bluuebunny/crossref_metadata_2025_split huggingface dataset:
User-Centered Design in Pediatric Acute Care Settings Antimicrobial Stewardship
Authors: Ward Michael J. , Chavis Bryson , Banerjee Ritu , Katz Sophie , Anders Shilo 
Published: January 2021

Abstract
Background Antibiotic prescribing in ambulatory care centers is increasing. Previous research suggests that 20 to 50% of antibiotic prescriptions are either unnecessary or inappropriate. Unnecessary antibiotic consumption can harm patients by increasing antibiotic resistance and drug-associated toxicities, and the reasons for such use are multifactorial. Antimicrobial Stewardship Programs (ASP) were developed to guide better use of antibiotics. A core element of ASP is to provide feedback to clinical providers. To create clinically meaningful feedback, user-center design (UCD) is a robust approach to include end-users in the design process to improve systems.
Objective The study aimed to take a UCD approach to developing antibiotic prescribing feedback through input from clinicians in two ambulatory care settings.
Methods We conducted two group prototyping sessions with pediatric clinicians who practice in the emergency department and urgent care settings at a tertiary care children's hospital. Participants received background on the problem of antibiotic prescribing and then were interviewed about their information needs, perceived value, and desired incentives for a prescribing feedback system. Sessions concluded with their response and recommendations to sample sections of an antibiotic feedback report including orienting material, report detail, targeted education, and resources.
Results A UCD approach was found to be highly valuable in the development of a feedback mechanism that is viewed as desirable by clinicians. Clinicians preferred interpreting the data themselves with aids such as diagrams and charts over the researcher concluded statements about the clinician's behavior. Specific feedback that clinicians considered redundant were removed from the model if preexisting alerts were established.
Conclusion Integrating a UCD approach in developing ASP feedback identified desirable report characteristics that substantially modified preliminary wireframes for feedback. Future research will evaluate the clinical effectiveness of our feedback reports in outpatient settings.
Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018
Authors: Herdt Maria Carolina Wensing , Magajewski Flávio Ricardo Liberal , Linzmeyer Andressa , Tomazzoni Rafaela Rodolfo , Domingues Nicole Pereira , Domingues Milla Pereira 
Published: January 2021

AbstractCases of maternal near miss are those in which women survive severe maternal complications during pregnancy or the puerperium. This ecological study aimed to identify the temporal trend of near-miss cases in different regions of Brazil between 2010 and 2018, using data from the Hospital Information System (HIS) of the Unified Brazilian Health System (SUS, in the Portuguese acronym). Hospital admission records of women between 10 and 49 years old with diagnosis included in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and codes indicating near-miss events were selected. From 20,891,040 admissions due to obstetric causes, 766,249 (3.66%) near-miss cases were identified, and 31,475 women needed admission to the intensive care unit (ICU). The cases were found to be more predominant in black women over 35 years old from the North and Northeast regions. There was a trend of increase in near-miss rates of ~ 13.5% a year during the period of the study. The trend presented a different behavior depending on the level of development of the region studied. The main causes of near miss were preeclampsia (47%), hemorrhage (24%), and sepsis (18%).
Switching of Hormone Therapies in Breast Cancer Women
Authors: Medeiros Luana Moreira de , Stahlschmidt Rebeca , Ferracini Amanda Canato , Souza Cinthia Madeira de , Juliato Cassia Raquel Teatin , Mazzola Priscila Gava 
Published: January 2021

Abstract
Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer.
Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017.
Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, ‘disease progression’ was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, ‘presence of side effects’ was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities.
Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.
Gestational Diabetes Mellitus and Obesity are Related to Persistent Hyperglycemia in the Postpartum Period
Authors: Rehder Patricia Moretti , Borovac-Pinheiro Anderson , de Araujo Raquel Oliveira Mena Barreto , Diniz Juliana Alves Pereira Matiuck , Ferreira Nathalia Lonardoni Crozatti , Branco Ana Claudia Rolim , Dias Aline de Fatima , Pereira Belmiro Gonçalves 
Published: January 2021

Abstract
Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6–12 weeks postpartum).
Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi-Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%.
Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period.
Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.
The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature
Authors: Flukes Stephanie , Sharma Rahul K. , Lohia Shivangi , Cohen Marc A. 
Published: January 2021

Abstract
Objective The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy.
Design  Systematic review of the literature.
Setting This review included national database and multi-institutional studies published between 1990 and 2019.
Participants PubMed was interrogated for keywords “hospital volume,” “facility volume,” and outcomes for “Nasopharyngeal carcinoma,” “Sinonasal carcinomas,” “Pituitary Tumors,” “Acoustic Neuromas,” “Chordomas,” and “Skull Base Tumors” to identify studies. Single-institution studies and self-reported surveys were excluded.
Main outcome measures The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications.
Results A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations.
Conclusion This systematic review demonstrates that a positive volume–outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes.
The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial
Authors: Shirazi Mahboobeh , Jalalian Mohamad Naser , Abed Masoumeh , Ghaemi Marjan 
Published: January 2021

Abstract
Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance.
Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups.
Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively.
Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance.
Trial registration The present study was registered by the name “Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders” with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).
Smell Regions in Patients with Vitamin D Deficiency: An MRI Evaluation
Authors: Şencan Ziya , Bayar Muluk Nuray , Şahan Mehmet Hamdi 
Published: January 2021

Abstract
Objective We investigated the effects of vitamin D deficiency in the peripheral and central smell regions by magnetic resonance imaging (MRI).
Methods This retrospective study included 29 patients (12 males, 17 females) with 25-dihydroxy vitamin D3 [25(OH)2D3] deficiency (group 1) and 34 subjects without 25(OH)2D3 deficiency (14 males, 20 females) (group 2). Using cranial MRIs, the peripheral (olfactory bulb [OB] volume and olfactory sulcus [OS] depth) and central (insular gyrus and corpus amygdala) smell regions were evaluated.
Results The OB volume and OS depth values of the 25(OH)2D3 deficiency group were significantly lower than those of the control group (p < 0.05). For the central smell regions, the insular gyrus and corpus amygdala areas of the 25(OH)2D3 deficiency group were nonsignificantly lower than those in the control group (p > 0.05). There were positive correlations between OB volumes, OS depths, and insular gyrus and corpus amygdala areas bilaterally in the 25(OH)2D3 deficiency group separately and in all subjects (groups 1 and 2) (p < 0.05). In the 25(OH)2D3 deficiency group, as the 25(OH)2D3 values became lower, the insular gyrus area values decreased bilaterally (p < 0.05). In females, the corpus amygdala area values were lower than in males (p < 0.05).
Conclusion Since vitamin D3 deficiency affected the peripheral and central smell regions negatively, we recommend evaluating patients' vitamin D levels as a health policy to prevent vitamin D3 deficiency-related cranial smell region problems. Moreover, sunlight exposure is very important to increase vitamin D levels, and the public should be informed about this topic.
Intrahepatic Cholestasis of Pregnancy: Natural History and Current Management
Authors: Roediger Rebecca , Fleckenstein Jaquelyn 
Published: January 2021

AbstractIntrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids (BAs) with spontaneous resolution after delivery. ICP carries a risk of adverse effects on the fetus which correlates with the degree of BA elevation. ICP occurs in genetically susceptible women as the reproductive hormones increase during pregnancy. Ursodeoxycholic acid is still considered the first-line treatment for ICP though it is of unproven benefit in preventing adverse effects on the fetus. Fetal complications, such as stillbirth, increase with gestational age, so preterm delivery is generally performed in cases of severe ICP, defined as BA levels above 40 μmol/L. ICP may recur in future pregnancies and is associated with an increased risk for future hepatobiliary, immune mediated, and cardiovascular diseases. Children born of mothers with ICP have normal development but may have a risk for subsequent metabolic disease.
Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit
Authors: Kassif Lerner Reut , Levinkopf Dana , Zaslavsky Paltiel Inna , Sadeh Tal , Rubinstein Marina , Pessach Itai M. , Keller Nathan , Lerner-Geva Liat , Paret Gideon 
Published: January 2021

AbstractThe incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.
Typical Orbital Pathologies: Hemangioma
Authors: Low Christopher M. , Stokken Janalee K. 
Published: January 2021

AbstractOrbital hemangiomas are the most common primary neoplasm of the orbit and manifest as two distinct pathologic entities: infantile hemangiomas and cavernous hemangiomas. In this article, both infantile and cavernous hemangiomas are reviewed, with special attention paid to the natural history, clinical presentation, and management teams and approaches involved. An example case of each type of hemangioma is presented along with pearls and tips a reader can take away after reading this article.
Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip–Knee–Ankle Angle in Varus Knees: A Navigation-Based Study
Authors: Larrainzar-Garijo Ricardo , Molanes-Lopez Elisa M. , Murillo-Vizuete David , Garcia-Bogalo Raul , Escobar-Anton David , Lopez-Fernandez Jesus , Diez-Rodriguez Angel , Corella-Montoya Fernando 
Published: January 2021

AbstractAfter knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip–knee–ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre–post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a “within-range” postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.
Arthroscopic Primary Repair of the Posterior Cruciate Ligament
Authors: Vermeijden Harmen D. , van der List Jelle P. , DiFelice Gregory S. 
Published: January 2021

AbstractThe posterior cruciate ligament (PCL) is one of the four major stabilizers of the knee joint and functions as the primary restraint to posterior tibial translation. PCL tears rarely occur in isolation and most commonly presents in the setting of multiligamentous knee injuries. Several treatment strategies for these injuries have been proposed over the last decades, including ligament reconstruction and primary repair. Arthroscopic primary PCL repair has the potential to preserve native tissue using a more minimally invasive approach, thereby avoiding donor-site morbidity and allowing early mobilization. While arthroscopic PCL repair is certainly not an effective surgical approach for all patients, this procedure may be a reasonable and less morbid alternative to PCL reconstruction in selected patients treated for proximal or distal avulsion tears, with low failure rates, good knee stability, and good to excellent subjective outcomes. The surgical indications, surgical techniques, postoperative management, and outcomes for arthroscopic primary repair of proximal and distal PCL tears will be discussed in this review.
Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke
Authors: de Havenon Adam , Petersen Nils , Sultan-Qurraie Ali , Alexander Matthew , Yaghi Shadi , Park Min , Grandhi Ramesh , Mistry Eva 
Published: January 2021

AbstractThere is an absence of specific evidence or guideline recommendations on blood pressure management for large vessel occlusion stroke patients. Until randomized data are available, the periprocedural blood pressure management of patients undergoing endovascular thrombectomy can be viewed in two phases relative to the achievement of recanalization. In the hyperacute phase, prior to recanalization, hypotension should be avoided to maintain adequate penumbral perfusion. The American Heart Association guidelines should be followed for the upper end of prethrombectomy blood pressure: ≤185/110 mm Hg, unless post–tissue plasminogen activator administration when the goal is <180/105 mm Hg. After successful recanalization (thrombolysis in cerebral infarction [TICI]: 2b–3), we recommend a target of a maximum systolic blood pressure of < 160 mm Hg, while the persistently occluded patients (TICI < 2b) may require more permissive goals up to <180/105 mm Hg. Future research should focus on generating randomized data on optimal blood pressure management both before and after endovascular thrombectomy, to optimize patient outcomes for these divergent clinical scenarios.
Evolution in the weak-mutation limit: Stasis periods punctuated by fast transitions between saddle points on the fitness landscape
Authors: Bakhtin Yuri , Katsnelson Mikhail I. , Wolf Yuri I. , Koonin Eugene V. 
Published: January 2021

Significance
The gradual character of evolution is a key feature of the Darwinian worldview. However, macroevolutionary events are often thought to occur in a nongradualist manner, in a regime known as punctuated equilibrium, whereby extended periods of evolutionary stasis are punctuated by rapid transitions between states. Here we analyze a simple mathematical model of population evolution on fitness landscapes and show that, for a large population in the weak-mutation limit, the process of adaptive evolution consists of extended periods of stasis, which the population spends around saddle points on the landscape, interrupted by rapid transitions to new saddle points when a beneficial mutation is fixed. Thus, phenomenologically, the default regime of biological evolution seems to closely resemble punctuated equilibrium.
Interpretations of ground-state symmetry breaking and strong correlation in wavefunction and density functional theories
Authors: Perdew John P. , Ruzsinszky Adrienn , Sun Jianwei , Nepal Niraj K. , Kaplan Aaron D. 
Published: January 2021

Significance
The ground state of a quantum mechanical system is the lowest-energy eigenstate of the Hamiltonian. In isolation, it persists unchanged forever, with symmetries dictated by those of the Hamiltonian. But near-eigenstates of broken symmetry can persist for long times, even on the scale of human measurement. The appearance of broken symmetries of the electron density or spin density in a density functional calculation can reveal strong correlations among the electrons that are present in a symmetry-unbroken wavefunction. Symmetry breaking can arise when a wave-like fluctuation drops to zero frequency. The presented examples are the stretched hydrogen molecule, antiferromagnetism in solids, and the static charge-density wave in a low-density jellium, which is shown quantitatively to be a zero-frequency plasma wave.