss of genes, including antimicrobial resistance genes, through mobile genetic elements including plasmids, and homologous recombination of the core genome. These events lead to new clones emerging at the local level, followed by the erosion of signals of clonality through recombination, and in some identifiable cases producing new clonal clusters. These patterns lead to new, emerging lineages which are able to spread globally over relatively short timeframes.ConclusionsThe ability of A1E. faeciumto continually present new combinations of genes for potential selection suggests that controlling this pathogen will remain challenging but establishing a framework for understanding genomic evolution is likely to aid in tracking the threats posed by newly emerging lineages.