bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Vortioxetine Monotherapy for Posttraumatic Stress Disorder
Authors: Dunlop Boadie W. , Rakofsky Jeffrey J. , Newport D. Jeffrey , Mletzko-Crowe Tanja , Barone Katelyn , Nemeroff Charles B. , Harvey Philip D. 
Published: February 2021

Abstract

Purpose/Background
There are few efficacious pharmacological treatments for posttraumatic stress disorder (PTSD) and many patients fail to benefit from existing treatments. Vortioxetine, a recently developed antidepressant, acts as a serotonin modulator through inhibition of the serotonin transporter and actions at multiple types of serotonin receptors. Its unique pharmacodynamic profile suggests it may have efficacy for the treatment of PTSD.

Methods/Procedures
We conducted a 12-week placebo-controlled, randomized clinical trial of vortioxetine (flexibly dosed from 10 to 20 mg/d) versus placebo in adults with PTSD. The primary outcome was change from baseline in the past-month version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), analyzed using a mixed-model repeated-measures analysis of variance.

Findings/Results
Forty-one patients were randomized, and 32 (78%) completed the 12 weeks of treatment. The mean reduction in CAPS-5 scores at week 12 did not significantly differ between the 2 arms; the effect size for the difference in changes between vortioxetine and placebo on CAPS-5 total scores at week 12 was Cohen d = 0.29. However, at week 8, the drug-placebo difference was d = 0.78, which met the multivariate criteria for statistical significance, P = 0.014.

Implications/Conclusions
In this study of 41 patients, vortioxetine did not demonstrate superiority over placebo for adults with PTSD. Future PTSD trials may benefit from stratifying the randomization based on number of years since the index traumatic event and a history of failure to respond to treatment.
Prevalence of Hormone-Related Cancers (HRCs) at Two-Time Points in Rural Saskatchewan
Authors: Khan Amal , Ahmed Shahid , Zaidi Adnan , Karunanayake Chandima , Dosman James A. , Pahwa Punam 
Published: February 2021

Objective:
This study aimed to determine the prevalence of hormone-related cancers (HRCs) among Saskatchewan rural dwellers and explore associated risk factors.

Methods:
Data were analyzed from the Saskatchewan Rural Health Study (SRHS), which was a prospective cohort (2010 to 2014). Completed questionnaires were obtained from 4624 (2797) households, with information about 8261 (4867) individuals more than or equal to 18 years at baseline (follow-up). The crude prevalence of HRCs was calculated using appropriate formulae. Adjusted prevalence was calculated using logistic regression based on the generalized estimating equation (GEE).

Results:
Crude prevalence of HRCs was 3.0% at the baseline. Variables significantly associated with HRCs were: exposure to radiation comprising ultraviolet radiation from sunlight as well as ionizing radiation (odds ratio [OR] 3.39; 95% confidence interval [CI]: 2.23, 4.84), previous history of cancer in sibling (OR = 1.51, 95% CI: 1.11, 2.07) and in father (OR = 1.37; 95% CI = 1.01, 1.86).

Conclusions:
The study informs the Saskatchewan Health Region for health care resource allocation.
Vestibular Schwannoma Measurements—Is Volumetric Analysis Clinically Necessary?
Authors: Selleck Anne Morgan , Rodriguez Justin D. , Brown Kevin D. 
Published: February 2021

Objective:
1) To compare vestibular schwannoma maximum linear dimensions and calculated volume with measured volume in accurately determining tumor volume and growth. 2) To determine natural growth history of vestibular schwannomas utilizing volumetric measurements in an observed patient population.

Study Design:
Retrospective chart review.

Setting:
Tertiary academic referral.

Patients:
One hundred fifty two adults with a vestibular schwannoma who underwent observational management with sequential magnetic resonance imaging (MRI) scans (496 scans).

Intervention:
MRI scans.

Main Outcome Measures:
Tumor volume calculated from linear dimensions compared with measured volume. The percentage change in tumor size (linear or volume) between consecutive MRI scans.

Results:
The percentage change in tumor size between consecutive MRIs is significantly different between maximum linear dimension (MLD) and measured tumor volume (p = 0.03), but no difference exists in the percentage change between measured and calculated tumor volume (p = 0.882 for three linear measurements, p = 0.637 for two linear measurements). The overall number of growing tumors is 57.2% (n = 87) with an average growth rate of 62.6%. If a criterion for growth of 20% change is used, 32.2% of tumors monitored by linear volume would have demonstrated growth while 57.2% of tumors with measured volume demonstrated growth.

Conclusion:
Maximum linear dimensions are a significantly less sensitive measure of tumor growth compared with measured volumes. Calculated tumor volume utilizing three linear measurements is an accurate predictor of both measured tumor volume and tumor growth.
Validation of Omron HEM-7600T, a wearable device for monitoring blood pressure, according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization 81060-2:2013 protocol in the general population without arrhythmias
Authors: Takahashi Hakuo , Saito Kanako , Hishiki Yukiko 
Published: February 2021

Objective
The present study aimed to evaluate the accuracy of the Omron HEM-7600T automated oscillometric upper-arm blood pressure (BP) monitor according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 protocol.

Methods
We recruited individuals until we obtained 86 eligible participants whose BP levels and ranges of arm circumference met the BP distribution requirements specified by the ANSI/AAMI/ISO. In each individual, we sequentially measured systolic and diastolic blood pressures (DBPs) using a mercury sphygmomanometer (two observers) and the HEM-7600T device (one supervisor) in the left upper arm. Data analysis was performed according to the ANSI/AAMI/ISO guidelines.

Results
A total of 101 individuals were recruited, and 86 were finally included in the analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP was −0.6 ± 6.6/1.0 ± 6.5 mmHg (systolic/diastolic). The data were in accordance with criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements (≤ 5 ± ≤ 8 mmHg). In addition, the mean device-observer difference in the 86 participants was −0.6 ± 5.65 mmHg for systolic blood pressure and 1.0 ± 5.96 mmHg for DBP, fulfilling criterion 2 with an SD of ≤6.91 mmHg for systolic blood pressure and ≤6.87 mmHg for DBP.

Conclusion
The Omron HEM-7600T BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation protocol in adults and can be recommended for home BP measurements.
Utilisation and Safety of Polyethylene Glycol 3350 With Electrolytes in Children Under 2 Years
Authors: Roy Debabrata , Akriche Fatma , Amlani Bharat , Shakir Saad 
Published: February 2021

ABSTRACT

Objectives:
In the UK, Movicol paediatric plain (polyethylene glycol 3350 with electrolytes [PEG 3350+E], Norgine, UK), is licensed for chronic constipation in children 2 –11 years of age and faecal impaction (FI) from 5 years. This study aimed to investigate usage and characterise the risk profile in children under 2 years of age using PEG 3350+E in the UK.

Methods:
Retrospective, single exposure cohort study, with patients identified from Clinical Practice Research Datalink (CPRD) GOLD. Patients first prescribed PEG 3350+E under 2 years of age for the treatment of constipation or FI, between September 2003 and July 2019, were included.

Results:
There were 13,235 patients with a constipation indication and 40 patients with FI. For the constipation cohort: median age of PEG 3350+E first prescription was 1.2 years [interquartile range (IQR) 0.9, 1.6] and 68.4% had one treatment episode (TE). The mean duration of exposure, in the first TE, was 88.9 days. The most common total daily dose was one sachet (6.9 g).
In terms of incident events on treatment, 0.5% of patients had abdominal pain, 3.0% had diarrhoea (may be attributed to treatment) and 4.1% had vomiting. 2.0% had signs/symptoms which could (in extreme cases) be associated with electrolyte disturbance, however, none had abnormal electrolyte values.

Discussion:
The safety aspect of this study did not identify any signals of concern in the constipation cohort. The number of patients in the FI cohort were too small for robust conclusions. If information were available, then a safety study would ideally assess treatment intake per kilogram, including electrolyte intake, before reaching safety conclusions. Nevertheless, these data contribute to real-world evidence on the use of PEG 3350+E in this population.
Storying the Past and the Future
Authors: Jensen Rikke Amalie Agergaard , Thomsen Dorthe Kirkegaard , Lind Majse , Ladegaard Nicolai , Bliksted Vibeke Fuglsang 
Published: February 2021

Abstract
Research has linked disturbances in narrative identity with schizophrenia and other psychiatric disorders. One such disturbance is diminished agency and communion themes in past life stories. However, projecting oneself into the future is also central to identity and potentially impacts recovery. Hence, we examined themes of agency and communion in both past and future life stories and related themes to psychosocial functioning in 20 individuals with schizophrenia, 20 individuals with depressive disorder, and 19 nonpsychiatric controls. Participants were asked to describe up to 10 past and future chapters in their life stories and were assessed on psychosocial functioning and neurocognition. Chapters were coded for agency and communion themes. Both clinical groups displayed diminished agency and communion themes in past but not future life story chapters compared with the nonpsychiatric controls. Furthermore, agency themes in future chapters explained variance in psychosocial functioning after controlling for neurocognition. The results suggest that constructing a narrative identity to foster agency and communion in both past and future chapters may be an important part of recovering from schizophrenia and depression.
Health-Promoting Leadership During an Infectious Disease Outbreak
Authors: Booth Laurel C. , Schwalb Molly E. , Kim Paul Y. , Adler Amy B. 
Published: February 2021

Abstract
Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3–4]:e171–e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.
An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients
Authors: Hrdy Michael , Mahesh Mahadevappa , Miller Marlene , Klein Bruce , Stewart Dylan , Ryan Leticia Manning 
Published: February 2021

Objective
To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure.

Methods
In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared.

Results
We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department.

Conclusions
Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.
Short Walking Exercise Leads to Gait Changes and Muscle Fatigue in Children With Cerebral Palsy Who Walk With Jump Gait
Authors: Parent Audrey , Dal Maso Fabien , Pouliot-Laforte Annie , Cherni Yosra , Marois Pierre , Ballaz Laurent 
Published: February 2021

ObjectiveThe aim of this study was to evaluate kinematic changes and muscle fatigue in jump gait during a walking exercise and the relationship between kinematic changes and muscle fatigue and strength.DesignThis preliminary study included 10 children with cerebral palsy who walk with jump gait. Hip and knee maximal isometric muscle strength were measured using a dynamometer. Then, lower-limb kinematics and electromyography were collected while children walked continuously for 6 min at their self-selected speed. Electromyography median frequency and lower-limb joint angles were compared between the first and the sixth minutes of the walking exercise usingttest and Wilcoxon rank test. The relationship between kinematic changes and muscle strength and changes in electromyography median frequency were assessed using correlation analyses.ResultsDuring stance, maximal knee flexion significantly increased at the sixth minute (P= 0.01) and was associated with knee extensor muscle weakness (ρ= −0.504,P= 0.03). Muscle fatigue was observed only in the gluteus medius muscle (P= 0.01).ConclusionsChildren with cerebral palsy who walked with jump gait and who had knee extensor weakness were more prone to an increase in knee flexion during a continuous walk. The fatigue in the gluteus medius muscle suggests that physical intervention should target the endurance of this muscle to improve jump gait.
Reducing Employee Injury Rates with a Hospital-wide Employee Safety Program
Authors: Fink Alia , Merkeley Kathryn , Tolliver Charika , McLeese Raven , Mason Janice J. , Mantasas Nikolas , Cheng Jenhao Jacob , Roberts-Turner Reneè , Fahey Lisbeth , Parra Martha , Talley Linda , Cady Rebecca , Shah Rahul K. 
Published: February 2021

Introduction:
Despite the well-known dangers of working in the healthcare industry, healthcare organizations have historically accepted workplace injuries as business as usual. In 2017, Children’s National Hospital began our Employee and Staff Safety program to drive down the employee injury rate and address this disturbing industry trend.

Methods:
With guidance and support from executive leadership, we created an Employee and Staff Safety program that aligned employee safety work with existing patient safety and quality improvement efforts. Team leads collected and analyzed baseline employee injury data and identified areas of highest injuries. Dedicated subcommittees focused on five specific areas: slips, trips, and falls; sharps injuries; blood and body fluid exposures; verbal and physical violence; and overexertion injuries. Subcommittees established aims, identified key drivers, and brainstormed interventions for tests of change.

Results:
Because the inception of the Employee and Staff Safety program, Children’s National has seen significant reductions in our Days Away Restricted or Transfer (DART) rate. The DART rate shows a sustained 37% reduction since the baseline period of FY16–FY17 (1.48 injuries/200,000 h worked to 0.93 injuries/200,000 h worked). The regression trend shows a significant decrease (38.3%) in DART injuries, from 1.544 to 0.952 over 56 months; P = 0.016.

Conclusions:
Active leadership support and analyzing data on specific employee harm areas coupled with targeted interventions, helped improve Children’s National’s DART rate. The Employee and Staff Safety program’s success in utilizing patient safety and quality improvement tools creates a generalizable framework for other hospitals to advance their high-reliability journey.
Morbidity and Mortality Caused by Noncompliance With California Hospital Licensure: Immediate Jeopardies in California Hospitals, 2007–2017
Authors: Zheng Micha Y. , Lui Hansen , Patino German , Mmonu Nnenaya , Cohen Andrew J. , Breyer Benjamin N. 
Published: February 2021

Objective
The California Department of Public Health investigates compliance with hospital licensure and issues an administrative penalty when there is an immediate jeopardy. Immediate jeopardies are situations in which a hospital’s noncompliance of licensure requirements causes serious injury or death to patient. In this study, we critically examine immediate jeopardies between 2007 and 2017 in California.

Methods
All immediate jeopardies reported between 2007 and 2017 were abstracted for hospital, location, date, details of noncompliance, and patient’s health outcome.

Results
Of 385 unique immediate jeopardies, 141 (36.6%) caused mortality, 120 (31.2%) caused morbidity, 96 (24.9%) led to a second surgery, 9 (2.3%) caused emotional trauma without physical trauma, and 19 (4.9%) were caught before patients were harmed. Immediate jeopardy categories included the following: surgical (34.2%), medication (18.9%), monitoring (14.2%), falls (7.8%), equipment (5.4%), procedural (5.4%), resuscitation (4.4%), suicide (3.9%), MD/RN miscommunication (3.4%), and abuse (2.3%).

Conclusions
Noncompliance to hospital licensure causes significant morbidity and mortality. Statewide hospital licensure policies should focus on enacting standardized reporting requirements of immediate jeopardies into an Internet-based form that public health officials can regularly analyze to improve hospital safety.
Clinical Characteristics and Outcomes of Mexican Patients With Polyarteritis Nodosa
Authors: Sánchez-Cubías Susy Marcela , Martín-Nares Eduardo , Hernández-Molina Gabriela , Hinojosa-Azaola Andrea 
Published: February 2021

Objective
The aim was to describe the clinical characteristics and outcomes of Mexican patients with polyarteritis nodosa (PAN) from a single center.

Methods
We conducted a medical records review study (1975–2018) that included patients with childhood- and adult-onset PAN. Demographics, organ involvement, phenotype, treatment, and outcomes were assessed and compared against previously published cohorts.

Results
Thirty-one patients were included, 20 (64.5%) female, with a median age at diagnosis of 28 years (interquartile range [IQR], 16–42). Seven (23%) were classified as cutaneous; 23 (74%), systemic; and 1 (3%), progressive systemic phenotype. Eleven patients (35%) had childhood-onset PAN. Most common manifestations were musculoskeletal (71%), cutaneous (68%), constitutional (61%), peripheral neuropathy (39%), and gastrointestinal (29%). The median Birmingham Vasculitis Activity Score and Five-Factor Score at diagnosis were 9 (IQR, 4–13) and 1 (IQR, 0–1), respectively. Most patients were treated with glucocorticoids (94%). Twenty-four (80%) achieved complete and 6 (20%) partial remission at a median follow-up time of 30 months (8–192 months). The median Vasculitis Damage Index at last follow-up was 1 (IQR, 0–1). Nineteen (66%) experienced relapses. Patients with childhood-onset PAN more frequently had central nervous system and gastrointestinal involvement (36% vs 5%, p = 0.04 and 64% vs 10%, p = 0.003, respectively), microaneurysms (100% vs 38%, p = 0.02), and lower levels of C-reactive protein (0.3 vs 15.4 mg/dL, p = 0.03), compared with adult-onset PAN patients.

Conclusions
Our cohort of PAN patients showed predominantly a systemic phenotype. Outcomes were generally good, with most patients achieving complete remission. Childhood-onset differed from adult-onset PAN in terms of clinical and serological characteristics, whereas clinical manifestations and outcomes may be different than the ones reported in other cohorts.
A Machine Learning Approach for Predicting Sustained Remission in Rheumatoid Arthritis Patients on Biologic Agents
Authors: Venerito Vincenzo , Angelini Orazio , Fornaro Marco , Cacciapaglia Fabio , Lopalco Giuseppe , Iannone Florenzo 
Published: February 2021

Background
Despite several studies having identified factors associated with successful treatment outcomes in rheumatoid arthritis (RA), there is a lack of accurate predictive models for sustained remission in patients on biologic agents. To the best of our knowledge, no machine learning (ML) approaches apart from logistic regression (LR) have ever been tried on this class of problems.

Methods
In this longitudinal study, patients with RA who started a biological disease-modifying antirheumatic drug (bDMARD) in a tertiary care center were analyzed. Demographic and clinical characteristics were collected at treatment baseline, 12-month, and 24-month follow-up. A wrapper feature selection algorithm was used to determine an attribute core set. Four different ML algorithms, namely, LR, random forest, K-nearest neighbors, and extreme gradient boosting, were then trained and validated with 10-fold cross-validation to predict 24-month sustained DAS28 (Disease Activity Score on 28 joints) remission. The performances of the algorithms were then compared assessing accuracy, precision, and recall.

Results
Our analysis included 367 patients (female 323/367, 88%) with mean age ± SD of 53.7 ± 12.5 years at bDMARD baseline. Sustained DAS28 remission was achieved by 175 (47.2%) of 367 patients. The attribute core set used to train algorithms included acute phase reactant levels, Clinical Disease Activity Index, Health Assessment Questionnaire–Disability Index, as well as several clinical characteristics. Extreme gradient boosting showed the best performance (accuracy, 72.7%; precision, 73.2%; recall, 68.1%), outperforming random forest (accuracy, 65.9%; precision, 65.6%; recall, 59.3%), LR (accuracy, 64.9%; precision, 62.6%; recall, 61.9%), and K-nearest neighbors (accuracy, 63%; precision, 61.5%; recall, 54.8%).

Conclusions
We showed that ML models can be used to predict sustained remission in RA patients on bDMARDs. Furthermore, our method only relies on a few easy-to-collect patient attributes. Our results are promising but need to be tested on longitudinal cohort studies.
68Ga-FAPI and 18F-FDG PET/CT in Perineum Extramammary Paget Disease
Authors: Jiang Chunjuan , Song Shaoli 
Published: February 2021

Abstract
Extramammary Paget disease is a rare skin intraepithelial adenocarcinoma. Our case presents 68Ga-fibroblast activation protein inhibitor and 18F-FDG PET/CT imaging in a patient with perineum extramammary Paget disease. Compared with 18F-FDG PET/CT, the primary tumor, enlarged pelvic lymph nodes and right maxillofacial lesion showed higher uptake in 68Ga-fibroblast activation protein inhibitor PET/CT.