bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inflammatory Response, Reactive Oxygen Species Production and DNA Damage in Mice After Intrapleural Exposure to Carbon Nanotubes
Authors: Wils Regitze Sølling , Jacobsen Nicklas Raun , Vogel Ulla , Roursgaard Martin , Møller Peter 
Published: June 2021

Abstract
Carbon nanotubes (CNTs) are speculated to cause mesothelioma by persistent inflammation, oxidative stress, tissue injury, and genotoxicity. To investigate the pleural response to CNTs, we exposed C57BL/6 mice by intrapleural injection of 0.2 or 5 µg multiwalled CNTs (MWCNT-7, NM-401, and NM-403) or single-walled CNTs (NM-411). Inflammatory response, cellular reactive oxygen species (ROS) production of pleural lavage cells, and genotoxicity in cells from the mesothelial surface were assessed at days 1 and 90 after the exposure. Long and rigid types of MWCNTs (MWCNT-7 and NM-401) caused acute inflammation, characterized by influx of macrophages, neutrophils, and eosinophils into the pleural cavity. The inflammation was still evident at 90 days after the exposure, although it had reduced dramatically. The cellular ROS production was increased at day 90 after the exposure to MWCNT-7 and NM-401. The short and tangled type of MWCNT (ie NM-403) did not cause pleural inflammation or ROS production in pleural fluid cells. The exposure to NM-411 did not cause consistent inflammation responses or cellular ROS production. Levels of DNA strand breaks and DNA oxidation damage were unaltered, except for NM-411-exposed mice that had increased levels of DNA strand breaks at 90 days after the exposure. In conclusion, the long and rigid CNTs caused prolonged inflammatory response and increased ROS production in pleural lavage cells, yet it was not reflected in higher levels of DNA damage in pleural tissue.
Genomic epidemiology of SARS-CoV-2 transmission lineages in Ecuador
Authors: Gutierrez Bernardo , Márquez Sully , Prado-Vivar Belén , Becerra-Wong Mónica , Guadalupe Juan José , Candido Darlan Da Silva , Fernandez-Cadena Juan Carlos , Morey-Leon Gabriel , Armas-Gonzalez Rubén , Andrade-Molina Derly Madeleiny , Bruno Alfredo , De Mora Domenica , Olmedo Maritza , Portugal Denisse , Gonzalez Manuel , Orlando Alberto , Drexler Jan Felix , Moreira-Soto Andres , Sander Anna-Lena , Brünink Sebastian , Kühne Arne , Patiño Leandro , Carrazco-Montalvo Andrés , Mestanza Orson , Zurita Jeannete , Sevillano Gabriela , Du Plessis Louis , McCrone John T , Coloma Josefina , Trueba Gabriel , Barragán Verónica , Rojas-Silva Patricio , Grunauer Michelle , Kraemer Moritz U G , Faria Nuno R , Escalera-Zamudio Marina , Pybus Oliver G , Cárdenas Paúl 
Published: June 2021

Abstract
Characterisation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic diversity through space and time can reveal trends in virus importation and domestic circulation and permit the exploration of questions regarding the early transmission dynamics. Here, we present a detailed description of SARS-CoV-2 genomic epidemiology in Ecuador, one of the hardest hit countries during the early stages of the coronavirus-19 pandemic. We generated and analysed 160 whole genome sequences sampled from all provinces of Ecuador in 2020. Molecular clock and phylogeographic analysis of these sequences in the context of global SARS-CoV-2 diversity enable us to identify and characterise individual transmission lineages within Ecuador, explore their spatiotemporal distributions, and consider their introduction and domestic circulation. Our results reveal a pattern of multiple international importations across the country, with apparent differences between key provinces. Transmission lineages were mostly introduced before the implementation of non-pharmaceutical interventions, with differential degrees of persistence and national dissemination.
II Old English
Authors: Burns Rachel , Curran Colleen , Yang Kaifan , Kehoe Niamh , Knowles Emma , Pascual Rafael J , Ponirakis Eleni , Tedford Margaret 
Published: June 2021

AbstractThis chapter has eleven sections: 1. Bibliography; 2. Manuscript Studies, Palaeography, and Facsimiles; 3. Cultural and Intellectual Contexts; 4. Literature: General; 5. The Poems of the Exeter Book; 6. The Poems of the Vercelli Book; 7. The Poems of the Junius Manuscript; 8. Beowulf and the Beowulf Manuscript; 9. Other Poems; 10. Prose; 11. Reception. Sections 1, 9, and 11 are by Eleni Ponirakis; section 2 is by Rachel Burns and Colleen Curran; sections 3, 4, and 10 are by Margaret Tedford; section 5 is by Niamh Kehoe; section 6 is by Rafael J. Pascual; section 7 is by Emma Knowles; section 8 is by Rachel Burns and Kaifan Yang.
Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury: A Retrospective Cohort Study
Authors: Alderden Jenny , Cadavero Allen , Zhao Yunchuan “Lucy” , Dougherty Desiree , Jung Se-Hee , Yap Tracey L. 
Published: June 2021

ABSTRACT

OBJECTIVE
To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI.

METHODS
Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data.

RESULTS
The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53–0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17–4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00–1.02; P = .009).

CONCLUSIONS
Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.
Recent Trends in Faculty Promotion in U.S. Medical Schools: Implications for Recruitment, Retention, and Diversity and Inclusion
Authors: Xierali Imam M. , Nivet Marc A. , Syed Zubair A. , Shakil Amer , Schneider F. David 
Published: June 2021

Purpose
Faculty promotion is important for retention and has implications for diversity. This study provides an update on recent trends in faculty promotion in U.S. medical schools.

Method
Using data from the Association of American Medical Colleges Faculty Roster, the authors examined trends in faculty promotion over 10 years. Promotion status for full-time assistant and full-time associate professors who started between 2000 and 2009 inclusive was followed from January 1, 2010 to January 1, 2019. The authors used bivariate analyses to assess associations and promotion rates by sex, race/ethnicity, department, tenure status, and degree type.

Results
The promotion rate for assistant professors was 44.3% (2,330/5,263) in basic science departments, 37.1% (17,232/46,473) in clinical science departments, and 33.6% (131/390) in other departments. Among clinical departments, family medicine had the lowest rate of promoting assistant professors (24.4%; 484/1,982) and otolaryngology the highest rate (51.2%; 282/551). Faculty members who were male (38.9%; 11,687/30,017), White (40.0%; 12,635/31,596), tenured (58.7%; 98/167) or tenure-eligible (55.6%; 6,653/11,976), and holding MDs/PhDs (48.7%; 1,968/4,038) had higher promotion rates than, respectively, faculty who were female (36.3%; 7,975/21,998), minorities underrepresented in medicine (URM; 31.0%; 1,716/5,539), nontenured (32.5%; 12,174/37,433), and holding other/unknown degrees (20.6%; 195/948; all P < .001). These differences were less pronounced among associate professors; however, URM and nontenured faculty continued to have lower promotion rates compared with White, Asian, or tenured faculty at the associate professor level.

Conclusions
Promotion rates varied not only by faculty rank but also by faculty sex, race/ethnicity, department, tenure status, and degree type. The differences were more pronounced for assistant professors than associate professors. URM faculty members, particularly assistant professors, were promoted at lower rates than their White and Asian peers. More research to understand the drivers of disparities in faculty promotion seems warranted.
A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace
Authors: Ryan Michael S. , Khamishon Rebecca , Richards Alicia , Perera Robert , Garber Adam , Santen Sally A. 
Published: June 2021

Purpose
Assessments of the Core Entrustable Professional Activities (Core EPAs) are based on observations of supervisors throughout a medical student’s progression toward entrustment. The purpose of this study was to compare generalizability of scores from 2 entrustment scales: the Ottawa Surgical Competency Operating Room Evaluation (Ottawa) scale and an undergraduate medical education supervisory scale proposed by Chen and colleagues (Chen). A secondary aim was to determine the impact of frequent assessors on generalizability of the data.

Method
For academic year 2019–2020, the Virginia Commonwealth University School of Medicine modified a previously described workplace-based assessment (WBA) system developed to provide feedback for the Core EPAs across clerkships. The WBA scored students’ performance using both Ottawa and Chen scales. Generalizability (G) and decision (D) studies were performed using an unbalanced random-effects model to determine the reliability of each scale. Secondary G- and D-studies explored whether faculty who rated more than 5 students demonstrated better reliability. The Phi-coefficient was used to estimate reliability; a cutoff of at least 0.70 was used to conduct D-studies.

Results
Using the Ottawa scale, variability attributable to the student ranged from 0.8% to 6.5%. For the Chen scale, student variability ranged from 1.8% to 7.1%. This indicates the majority of variation was due to the rater (42.8%–61.3%) and other unexplained factors. Between 28 and 127 assessments were required to obtain a Phi-coefficient of 0.70. For 2 EPAs, using faculty who frequently assessed the EPA improved generalizability, requiring only 5 and 13 assessments for the Chen scale.

Conclusions
Both scales performed poorly in terms of learner-attributed variance, with some improvement in 2 EPAs when considering only frequent assessors using the Chen scale. Based on these findings in conjunction with prior evidence, the authors provide a root cause analysis highlighting challenges with WBAs for Core EPAs.
The Gait Outcomes Assessment List for Children With Lower Limb Difference (GOAL-LD): Assessment of Reliability and Validity
Authors: Griffiths Alison L. , Donnan Leo T. , Iobst Christopher A. , Kelley Simon P. , Bouchard Maryse , Narayanan Unni G. 
Published: June 2021

Background:
The Gait Outcomes Assessment List for children with Lower Limb Difference (GOAL-LD) is a patient and parent-reported outcome measure that incorporates the framework of the International Classification of Functioning, Disability, and Health. This prospective multicenter cohort study evaluates the validity and reliability of the GOAL-LD and the differences between parent and adolescent report.

Method:
One hundred thirty-seven pediatric patients aged over 5 years attending limb reconstruction clinics at the participating sites were assessed at baseline, and a self-selected cohort also completed an assessment 2 to 6 weeks later. Construct and criterion validity were assessed by comparing GOAL-LD scores with a measure of limb deformity complexity (LLRS-AIM) and the Pediatric Outcomes Data Collection Instrument, using Spearman correlation coefficients. Face and content validity were determined through ratings of item importance. Test-retest reliability was reported as an intraclass correlation coefficient and internal consistency using Cronbach α. Adolescent reports were compared with their parents using paired t tests.

Results:
The GOAL-LD demonstrated a moderate negative correlation with the LLRS-AIM (r=−0.40, P<0.001) and was able to discriminate between deformity complexity groups as defined by the LLRS-AIM (χ2=11.43, P=0.022). Internal consistency was high across all domains (α≥0.68 to 0.97). Like domains of the Pediatric Outcomes Data Collection Instrument and the GOAL-LD were well correlated. Parents reported a lower total GOAL-LD score when compared with adolescents (mean difference 3.04; SE 1.06; 95% confidence interval, 0.92-5.16; P<0.01); however this difference was only significant for body image and self-esteem (Domain F) and gait appearance (Domain D). Test-retest reliability remained high over the study period (intraclass correlation coefficient 0.85; SE 0.03; 95% confidence interval, 0.77-0.91).

Conclusions:
The GOAL-LD is a valid and reliable self and parent-reported outcome measure for children with lower limb difference. Parents report a lower level of function and attribute a higher importance to items when compared with their children. The GOAL-LD helps to communicate parent and child perspectives on their function and priorities and therefore has the capacity to facilitate family centered treatment planning and care.

Level of Evidence:
Level II—diagnostic. Prospective cross-sectional and a longitudinal cohort design.
Irritable bowel syndrome in China: a review on the epidemiology, diagnosis, and management
Authors: Liu Yi-Lin , Liu Jin-Song 
Published: June 2021

Abstract
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease worldwide. Current guidelines of IBS are mostly based on the western populations and expected to vary in different communities. China has a large population and a vast literature is available on IBS. Due to linguistic variations in the literature, the studies are not widely known and their conclusions thus remain largely obscured to the western medical literature. In this article, we reviewed the published literatures on the investigations of IBS epidemiology, diagnosis, and management in the Chinese population and emphasized the different findings gleaned from the western publications. The detailed literature review will benefit understanding of and promote future study on IBS.
Mobile health application usage and quality of care at a hypertension clinic: an observational cohort study
Authors: Agnihothri Saligrama , Cui Leon , Rajan Balaraman , Banerjee Anu , Ramanujan Ramanujapuram 
Published: June 2021

Objective:
The aim of this study was to test whether a physician-supervised web-based app, integrated with an electronic medical record, helps in improving blood pressure (BP) management in clinical practice.

Materials and Methods:
An observational study of 1633 patients seen at a hypertension clinic managed by an endocrinologist with two cohorts (726 adopted the app and 907 had not). The app allowed patients and doctors to monitor BP, blood sugar and other vital signs. Patients decided whether to opt in to using the app and how often to upload their readings. The provider could offer feedback and communicate with patients through the app. We evaluated the change in office-based BP measurement before and after app adoption (at least 12 months apart). We performed a difference-in-difference analysis along with matching based on patient-individual characteristics.

Results:
The difference-in-difference estimates were 6.23 mmHg systolic [95% confidence interval (95% CI) 0.87–11.59] for patients with SBP 150 mmHg or above, 4.01 mmHg systolic (95% CI 1.11–6.91) for patients with SBP 140 mmHg or above, 4.37 mmHg diastolic (95% CI 1.06–7.68) for patients with DBP 90 mmHg or above, 1.89 mmHg systolic (95% CI 0.58–3.2) and 0.87 mmHg diastolic (95% CI 0.17–1.57) overall for an average patient. Higher frequency of app usage was also associated with a greater reduction in BP.

Conclusion:
Use of an mHealth app in a clinical practice, was associated with a significant reduction in BP for average patients as well as high-severity patients. Physician-supervised mHealth apps in a clinical practice could be instrumental in managing patient BP.
PSEUDOPANUVEITIS AS A HARBINGER FOR SYSTEMIC LEUKEMIA RECURRENCE
Authors: Altman Marcus T. , Staubach Zane , Dunlap Jennifer , Zaki Amr , Skalet Alison H. , Leonard Jessica , Lin Phoebe 
Published: June 2021

Purpose:
To describe a patient with a history of pre–B-cell acute lymphoblastic leukemia in remission, who developed recurrent alternating intraocular leukemia manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances, this constellation of ocular findings preceded systemic leukemia recurrence.

Method:
Case report.

Results:
A 29-year-old man with a history of pre–B-cell acute lymphoblastic leukemia, in remission after a hematopoietic stem cell transplant, presented with pseudohypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudohypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution.

Conclusion:
The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudopanuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.
Corneal Toxicity of Intravitreal Methotrexate Used for the Treatment of Proliferative Vitreoretinopathy in Silicone Oil-Filled Eyes: A Case Series
Authors: Shen-Sampas John H. , Ahmad Tessnim R. , Stewart Jay M. 
Published: June 2021

Purpose:
The purpose of this study was to evaluate the corneal toxicity of intravitreal methotrexate used for the prevention of proliferative vitreoretinopathy (PVR).

Methods:
In this retrospective case series, eyes with recurrent retinal detachment secondary to PVR were treated with intravitreal injections of 400 μg methotrexate at an average frequency of every 7 days after vitrectomy with silicone oil tamponade. Corneas were examined for corneal epitheliopathy by slit-lamp biomicroscopy before each injection.

Results:
Thirteen eyes of 12 patients were reviewed. All had a history of recurrent retinal detachment secondary to PVR treated with vitrectomy and silicone oil. The median age was 35 years (range: 9–83). Four patients (33%) were female. The median follow-up duration was 8 weeks (range: 5–10). The median BCVA (logMAR notation) was 2.00 preoperatively, 2.00 at 1 month postoperatively, and 2.00 at the most recent follow-up (P = 0.969). Ten eyes (77%) were pseudophakic. Nine eyes (69%) had a preexisting ocular comorbidity. The median number of injections was 8 (range: 5–10). The median interval time between each injection was 7.0 days (range: 5.8–10.5), and the median follow-up period beyond last injection was 16 weeks (range: 8–28). Two eyes (15.4%) developed mild corneal epitheliopathy during the course of the treatment.

Conclusions:
Most eyes in this small series tolerated methotrexate injections without corneal toxicity. In eyes that developed epitheliopathy, the findings were mild and not treatment-limiting.
Corneal Effects of Tea Tree Oil
Authors: Tharmarajah Brindhan , Coroneo Minas Theodore 
Published: June 2021

Purpose:
The purpose of this study is to report a case of corneal epithelial defects resulting from topical treatment of blepharitis with tea tree oil (TTO).

Methods:
A 44-year-old man with a 1 year history of blepharitis non-responsive to eyelid hygiene was found to have signs of Demodex infestation. He was treated with a topical, off-label 50% TTO solution. Shortly afterward, the patient complained of bilateral ocular discomfort.

Results:
Slit-lamp examination revealed conjunctival injection and a corneal epithelial defect in both eyes. Treatment with lubricant, antibiotic, and steroid eye drops as well as bandage contact lenses was required to facilitate corneal healing.

Conclusions:
Topical use of off-label, 50% concentration TTO can result in corneal epithelial defects. Eye care professionals should remain aware of this risk and only use approved, low-concentration TTO products when treating Demodex-related blepharitis.
Impact of Early Intraocular Pressure Elevation on Postoperative Outcomes After Descemet Membrane Endothelial Keratoplasty in Non-glaucoma Patients
Authors: Lentzsch Anna M. , Adler Werner , Siebelmann Sebastian , Grajewski Rafael , Schrittenlocher Silvia , Bachmann Bjoern O. , Cursiefen Claus , Heindl Ludwig M. , Matthaei Mario 
Published: June 2021

Purpose:
The purpose of this study was to investigate the impact of transient elevations in postoperative intraocular pressure (IOP) on the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) surgery in non-glaucoma patients.

Methods:
Retrospective analysis from a prospective database of eyes without preexisting glaucoma that underwent DMEK with 90% anterior chamber and 20% sulfur hexafluoride endotamponade. Group A included eyes without postoperative IOP increase (IOP <30 mm Hg and a relative increase from preoperative value <10 mm Hg). Group B included eyes with IOP elevation (postoperative IOP ≥30 mm Hg or a relative increase from preoperative value ≥10 mm Hg) handled according to a standardized protocol. The impact of elevated IOP within 3 days after DMEK surgery was evaluated regarding best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) at 1, 3, and 6 months.

Results:
One hundred seventy-six eyes from 164 patients were included. An IOP increase after DMEK occurred in 20 eyes (11.3%; 19 patients, group B), and the mean peak IOP was 48 ± 12 mm Hg (range 32–69 mm Hg). There were no significant postoperative differences in BCVA, CCT, and ECC on comparing both groups. The BCVA increased significantly (P < 0.001, respectively), whereas CCT (P < 0.001, respectively) and ECC (P < 0.001, respectively) decreased significantly from preoperative values. The rebubbling rate tended to be higher in group B without statistical significance (6.4% vs. 10%, P = 0.648).

Conclusions:
Temporary IOP elevation after DMEK may not affect functional and morphological outcomes in non-glaucoma patients. However, careful postoperative IOP monitoring and appropriate management are crucial to avoid irreversible ocular damage.