bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSESSMENT OF TECHNICAL ABILITIES IN ENDOSCOPIC SURGERY SIMULATED BY MEDICINE STUDENTS
Authors: Ibero Casadiego G P , Rodriguez Garcia J I , Garcia-Santos G , Mejia-Gil S C , Martinez Izquierdo G , Silva Cano D W , Merayo Alvarez M , Granero Trancon J E 
Published: May 2021

Abstract

INTRODUCTION
Simulation training has become a widely accepted educational tool for the development of technical skills in endoscopic surgery. The objective of this work was to evaluate bachelors who hold a Degree in Medicine in the execution of exercises carried out in both physical and virtual simulations.

MATERIAL AND METHODS
The descriptive study was carried out among 400 students (266 women and 134 men) in their third year of medicine studies between 2016 and 2019. The practises consisted of 11 hours of teaching, made of theory introduction, and exercise work in groups of 15-20 students on 4 workstations: LapSim, Pelvitrainer, Transanal Endoscopic Surgery (singleport) and Flexible Endoscopy. The execution time per individual exercise and in pairs is collected.

RESULTS
Individual exercises: the average execution time was: 277.0±117.8 sg, LapSim: 158.8± 66.44 sg and Pelvitrainer: 123.6±82.7sg. Couple exercises: the average execution time in Transanal Endoscopic Surgery was: 79.4±51.9 sg and Flexible Endoscopy: 53.56±34.4 sg. The analysis by gender showed that men performed better in LapSim with an average of 141.4 sg ± 52.2 in respect to women, 167.8 sg ± 71.1 (p &lt; 0.05). In the rest of the exercises, no significant differences were shown.

CONCLUSIONS
Conducting simulated practises or studies for further development in the Degree is feasible, with objective evaluations of the skills acquired. The possibility of interacting in a controlled environment and with immediate feedback has made it possible to identify baseline differences by gender only in virtual simulation.
CHRONIC POSTOPERATIVE PAIN AFTER ANTERIOR INGUINAL HERNIA REPAIR
Authors: Arango Bravo A , Sosa Rodríguez V , Pérez Prudencio E , Soto Dopazo M , Nuño Iglesias C , Mateos Palacio C , Vazquez Presa E Mª , López-Mosquera Bayón E 
Published: May 2021

Abstract

INTRODUCTION
Chronic postoperative pain after inguinal hernia repair is one of the most prevalent sequel after inguinal hernioplasty.

MATERIAL AND METHODS
A retrospective descriptive study was done, studying 414 patients who underwent programmed anterior inguinal hernioplasty in our centre between 01/01/18 and 12/31/19. Laterality, the type of mesh used and fixation method are studied, as well as the appearance of early postoperative pain, at one month and after the third month. P &lt; 0.05 is considered a statistically significant value.

RESULTS
Of 414 patients, 90.6% were male, with a mean age of 65.5 years. In 89.1% the surgery was unilateral and 8.7% was hernia recurrence. 46.1% presented pre-surgical pain. 10.4% presented pain in the first check-up and 1.9% chronic pain. In 81.4%, flat mesh was placed, fixing it with suture in 83.6%. Greater pain was observed in the first review in patients operated on for bilateral hernia (22%, p 0.006). No differences were found regarding age, sex or recurrent hernias. In bilateral hernias, recurrent hernias and hernioplasty with plug, more postoperative complications were observed with a p &lt; 0.05. In those patients who present complications, postoperative pain was observed in the first review in 16% (p &lt; 0,05).

CONCLUSIONS
Patients who underwent bilateral hernioplasty present more complications and greater postoperative pain in the first revision, but not after the third postoperative month. No differences were observed in chronic pain in primary vs recurrent hernias. Post-surgical complications are related to greater initial postoperative pain but not to chronic pain.
USEFULNESS OF BIODEGRADABLE STENT IN THE PREVENTION OF PANCREATIC FISTULA AFTER PANCREATIC SURGERY
Authors: Ferreras Martínez D , Gil Vázquez P , Egea Valenzuela J , Alberca de Las Parras F , Sánchez-Bueno F 
Published: May 2021

Abstract

INTRODUCTION
Postoperative pancreatic fistula (POPF) remains the most important cause of morbidity after cephalic pancreaticoduodenectomy (PD), affecting up to one third of cases.
The aim of this paper is to present a prospective single-center study with 16 patients undergoing PD in whom a biodegradable stent was placed, analyzing morbidity and mortality, the presence of POPF and the correct position and degradation time of the stent.

MATERIAL Y METHODS
A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (“Archimedes”, amg International GmbH, Germany) was placed from the pancreatic duct to the jejunum (Figure 1). The stent has a helical shape that facilitates the flow of pancreatic juice. POPF was defined as drainage fluid amylase value of &gt; 5000 U/L on the first day after surgery.

RESULTS
Only one patient developed POPF in the postoperative period and it was successfully treated with interventional radiology drainage and somatostatin analogues. There was no mortality at 30 days after PD. An abdominal radiograph was performed to asses well-positioning of the stent on postoperative day 7. To evaluate the degradation after three months we used the CT scan. A complete degradation was defined as &lt; 25% of stent length or stent fragments visible at CT. Completed degradation occurred after 3 months in all cases.

CONCLUSION
The use of resorbable internal pancreatic stent could be a valid alternative to prevent the development of pancreatic fistula after a pancreaticoduodenectomy.
Brain Dynamics Underlying Cognitive Flexibility Across the Lifespan
Authors: Kupis Lauren , Goodman Zachary T , Kornfeld Salome , Hoang Stephanie , Romero Celia , Dirks Bryce , Dehoney Joseph , Chang Catie , Spreng R Nathan , Nomi Jason S , Uddin Lucina Q 
Published: May 2021

Abstract
The neural mechanisms contributing to flexible cognition and behavior and how they change with development and aging are incompletely understood. The current study explored intrinsic brain dynamics across the lifespan using resting-state fMRI data (n = 601, 6–85 years) and examined the interactions between age and brain dynamics among three neurocognitive networks (midcingulo-insular network, M-CIN; medial frontoparietal network, M-FPN; and lateral frontoparietal network, L-FPN) in relation to behavioral measures of cognitive flexibility. Hierarchical multiple regression analysis revealed brain dynamics among a brain state characterized by co-activation of the L-FPN and M-FPN, and brain state transitions, moderated the relationship between quadratic effects of age and cognitive flexibility as measured by scores on the Delis-Kaplan Executive Function System (D-KEFS) test. Furthermore, simple slope analyses of significant interactions revealed children and older adults were more likely to exhibit brain dynamic patterns associated with poorer cognitive flexibility compared with younger adults. Our findings link changes in cognitive flexibility observed with age with the underlying brain dynamics supporting these changes. Preventative and intervention measures should prioritize targeting these networks with cognitive flexibility training to promote optimal outcomes across the lifespan.
Greater Neural Differentiation in the Ventral Visual Cortex Is Associated with Youthful Memory in Superaging
Authors: Katsumi Yuta , Andreano Joseph M , Barrett Lisa Feldman , Dickerson Bradford C , Touroutoglou Alexandra 
Published: May 2021

Abstract
Superagers are older adults who maintain youthful memory despite advanced age. Previous studies showed that superagers exhibit greater structural and intrinsic functional brain integrity, which contribute to their youthful memory. However, no studies, to date, have examined brain activity as superagers learn and remember novel information. Here, we analyzed functional magnetic resonance imaging data collected from 41 young and 40 older adults while they performed a paired associate visual recognition memory task. Superaging was defined as youthful performance on the long delay free recall of the California Verbal Learning Test. We assessed the fidelity of neural representations as participants encoded and later retrieved a series of word stimuli paired with a face or a scene image. Superagers, like young adults, exhibited more distinct neural representations in the fusiform gyrus and parahippocampal gyrus while viewing visual stimuli belonging to different categories (greater neural differentiation) and more similar category representations between encoding and retrieval (greater neural reinstatement), compared with typical older adults. Greater neural differentiation and reinstatement were associated with superior memory performance in all older adults. Given that the fidelity of cortical sensory processing depends on neural plasticity and is trainable, these mechanisms may be potential biomarkers for future interventions to promote successful aging.
Impact of Oral Metronidazole, Vancomycin, and Fidaxomicin on Host Shedding and Environmental Contamination With Clostridioides difficile
Authors: Turner Nicholas A , Warren Bobby G , Gergen-Teague Maria F , Addison Rachel M , Addison Bechtler , Rutala William A , Weber David J , Sexton Daniel J , Anderson Deverick J 
Published: May 2021

Abstract

Background
Shedding of Clostridioides difficile spores from infected individuals contaminates the hospital environment and contributes to infection transmission. We assessed whether antibiotic selection affects C. difficile shedding and contamination of the hospital environment.

Methods
In this prospective, unblinded, randomized controlled trial of hospitalized adults with C. difficile infection, patients were randomized 1:1:1 to receive fidaxomicin, oral vancomycin, or metronidazole. The primary outcome was change in environmental contamination rate during treatment. Secondary outcomes included stool shedding, total burden of contamination, and molecular relatedness of stool versus environmental C. difficile isolates.

Results
Of 33 patients enrolled, 31 (94%) completed the study. Fidaxomicin (−0.36 log10 colony-forming units [CFUs]/d [95% confidence interval (CI), −.52 to −.19]; P &lt; .01) and vancomycin (−0.17 log10 CFUs/d [−.34 to −.01]; P = .05) were associated with more rapid decline in C. difficile shedding than metronidazole (−0.01 log10 CFUs/d [95% CI, −.10 to .08). Both vancomycin (6.3% [95% CI, 4.7–8.3) and fidaxomicin (13.1% [10.7–15.9]) were associated with lower rates of environmental contamination than metronidazole (21.4% [18.0–25.2]). With specific modeling of within-subject change over time, fidaxomicin (adjusted odds ratio, 0.83 [95% CI, .70–.99]; P = .04) was associated with more rapid decline in environmental contamination than vancomycin or metronidazole. Overall, 207 of 233 environmental C. difficile isolates (88.8%) matched patient stool isolates by ribotyping, without significant difference by treatment.

Conclusions
Fidaxomicin, and to a lesser extent vancomycin, reduces C. difficile shedding and contamination of the hospital environment relative to metronidazole. Treatment choice may play a role in reducing healthcare-associated C. difficile transmission.

Clinical Trials Registration
NCT02057198.
Genetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States
Authors: Azar Marwan M , Cohen Elizabeth , Ma Liang , Cissé Ousmane H , Gan Geliang , Deng Yanhong , Belfield Kristen , Asch William , Grant Matthew , Gleeson Shana , Koff Alan , Gaston David C , Topal Jeffrey , Curran Shelly , Kulkarni Sanjay , Kovacs Joseph A , Malinis Maricar 
Published: May 2021

Abstract

Background
Pneumocystis jirovecii is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised hosts. Over an 11-month period, we observed a rise in cases of PCP among kidney-transplant recipients (KTR), prompting an outbreak investigation.

Methods
Clinical and epidemiologic data were collected for KTR diagnosed with PCP between July 2019 and May 2020. Pneumocystis strain typing was performed using restriction fragment length polymorphism analyses and multilocus sequence typing in combination with next-generation sequencing. A transmission map was drawn, and a case-control analysis was performed to determine risk factors associated with PCP.

Results
Nineteen cases of PCP in KTR were diagnosed at a median of 79 months post-transplantation; 8 received monthly belatacept infusions. Baseline characteristics were similar for KTR on belatacept versus other regimens; the number of clinic visits was numerically higher for the belatacept group during the study period (median 7.5 vs 3). Molecular typing of respiratory specimens from 9 patients revealed coinfection with up to 7 P. jirovecii strains per patient. A transmission map suggested multiple clusters of interhuman transmission. In a case-control univariate analysis, belatacept, lower absolute lymphocyte count, non-White race, and more transplant clinic visits were associated with an increased risk of PCP. In multivariate and prediction power estimate analyses, frequent clinic visits was the strongest risk factor for PCP.

Conclusions
Increased clinic exposure appeared to facilitate multiple clusters of nosocomial PCP transmission among KTR. Belatacept was a risk factor for PCP, possibly by increasing clinic exposure through the need for frequent visits for monthly infusions.
Understanding the genetics of adult-onset dilated cardiomyopathy: what a clinician needs to know
Authors: Tayal Upasana , Ware James S , Lakdawala Neal K , Heymans Stephane , Prasad Sanjay K 
Published: May 2021

Abstract
There is increasing understanding of the genetic basis to dilated cardiomyopathy and in this review, we offer a practical primer for the practising clinician. We aim to help all clinicians involved in the care of patients with dilated cardiomyopathy to understand the clinical relevance of the genetic basis of dilated cardiomyopathy, introduce key genetic concepts, explain which patients and families may benefit from genetic testing, which genetic tests are commonly performed, how to interpret genetic results, and the clinical applications of results. We conclude by reviewing areas for future research in this dynamic field.
Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans
Authors: George Kristen M , Gilsanz Paola , Peterson Rachel L , Barnes Lisa L , DeCarli Charles S , Mayeda Elizabeth Rose , Mungas Dan M , Whitmer Rachel A 
Published: May 2021

Abstract

Background
Midlife cardiovascular risk factors (CVRFs) increase risk of dementia. Black Americans experience an elevated prevalence of CVRFs and dementia. However, little is known of how CVRFs prior to midlife affect late-life cognition. We examined CVRFs in adolescence, young adulthood, and midlife with late-life cognition in the Study of Healthy Aging in African Americans (STAR).

Method
STAR assesses cognitive aging among 764 Black Americans aged ≥50 (mean age = 69; SD = 9; range = 53–95). Participants’ body mass index, blood pressure, glucose, and total cholesterol were collected during Multiphasic Health Checkups (MHC; 1964–1985). At STAR baseline (2018–2019), executive function, verbal episodic memory, and semantic memory were measured using the Spanish and English Neuropsychological Assessment Scales. Linear regression models examined associations between CVRFs and cognition adjusting for demographics and years since MHC.

Results
At MHC, 36% of participants had 1 CVRF and 26% had ≥2. Twenty-two percent of participants were adolescents (age 12–20), 62% young adults (age 21–34), and 16% midlife adults (age 35–56). Overweight/obesity was not associated with cognition. Hypertension was associated with worse executive function (β [95% CI]: −0.14 [−0.28, −0.0003]) and verbal episodic memory (β [95% CI]: −0.22 [−0.37, −0.07]) compared to normotension. Diabetes was associated with worse executive function (β [95% CI]: −0.43 [−0.83, −0.03]). Having ≥2 CVRFs (vs 0) was associated with worse executive function (β [95% CI]: −0.19 [−0.34, −0.03]) and verbal episodic memory (β [95% CI]: −0.25 [−0.41, −0.08]). Adolescents with hypertension had lower late-life executive function compared to normotensive adolescents (β [95% CI]: −0.39 [−0.67, −0.11]). Young adulthood hypertension (β [95% CI]: −0.29 [−0.49, −0.09]) and midlife hyperlipidemia (β [95% CI]: −0.386 [−0.70, −0.02]) were associated with lower verbal episodic memory.

Conclusions
Among Black Americans, life-course CVRFs were associated with poorer executive function and verbal episodic memory emphasizing the importance of cardiovascular health on the aging brain.
Responsibility-sharing for pets in disasters: lessons for One Health promotion arising from disaster management challenges
Authors: Travers Cheryl , Rock Melanie , Degeling Chris 
Published: May 2021

Summary
During disasters, the behaviour of pet owners and of pets themselves may compromise the ability of emergency responders to perform their duties safely. Furthermore, pet loss can have deleterious effects on personal and community recovery. To explore these issues and their implications for health promotion and disaster management practice, we conducted semi-structured interviews with 27 emergency responders in Australia, where disaster policy embraces shared responsibility yet does not acknowledge pets. We found that responders commit to being responsible for protecting human lives, especially members of their teams. Frontline emergency responders did not regard pets as their responsibility, yet decisions made with tragic consequences for pets exacted an emotional toll. Emergency managers consider community education as a pivotal strategy to support building people’s capacity to reduce their own risk in disasters. While important, we question whether this is sufficient given that human life is lived in more-than-human contexts. Reformulating the parameters of the Ottawa Charter for Health Promotion as ‘One Health Promotion’ may help to account for the intermeshed lives of people and pets, while acknowledging human priority in public policy and programming. To acknowledge the influence of people’s pets in disaster responses and recovery, we recommend five overlapping spheres of action: (i) integrate pets into disaster management practice and policy; (ii) create pet-friendly environments and related policies; (iii) engage community action in disaster management planning; (iv) develop personal skills by engaging owners in capacity building and (v) reorient health and emergency services toward a more-than-human approach.
A design of low-carbon architecture near water under self-circulation system using dead water effect
Authors: Li Yangluxi , Chen Lei 
Published: May 2021

Abstract
The purpose of this research is to design a self-circulation residence near Greenland using fully renewable energy and dead water effect. Special values in terms of commercial for Greenland lead to the increase of local population. Previous investigations mainly study the particular dead water effect phenomenon neglecting the utilization of this influence, which may provide energy for local residence. This research implements electromagnetic induction to design a power generation equipment and self-circulation system. Final results show that the designed device could successfully produce power using dead water effect occurring in Greenland. In addition, a building utilizing self-circulation system is also devised to achieve energy circulation. In conclusion, dead water effect could be used to generate electricity and some special places have the potential to realize energy circulation.
Human Papillomavirus Vaccines
Authors: Markowitz Lauri E , Schiller John T 
Published: May 2021

Abstract
Human papillomavirus (HPV) vaccines are among the most effective vaccines available, the first to prevent infection by a mucosatropic sexually transmitted infectious agent and to do so without specific induction of mucosal immunity. Currently available prophylactic HPV vaccines are based on virus-like particles that self-assemble spontaneously from the L1 major capsid protein. The first HPV vaccine was licensed in 2006. All vaccines target HPV-16 and HPV-18, types which cause the majority of HPV-attributable cancers. As of 2020, HPV vaccines had been introduced into national immunization programs in more than 100 countries. Vaccination polices have evolved; most programs target vaccination of young adolescent girls, with an increasing number also including boys. The efficacy and safety found in prelicensure trials have been confirmed by data from national immunization programs. The dramatic impact and effectiveness observed has stimulated interest in ambitious disease reduction goals.
Why the Sublime Is Aesthetic Awe
Authors: Clewis Robert R 
Published: May 2021

Abstract
This article focuses on the conceptual relationship between awe and the experience of the sublime. I argue that the experience of the sublime is best conceived as a species of awe, namely, as aesthetic awe. I support this conclusion by considering the prominent conceptual relations between awe and the experience of the sublime, showing that all of the options except the proposed one suffer from serious shortcomings. In maintaining that the experience of the sublime is best conceived as aesthetic awe, I draw from historical theories of the sublime as well as recent work in empirical psychology.
Evaluating Commutability of Control Materials in Three Nordic External Quality Assessment Schemes for Lipoproteins
Authors: Norling Anna , Bökman C Fredrik , Göransson Emma , Wande Birgitta , Pedersen Morten M , Berghäll Heidi , Svala Emilia 
Published: May 2021

Abstract

Background
The quality of control materials is crucial for evaluating external quality assessment (EQA) results. To detect method differences, the EQA material should behave the same as a patient sample, meaning the material must be commutable. Noncommutable materials may cause misinterpretations of EQA results. Here, we examined the commutability of EQA materials used in 3 Nordic EQA schemes for lipids.

Methods
The study was designed according to the procedures recommended for assessing commutability by the International Federation of Clinical Chemistry and Laboratory Medicine. Commutability was assessed based on the difference in bias between a control material (CM) and clinical samples (CS) consisting of human plasma using 2 different measurement procedures (MPs). Measurands: LDL-cholesterol (LDL-C), total cholesterol (TC), HDL-cholesterol (HDL-C), and triglycerides (TG). Four CMs (CM1–4) were assessed for commutability by using 40 CS and 3 MPs (Abbott Architect, Roche Cobas, and Siemens Atellica).

Results
Unmodified native CMs (CM1 and CM3), stored at −80 °C, were commutable for all included measurands, except for LDL-C that was indeterminate, when comparing MPs pairwise. Modified CM2 was noncommutable for HDL-C, LDL-C, non-HDL-C, and LDL-C calculations. Unmodified native CM4, stored at −20°C, was noncommutable for LDL-C.

Conclusions
Unmodified serum samples stored at −80 °C were commutable for lipids on the evaluated MPs, and therefore suitable as CMs in EQA schemes. Moreover, the study demonstrated that minor modifications of samples may lead to noncommutability.