bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deployment and testing of an automated medical equipment service communication and documentation system at a rural hospital in Kenya
Authors: Gordon Rayonna M , Saldana Santiago J , Brown Philip J , Gayzik F Scott , Anthony Evelyn Y 
Published: March 2021

Abstract

Background
The Medical Equipment Network Documentation System (MENDS) provides a simple communication network for equipment servicing from failure to restoration. It is a text messaging-based platform, designed to use existing technologies in place in low- and middle-income settings. The system gathers and relays information about equipment service requests and reports and automatically saves them to an online database.

Methods
MENDS was deployed at a high volume, rural, charity medical facility in Kijabe, Kenya for a 3-mo pilot test.

Results
The results show MENDS more than tripled documentation and enhanced ease and speed of communication.

Conclusions
Comprehensive data provided by MENDS created more accurate measures of equipment performance, which can be used to decrease the time that equipment is out of service and improve the efficiency of repairs, equipment quality and procurement.
Role of the high-affinity reductive iron acquisition pathway of Candida albicans in prostaglandin E2 production, virulence, and interaction with Pseudomonas aeruginosa
Authors: Mochochoko Bonang M , Ezeokoli Obinna T , Sebolai Olihile , Albertyn Jacobus , Pohl Carolina H 
Published: March 2021

Abstract

Components of the iron reductive pathway of Candida albicans have been implicated in the production of prostaglandin E2 (PGE2) and virulence. However, it is unknown whether other components of this pathway influence PGE2. We investigated the role of the iron reductive pathway of C. albicans in biofilm formation, PGE2 production, and virulence in Caenorhabditis elegans. Additionally, as the co-occurrence of C. albicans and Pseudomonas aeruginosa in host tissues is frequent and involves competition for host-associated iron, we examined the effects of this interaction. Deletion of multicopper oxidase gene, FET99, and iron permease genes, FTH1 and FTH2, affected biofilm metabolic activity, and for the FTH2 mutant, also biofilm morphology. Deletion of CCC1 (vacuolar iron transporter) and CCC2 (P-type ATPase copper importer) also influenced biofilm morphology. For PGE2 production, deletion of FET99, FTH1, FTH2, CCC1, and CCC2 caused a significant reduction by monomicrobial biofilms, while FTH2deletion caused the highest reduction in polymicrobial biofilms. URA3 positive mutants of FET99 and FTH2 demonstrated attenuated virulence in C. elegans, potentially due to the inability of mutants to form hyphae in vivo. Deductively, the role of the iron reductive pathway in PGE2 synthesis is indirect, possibly due to their role in iron homeostasis.

Lay Summary
Iron uptake is vital for disease-causing microbes like Candida albicans. Using strains deficient in some iron-uptake genes, we show that iron-uptake genes, especially FET99 and FTH2, play a role in biofilm formation, prostaglandin production, and virulence in the nematode infection model.
Implementation of Individualized Pain Care Plans Decreases Length of Stay and Hospital Admission Rates for High Utilizing Adults with Sickle Cell Disease
Authors: Welch-Coltrane Jena L , Wachnik Anthony A , Adams Meredith C B , Avants Cherie R , Blumstein Howard A , Brooks Amber K , Farland Andrew M , Johnson Joshua B , Pariyadath Manoj , Summers Erik C , Hurley Robert W 
Published: March 2021

AbstractObjectivePatients with sickle cell disease (SCD) face inconsistent effective analgesic management, leading to high inpatient healthcare utilization and significant financial burden for healthcare institutions. Current evidence does not provide guidance for inpatient management of acute pain in adults with sickle cell disease. We conducted a retrospective analysis of a longitudinal cohort quality improvement project to characterize the role of individualized care plans on improving patient care and reducing financial burden in high healthcare-utilizing patients with SCD-related pain.MethodsIndividualized care plans were developed for patients with hospital admissions resulting from pain associated with sickle cell disease. A 2-year prospective longitudinal cohort quality improvement project was performed and retrospectively analyzed. Primary outcome measure was duration of hospitalization. Secondary outcome measures included: pain intensity; 7, 30, and 90-day readmission rates; cost per day; total admissions; total cost per year; analgesic regimen at index admission; and discharge disposition.ResultsDuration of hospitalization, the primary outcome, significantly decreased by 1.23 days with no worsening of pain intensity scores. Seven-day readmission decreased by 34%. Use of intravenous hydromorphone significantly decreased by 25%. The potential cost saving was $1,398,827 as a result of this quality initiative.ConclusionsImplementation of individualized care plans reduced both admission rate and financial burden of high utilizing patients. Importantly, pain outcomes were not diminished. Results suggest that individualized care plans are a promising strategy for managing acute pain crisis in adult sickle cell patients from both care-focused and utilization outcomes.
Toward physician well-being and the mitigation of burnout
Authors: Janosy Norah R. , Anderson Corrie T.M. 
Published: March 2021

Purpose of review
Healthcare provider burnout is a real phenomenon. The rates of burnout are on the rise. Burnout-associated suicide amongst physicians represents a real “public health crisis.” This article discusses the drivers of burnout and offers some strategies to mitigate burnout and improve well-being.

Recent findings
Measures of burnout such as stress, micro, and macro-aggression in the workplace have a psychological impact on staff. Additionally, a measurable economic price is exacted when an organization fails to address the lack of well-being burnout represents.

Summary
As healthcare providers struggle to survive and deal with the complex new set of problems and obstacles that the COVID-19 pandemic, the National economic crisis, and the increasing regulatory obligations have summoned forth, professional burnout rates have risen drastically. With good leadership, developing comprehensive programs to identify, track, and treat burnout symptoms and improve well-being in the work environment can result in greater work satisfaction and save resources.
Reinstating Elective Surgeries in MedStar Health
Authors: Stein David E. , Chia Stanley H. , Breakey Thomas H. , Song David H. , Woo Edward Y. , Fairbanks Rollin J. , Jordan David , Curl Leigh Ann , Boucher Henry R. , Boyle Lisa , Edwards Karol , Friedrich Hanna , Gilbert Robert J. , Matton Jeffrey , Mucci Kathy , Chambers Bradley , Sachtleben Michael , Watson Thomas J. 
Published: March 2021

Introduction:
Coronavirus disease 2019 (COVID-19) infections have strained hospital resources worldwide. As a result, many facilities have suspended elective operations and ambulatory procedures. As the incidence of new cases of COVID-19 decreases, hospitals will need policies and algorithms to facilitate safe and orderly return of normal activities. We describe the recommendations of a task force established in a multi-institutional healthcare system for resumption of elective operative and ambulatory procedures applicable to all hospitals and service lines.

Methods:
MedStar Health created a multidisciplinary task force to develop guidelines for resumption of elective surgeries/procedures. The primary focus areas included the establishment of a governance structure at each healthcare facility, prioritization of elective cases, preoperative severe acute respiratory syndrome coronavirus 2 testing, and an assessment of the needs and availability of staff, personal protective equipment, and other essential resources.

Results:
Each hospital president was tasked with establishing a local perioperative leadership team answering directly to them and granted the authority to prioritize elective surgery and ambulatory procedures. An elective surgery algorithm was established using a simplified Medically Necessary Time Sensitive score, with multiple steps requiring a “go/no-go” assessment based on local resources. In addition, mandatory preoperative COVID testing policies were developed and operationalized.

Conclusions:
Even when the COVID pandemic has passed, hospitals and surgical centers will require COVID screening and testing, case prioritization, and supply chain management to provide care essential to the surgical patient while protecting their safety and that of staff. Our guidelines consider these factors and are applicable to both tertiary academic medical centers and smaller community facilities.
Quasi-Contextualized Speech Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge
Authors: Beaulieu Cynthia L. , Peng Juan , Hade Erinn M. , Montgomery Erin , Gilchrist Kamie , Corrigan John D. , Horn Susan D. , Bogner Jennifer 
Published: March 2021

Objective:
To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI).

Setting:
Acute inpatient rehabilitation.

Participants:
Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation.

Design:
Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data.

Main Measures:
Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9.

Results:
When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment.

Conclusions:
The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.
Change in Learning and Memory Partially Mediates Effects of Compensatory Cognitive Training on Self-Reported Cognitive Symptoms
Authors: O'Neil Maya Elin , Cameron David , Shirley Kate , Sano Emily , Twamley Elizabeth , Williams Rhonda , Turner Aaron , Pagulayan Kathleen , Roost Mai , Jak Amy , Storzbach Daniel , Huckans Marilyn 
Published: March 2021

Objective:
To examine associations among compensatory cognitive training (CCT), objective cognitive functioning, and self-reported cognitive symptoms. We examined whether change in objective cognitive functioning associated with participation in CCT at 10-week follow-up mediates change in self-reported cognitive symptoms associated with CCT at 15-week follow-up.

Setting:
Three VA outpatient mental health clinics.

Participants:
Veterans with a history of mild traumatic brain injury who reported cognitive deficits.

Design:
Randomized controlled trial post hoc causal mediation analysis.

Main Measures:
Self-reported cognitive symptoms were measured by the Prospective-Retrospective Memory Questionnaire and the Multiple Sclerosis Neuropsychological Screening Questionnaire. Objective cognitive functioning was measured using a battery of neuropsychological tests.

Results:
Improvement on the Hopkins Verbal Learning Test—Revised (HVLT-R) Delayed Recall test mediated the association between participation in CCT and decrease in the Prospective-Retrospective Memory Questionnaire total score. Improvement on the HVLT-R Total Recall and HVLT-R Delayed Recall tests both meditated the association between participation in CCT and decrease in the Multiple Sclerosis Neuropsychological Screening Questionnaire total score. No other measures of objective cognitive functioning were significant mediators.

Conclusion:
Patients' perceptions of cognitive symptom improvement due to CCT are partially mediated by learning and memory, though these subjective improvements occur regardless of other changes in objective cognitive functioning associated with CCT.
In-vivo imaging of the conventional aqueous outflow system
Authors: Lee Daniel , Kolomeyer Natasha N. , Razeghinejad Reza , Myers Jonathan S. 
Published: March 2021

Purpose of review
The aim of this study was to provide a comprehensive summary of in-vivo imaging techniques of the aqueous outflow system and discuss its role in improving our understanding of glaucoma pathogenesis and management.

Recent findings
Our understanding of the aqueous outflow system is largely derived from ex-vivo studies. Recent innovations in imaging technology and techniques enable in-vivo evaluation of the conventional outflow system in real-time. Optical coherence tomography allows for noninvasive, high-resolution, volumetric imaging of ocular tissues. Dynamic structural changes have been observed at the trabecular meshwork and Schlemm's canal. In parallel, aqueous angiography using injected tracers show a similar dynamism with variable and pulsatile flow signals.

Summary
In-vivo imaging enable real-time evaluation of the conventional aqueous outflow pathway. This emerging field shows great promise to expand our understanding of the pathogenesis and treatment of glaucoma.
A Review of the State of the Science of HIV and Stigma: Context, Conceptualization, Measurement, Interventions, Gaps, and Future Priorities
Authors: Relf Michael V. , L. Holzemer William , Holt Lauren , Nyblade Laura , Ellis Caiola Courtney 
Published: March 2021

ABSTRACT
Stigma is a fundamental cause of health inequities. As such, stigma is a major barrier to HIV prevention, care, and treatment. This review will examine the concept of stigma, explicating the mechanisms of action of HIV-related stigma while also examining intersectional stigma and structural stigma. Instruments to measure HIV-related stigma and its mechanisms of action, as well as stigma enacted and experienced by HIV health care providers, will also be reviewed. This article will conclude with a review of stigma interventions, gaps in the literature, and priorities for future HIV, intersectional, and structural stigma research.
Serine/Threonine Kinase 11 Plays a Canonical Role in Malignant Progression of KRAS-Mutant and GNAS-Wild-Type Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Omori Yuko , Ono Yusuke , Morikawa Takanori , Motoi Fuyuhiko , Higuchi Ryota , Yamamoto Masakazu , Hayakawa Yuko , Karasaki Hidenori , Mizukami Yusuke , Unno Michiaki , Furukawa Toru 
Published: March 2021

Objective:
We aimed to elucidate the clinicopathobiological significance of Serine/Threonine Kinase 11 (STK11) in pancreatic intraductal papillary mucinous neoplasms (IPMNs).

Background:
STK11 is a tumor suppressor involved in certain IPMNs; however, its significance is not well known.

Methods:
In 184 IPMNs without Peutz-Jeghers syndrome, we analyzed expression of STK11 and phosphorylated-AMPKa in all cases, and p16, p53, SMAD4, and β-catenin in 140 cases by immunohistochemistry; and we analyzed mutations in 37 genes, including whole coding exons of STK11, CDKN2A, TP53, and SMAD4, and hotspots of KRAS, BRAF, and GNAS in 64 cases by targeted sequencing. KRAS and GNAS were additionally analyzed in 86 STK11-normal IPMNs using digital-PCR.

Results:
Consistent loss or reduction of STK11 expression was observed in 26 of 184 (14%) IPMNs. These STK11-aberrant IPMNs were 17 of 45 (38%) pancreatobiliary, 8 of 27 (30%) oncocytic, 1 of 54 (2%) gastric, and 0 of 58 (0%) intestinal subtypes (P = 8.5E-11), and 20 of 66 (30%) invasive, 6 of 74 (8%) high-grade, and 0 of 44 (0%) low-grade (P = 3.9E-06). Sixteen somatic STK11 mutations (5 frameshift, 6 nonsense, 1 splicing, and 4 missense) were detected in 15/26 STK11-aberrant IPMNs (P = 4.1E-06). All STK11-aberrant
IPMNs were GNAS-wild-type and 96% of them were KRAS or BRAF-mutant.
Morphologically, STK11-aberrant IPMNs presented “fern-like” arborizing papillae with thin fibrovascular core. Phosphorylated-AMPKa was down-regulated in STK11-aberrant IPMNs (92%, P = 6.8E-11). Patients with STK11-aberrant IPMNs showed poorer survival than patients with STK11-normal IPMNs (P = 3.6E-04 overall; P = 6.1E-04 disease-free).

Conclusion:
STK11 may play a canonical role in malignant progression and poor survival of patients with IPMNs. Aberrant STK11-driven phosphorylated AMPK downregulation may provide therapeutic opportunities with mTOR inhibitors/AMPK activators.
Attrition From a National Surgical Training Program
Authors: Nally Deirdre M. , Kavanagh Dara , Traynor Oscar , Bennett Deirdre 
Published: March 2021

Objective:
The objective of this study was to examine the trainee experience to identify some of the factors which contribute to attrition from surgical training.

Summary Background:
Not all trainees who commence a surgical training program continue and complete it. Surgical training can be personally and professionally demanding and trainees may, for a multitude of reasons, change career direction. Attrition from surgical training impacts upon multiple stakeholders: A decision to leave may be difficult and time consuming for the individual and can generate unanticipated inefficiency at a systems level. This project examined attrition from a national surgical training program to deepen understanding of some of the causes of the phenomenon.

Methods:
A qualitative study was performed. A purposeful sampling strategy was used to identify representative participants. Semistructured interviews were conducted with eleven trainees who withdrew or considered doing so. A thematic analysis was performed to examine the experiences of trainees and explore the factors which influenced a decision to withdraw.

Findings:
Five major themes emerged from the interview data: delivery of training, the training atmosphere, influence of seniors, concerns regarding progression, and the perception of the future role with respect to lifestyle.

Conclusions:
The personal experience of surgical training is crucial in informing a decision to withdraw from a program. Voluntary attrition is appropriate where doctors, after experiencing some time in surgical training, recognize that a surgical career does not meet their expectation. However, improving the delivery of training by addressing the concerns identified in this study may serve to enhance the personal training experience and hence maximize retention.
Abnormal intrinsic functional network hubs in diabetic retinopathy patients
Authors: Huang Xin , Xie Bao-Jun , Qi Chen-Xing , Tong Yan , Shen Yin 
Published: March 2021

Background
However, whether the whole-brain functional network hub changes occur in diabetic retinopathy patients remains unknown.

Purpose
The purpose of the study was to investigate the function network centrality and connectivity changes in diabetic retinopathy patients using the voxel-wise degree centrality method.

Materials and methods
Thirty-four diabetic retinopathy patients (18 male and 16 female) and 38 healthy controls (18 male and 20 female) closely matched in age, sex, and education were enrolled in the study. Graph theory-based network analysis was performed to investigate the degree centrality between two groups.

Results
Compared with healthy controls, diabetic retinopathy patients had significantly higher degree centrality values in the pons and bilateral caudate and had significantly lower degree centrality values in the left lingual and right lingual, and right angular/middle occipital gyrus (MOG). Moreover, diabetic retinopathy patients exhibited increased functional connectivity between the bilateral lingual and right cerebellum lobe and right fusiform/bilateral caudate and increased functional connectivity between the right angular/MOG and bilateral anterior cingulum and right cuneus/bilateral precuneus and increased functional connectivity between the bilateral caudate and right lingual and right superior occipital gyrus. In contrast, diabetic retinopathy patients showed decreased functional connectivity between bilateral lingual and left lingual and right lingual and left superior occipital gyrus and decreased functional connectivity between the angular/MOG and right inferior occipital gyrus/right fusiform and left MOG/inferior occipital gyrus and decreased functional connectivity between the bilateral caudate and bilateral cerebellum crus1.

Conclusion
Our results highlight that reorganization of the hierarchy of the cortical connectivity network related to visual network.
Management Algorithm of External Fixation in Lower Leg Arterial Injury for Limb Salvages
Authors: Jin Lei , Zhang Song , Liu Motao , Zhang Yuxuan , Lin Xin , Feng Dehong , Hu Kejia 
Published: March 2021

AbstractPurposeThe purpose of this study was to review the roles of using external fixation to rescue the patients who sustained arterial injuries in the lower legs.MethodsDemographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery.Results80 patients (90 legs) maintained a successful lower leg salvage. The patients were followed up for an average of 15.5±5.5 months. 6 patients (8 pins) experienced pin-tract infection, pins loosening happened in 2 patients (4 pins), 7 patients (7 legs) developed wound superficial infection, 3 patients (3 legs) with a deep infection developed osteomyelitis, 16 patients (17 legs) suffered the bone nonunion or bone defect. The average healing time of fracture was 5.6±4.3months. The maintain of external fixation average time was 5.8±3.6 months.ConclusionWith correctly judging the condition of limb ischemia, mastering reasonably the operation indications, and preventing complications, good clinical effects can be achieved when external fixation is used.Level of evidenceRetrospective cohort, level IV.
Contextual Embeddings from Clinical Notes Improves Prediction of Sepsis
Authors: Amrollahi Fatemeh , P. Shashikumar Supreeth , Razmi Fereshteh , Nemati Shamim 
Published: March 2021

AbstractSepsis, a life-threatening organ dysfunction, is a clinical syndrome triggered by acute infection and affects over 1 million Americans every year. Untreated sepsis can progress to septic shock and organ failure, making sepsis one of the leading causes of morbidity and mortality in hospitals. Early detection of sepsis and timely antibiotics administration is known to save lives. In this work, we design a sepsis prediction algorithm based on data from electronic health records (EHR) using a deep learning approach. While most existing EHR-based sepsis prediction models utilize structured data including vitals, labs, and clinical information, we show that incorporation of features based on clinical texts, using a pre-trained neural language representation model, allows for incorporation of unstructured data without an explicit need for ontology-based named-entity recognition and classification. The proposed model is trained on a large critical care database of over 40,000 patients, including 2805 septic patients, and is compared against competing baseline models. In comparison to a baseline model based on structured data alone, incorporation of clinical texts improved AUC from 0.81 to 0.84. Our findings indicate that incorporation of clinical text features via a pre-trained language representation model can improve early prediction of sepsis and reduce false alarms.