bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographics of Surgical Specialty Residency Program Directors in the United States: A Cross-sectional Analysis
Authors: Patel Annika , Burton Adam , Pandya Shivani , Venincasa Michael , Gedde Steven J. , Cavuoto Kara M. , Sridhar Divya , Kloosterboer Amy , Sridhar Jayanth 
Published: March 2021

Objective:
To evaluate program director (PD) demographics, training background, and academic productivity in 11 surgical specialties.

Summary Background Data:
There is currently no comprehensive study comparing educational background, research output, and gender differences between PDs of surgical residencies in the United States.

Methods:
The Accreditation Council for Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) websites were used to identify residency PDs. Age, information related to service as PD, educational background, and research output were collected utilizing online searches including Doximity, PubMed, and Scopus. The ACGME Data Resource Book was used to obtain data on the gender makeup of residents in each surgical specialty. Data collection occurred between December 14, 2019, and May 9, 2020.

Results:
One thousand five hundred seventy-one residency PDs across 11 surgical specialties were included. Significant differences between specialties were found with respect to PD gender, current age, age at appointment, years between residency and assignment, term duration, number of PubMed publications, and Scopus h-index. The current age (mean ± SD) ranged from 46.8 ± 8.5 years among Interventional Radiology (IR) PDs to 53.4 ± 9.1 years among Neurological Surgery (NEUROSURG) PDs. The proportion of female PDs ranged from 5.9% in NEUROSURG to 63.5% in Obstetrics and Gynecology (OB-GYN). Completion of a postresidency fellowship was least common for OB-GYN PDs at 9.1% and most common for IR PDs at 98.8%. The number (mean ± SD) of PubMed publications and Scopus h-index ranged from 13.1 ± 22.3 publications and h index 4.5 ± 5.7 among OB-GYN PDs to 112.5 ± 103.0 publications and h index 27.4 ± 16.7 among Thoracic Surgery PDs. Age and academic productivity as measured by PubMed publications and Scopus h-index were significantly lower among female PDs in multiple surgical specialties.

Conclusions:
There were significant variations in the PDs of surgical specialties, particularly with respect to gender and academic productivity. Efforts should be made to support and encourage greater female representation in the role of surgical residency PD.
Decreased Intestinal Microbiome Diversity in Pediatric Sepsis: A Conceptual Framework for Intestinal Dysbiosis to Influence Immunometabolic Function
Authors: Weiss Scott L. , Bittinger Kyle , Lee Jung-Jin , Friedman Elliot S. , Mattei Lisa M. , Graham Kathryn , Zhang Donglan , Bush Jeny , Balamuth Fran , McGowan Francis X. , Bushman Frederic D. , Baldassano Robert N. , Wu Gary D. , Wallace Douglas C. , Collman Ronald G. 
Published: March 2021

Objectives:
The intestinal microbiome can modulate immune function through production of microbial-derived short-chain fatty acids. We explored whether intestinal dysbiosis in children with sepsis leads to changes in microbial-derived short-chain fatty acids in plasma and stool that are associated with immunometabolic dysfunction in peripheral blood mononuclear cells.

Design:
Prospective observational pilot study.

Setting:
Single academic PICU.

Patients:
Forty-three children with sepsis/septic shock and 44 healthy controls.

Measurements and Main Results:
Stool and plasma samples were serially collected for sepsis patients; stool was collected once for controls. The intestinal microbiome was assessed using 16S ribosomal RNA sequencing and alpha- and beta-diversity were determined. We measured short-chain fatty acids using liquid chromatography, peripheral blood mononuclear cell mitochondrial respiration using high-resolution respirometry, and immune function using ex vivo lipopolysaccharide-stimulated whole blood tumor necrosis factor-α. Sepsis patients exhibited reduced microbial diversity compared with healthy controls, with lower alpha- and beta-diversity. Reduced microbial diversity among sepsis patients (mainly from lower abundance of commensal obligate anaerobes) was associated with increased acetic and propionic acid and decreased butyric, isobutyric, and caproic acid. Decreased levels of plasma butyric acid were further associated with lower peripheral blood mononuclear cell mitochondrial respiration, which in turn, was associated with lower lipopolysaccharide-stimulated tumor necrosis factor-α. However, neither intestinal dysbiosis nor specific patterns of short-chain fatty acids were associated with lipopolysaccharide-stimulated tumor necrosis factor-α.

Conclusions:
Intestinal dysbiosis was associated with altered short-chain fatty acid metabolites in children with sepsis, but these findings were not linked directly to mitochondrial or immunologic changes. More detailed mechanistic studies are needed to test the role of microbial-derived short-chain fatty acids in the progression of sepsis.
Preclinical models of endometriosis and interstitial cystitis/bladder pain syndrome: an Innovative Medicines Initiative-PainCare initiative to improve their value for translational research in pelvic pain
Authors: Nunez-Badinez Paulina , De Leo Bianca , Laux-Biehlmann Alexis , Hoffmann Anja , Zollner Thomas M. , Saunders Philippa T.K. , Simitsidellis Ioannis , Charrua Ana , Cruz Francisco , Gomez Raul , Tejada Miguel Angel , McMahon Stephen B. , Lo Re Laure , Barthas Florent , Vincent Katy , Birch Judy , Meijlink Jane , Hummelshoj Lone , Sweeney Patrick J. , Armstrong J. Douglas , Treede Rolf-Detlef , Nagel Jens 
Published: March 2021

Abstract
Endometriosis (ENDO) and interstitial cystitis/bladder pain syndrome (IC/BPS) are chronic pain conditions for which better treatments are urgently needed. Development of new therapies with proven clinical benefit has been slow. We have conducted a review of existing preclinical in vivo models for ENDO and IC/BPS in rodents, discussed to what extent they replicate the phenotype and pain experience of patients, as well as their relevance for translational research. In 1009 publications detailing ENDO models, 41% used autologous, 26% syngeneic, 18% xenograft, and 11% allogeneic tissue in transplantation models. Intraperitoneal injection of endometrial tissue was the subcategory with the highest construct validity score for translational research. From 1055 IC/BPS publications, most interventions were bladder centric (85%), followed by complex mechanisms (8%) and stress-induced models (7%). Within these categories, the most frequently used models were instillation of irritants (92%), autoimmune (43%), and water avoidance stress (39%), respectively. Notably, although pelvic pain is a hallmark of both conditions and a key endpoint for development of novel therapies, only a small proportion of the studies (models of ENDO: 0.5%-12% and models of IC/BPS: 20%-44%) examined endpoints associated with pain. Moreover, only 2% and 3% of publications using models of ENDO and IC/BPS investigated nonevoked pain endpoints. This analysis highlights the wide variety of models used, limiting reproducibility and translation of results. We recommend refining models so that they better reflect clinical reality, sharing protocols, and using standardized endpoints to improve reproducibility. We are addressing this in our project Innovative Medicines Initiative-PainCare/Translational Research in Pelvic Pain.
Barriers and facilitators to older adults' use of nonpharmacologic approaches for chronic pain: a person-focused model
Authors: Garrett Sarah B. , Nicosia Francesca , Thompson Nicole , Miaskowski Christine , Ritchie Christine S. 
Published: March 2021

Abstract
In the context of the opioid epidemic and the growing population of older adults living with chronic pain, clinicians are increasingly recommending nonpharmacologic approaches to patients as complements to or substitutes for pharmacologic treatments for pain. Currently, little is known about the factors that influence older adults' use of these approaches. We aimed to characterize the factors that hinder or support the use of nonpharmacologic approaches for pain management among older adults with multiple morbidities. We collected semistructured qualitative interview data from 25 older adults with multiple morbidities living with chronic pain for 6 months or more. Transcripts were coded to identify factors that hindered or supported participants' use of various nonpharmacologic approaches. We used the constant comparative method to develop a person-focused model of barriers and facilitators to participants' use of these approaches for chronic pain management. Participants described a wide range of factors that influenced their use of nonpharmacologic approaches. We grouped these factors into 3 person-focused domains: awareness of the nonpharmacologic approach as relevant to their chronic pain, appeal of the approach, and access to the approach. We propose and illustrate a conceptual model of barriers and facilitators to guide research and clinical care. This study identifies numerous factors that influence patients' use of nonpharmacologic approaches, some of which are not captured in existing research or routinely addressed in clinical practice. The person-centered model proposed may help to structure and support patient–clinician communication about nonpharmacologic approaches to chronic pain management.
Prognostic prediction models for chronic postsurgical pain in adults: a systematic review
Authors: Papadomanolakis-Pakis Nicholas , Uhrbrand Peter , Haroutounian Simon , Nikolajsen Lone 
Published: March 2021

Abstract
Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. A systematic search was performed in MEDLINE, Embase, PsychINFO, and the Cochrane Database of Systematic Reviews in March 2020 for English peer-reviewed studies that used data collected between 2000 and 2020. Studies that developed, validated, or updated a prediction model in adult patients who underwent any surgical procedure were included. Two reviewers independently screened titles, abstracts, and full texts for eligibility; extracted data; and assessed risk of bias using the Prediction model Risk of Bias Assessment Tool. The search identified 2037 records; 28 articles were reviewed in full text. Fifteen studies reporting on 19 prediction models were included; all were at high risk of bias. Model discrimination, measured by the area under receiver operating curves or c-statistic, ranged from 0.690 to 0.816. The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.
Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data
Authors: Foley Heather E. , Knight John C. , Ploughman Michelle , Asghari Shabnam , Audas Richard 
Published: March 2021

AbstractHealth administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
Systematic review and meta-analysis of cannabinoids, cannabis-based medicines, and endocannabinoid system modulators tested for antinociceptive effects in animal models of injury-related or pathological persistent pain
Authors: Soliman Nadia , Haroutounian Simon , Hohmann Andrea G. , Krane Elliot , Liao Jing , Macleod Malcolm , Segelcke Daniel , Sena Christopher , Thomas James , Vollert Jan , Wever Kimberley , Alaverdyan Harutyun , Barakat Ahmed , Barthlow Tyler , Bozer Amber L. Harris , Davidson Alexander , Diaz-delCastillo Marta , Dolgorukova Antonina , Ferdousi Mehnaz I. , Healy Catherine , Hong Simon , Hopkins Mary , James Arul , Leake Hayley B. , Malewicz Nathalie M. , Mansfield Michael , Mardon Amelia K. , Mattimoe Darragh , McLoone Daniel P. , Noes-Holt Gith , Pogatzki-Zahn Esther M. , Power Emer , Pradier Bruno , Romanos-Sirakis Eleny , Segelcke Astra , Vinagre Rafael , Yanes Julio A. , Zhang Jingwen , Zhang Xue Ying , Finn David P. , Rice Andrew S.C. 
Published: March 2021

Abstract
We report a systematic review and meta-analysis of studies that assessed the antinociceptive efficacy of cannabinoids, cannabis-based medicines, and endocannabinoid system modulators on pain-associated behavioural outcomes in animal models of pathological or injury-related persistent pain. In April 2019, we systematically searched 3 online databases and used crowd science and machine learning to identify studies for inclusion. We calculated a standardised mean difference effect size for each comparison and performed a random-effects meta-analysis. We assessed the impact of study design characteristics and reporting of mitigations to reduce the risk of bias. We meta-analysed 374 studies in which 171 interventions were assessed for antinociceptive efficacy in rodent models of pathological or injury-related pain. Most experiments were conducted in male animals (86%). Antinociceptive efficacy was most frequently measured by attenuation of hypersensitivity to evoked limb withdrawal. Selective cannabinoid type 1, cannabinoid type 2, nonselective cannabinoid receptor agonists (including delta-9-tetrahydrocannabinol) and peroxisome proliferator-activated receptor-alpha agonists (predominantly palmitoylethanolamide) significantly attenuated pain-associated behaviours in a broad range of inflammatory and neuropathic pain models. Fatty acid amide hydrolase inhibitors, monoacylglycerol lipase inhibitors, and cannabidiol significantly attenuated pain-associated behaviours in neuropathic pain models but yielded mixed results in inflammatory pain models. The reporting of criteria to reduce the risk of bias was low; therefore, the studies have an unclear risk of bias. The value of future studies could be enhanced by improving the reporting of methodological criteria, the clinical relevance of the models, and behavioural assessments. Notwithstanding, the evidence supports the hypothesis of cannabinoid-induced analgesia.
Opioid Prescription Trends in a US Dental School Clinic, 2014-2018: A Retrospective Study Using Electronic Health Record Data
Authors: Freund Colleen R. , VanDuine Stefanie M. , Cullen Jennifer L. 
Published: March 2021

Objectives:
Opioid misuse and abuse continues to be a grave public health concern in the United States. The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively analyze trends in opioid prescription frequencies.

Design:
A database review was conducted using EHR data from 20 patient care clinics in a dental school over a 5-year period during which local, state, and national policies and guidelines to mitigate harm from opioid misuse were introduced.

Setting:
University of Michigan School of Dentistry, state of Michigan.

Outcome Measure:
Descriptive statistics using measures of frequency and distribution of opioid prescriptions written were compared over a 5-year period by dental school clinic specialty, CDT (Code on Dental Procedures and Nomenclature) procedure, drug type, and patient age/gender.

Results:
From 2014 to 2018, a total of 12 401 opioid-based prescriptions were written by dental providers in the school's patient care clinics. An ARIMA (autoregressive integrated moving average) model time trend analysis demonstrated a significant decrease in the number of prescribed opioids after 2016.

Conclusions:
While causal relationships cannot be drawn between drug abuse and prescription trends alone, this exploratory study provided a better understanding of prescription frequency patterns that can help monitor distribution of opioids and identify areas where future public health interventions may be needed. Dental education institutions have an obligation to ensure a competent health care workforce as well as unique opportunities to support regional and national public health strategies aimed at reducing misuse of opioids.
Screening for Excessive Alcohol Consumption in Emergency Departments: A Nationwide Assessment of Emergency Department Physicians
Authors: Uong Stephen , Tomedi Laura E. , Gloppen Kari M. , Stahre Mandy , Hindman Patrick , Goodson Valerie N. , Crandall Cameron , Sklar David , Brewer Robert D. 
Published: March 2021

Objective:
To assess current screening practices for excessive alcohol consumption, as well as perceived barriers, perceptions, and attitudes toward performing this screening among emergency department (ED) physicians.

Design:
A brief online assessment of screening practices for excessive drinking was disseminated electronically to a representative panel of ED physicians from November 2016 to January 2017. Descriptive statistics were calculated on the frequency of alcohol screening, factors affecting screening, and attitudes toward screening.

Setting:
An online assessment was sent to a national panel of ED physicians.

Participants:
A panel of ED physicians who volunteered to be part of the American College of Emergency Physicians Emergency Medicine Practice Research Network survey panel.

Main Outcome Measure:
The primary outcome measures were the percentage of respondents who reported screening for excessive alcohol consumption and the percentage of respondents using a validated excessive alcohol consumption screening tool.

Results:
Of the 347 ED physicians evaluated (38.6% response rate), approximately 16% reported “always/usually,” 70% “sometimes,” and 14% “never” screening adult patients (≥18 years) for excessive alcohol use. Less than 20% of the respondents who screened for excessive drinking used a recommended screening tool. Only 10.5% of all respondents (15.4% “always,” 9.5% “sometimes” screened) received an electronic health record (EHR) reminder to screen for excessive alcohol use. Key barriers to screening included limited time (66.2%) and treatment options for patients with drinking problems (43.1%).

Conclusions:
Only 1 in 6 ED physicians consistently screened their patients for excessive drinking. Increased use of EHR reminders and other systems interventions (eg, electronic screening and brief intervention) could help improve the delivery of screening and follow-up services for excessive drinkers in EDs.
Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health
Authors: Santana Stephanie , Brach Cindy , Harris Linda , Ochiai Emmeline , Blakey Carter , Bevington Frances , Kleinman Dushanka , Pronk Nico 
Published: March 2021

Content:
Healthy People 2030, the fifth iteration of the Healthy People initiative, provides science-based national health objectives with targets to improve the health and well-being of Americans. For the first time since its 1979 establishment, the Healthy People framework aims to attain health literacy as an overarching goal and foundational principle to achieving health and well-being. Growing literature on health literacy describes it as a concept not solely reliant on individual capabilities but also on organizations' ability to make health-related information and services equitably accessible and comprehensible.

Program:
The US Department of Health and Human Services (HHS) updates the Healthy People objectives each decade based on the most current science. For the development of Healthy People 2030, HHS drew on recommendations from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), an independent advisory committee of national health experts, to update the 20-year old individual-focused Healthy People definition of health literacy. HHS solicited input from members of the public and users on the proposed changes to that definition.

Implementation:
HHS published a Federal Register notice to solicit public comments, which were qualitatively analyzed by government staff.

Evaluation:
The 2 separate analyses revealed plurality support for improving the definition to focus on both individual and organizational roles in health literacy. Results led HHS subject matter experts to update the definition to include definitions of personal health literacy and organizational health literacy. Healthy People 2030's expanded health literacy definition reflects the most current science and input from the Secretary's Advisory Committee, public comments, and HHS subject matter experts.

Discussion:
The updated definition is intended to advance Healthy People 2030's health literacy goals particularly as more organizations in public health and other sectors acknowledge their role in the delivery of quality health information and services.