bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leadership development for orthopaedic trauma surgeons in Latin America: opportunities for and barriers to skill acquisition
Authors: MacKechnie Madeline C. , MacKechnie Michael A. , Lieshout Esther M.M. van , Verhofstad Michael H.J. , Quintero Jose Eduardo , Padilla Rojas Luis G. , Tabares Neyra Horacio , Russo Bibiana Dello , Giordano Vincenzo , Vilensky Eduardo , Fuehrer Sheryl L. , Miclau Theodore 
Published: October 2021

Abstract

Introduction:
There is growing interest in leadership courses for physicians. Few opportunities are available in global regions with limited resources. This study describes orthopaedic trauma surgeons’ desired leadership skill acquisition, opportunities, and barriers to course participation in Latin America.

Methods:
Latin American orthopaedic trauma surgeons from the Asociación de Cirujanos Traumatólogos de las Americas (ACTUAR) network were surveyed. This survey solicited and gauged the surgeons’ level of interest in leadership topics and their relative importance utilizing a 5-point Likert-scale. Additionally, comparisons were calculated between middle-income countries (MICs) and high-income countries (HICs) to ascertain if needs were different between groups. The survey included demographic information, nationality, level of training, years in practice, leadership position, needs assessment, and perceived barriers for leadership educational opportunities.

Results:
One hundred forty-four orthopaedic surgeons completed the survey, representing 18 countries across Latin America; 15 MICs and 3 HICs. Participants had more than 20 years in practice (49%) and held leadership positions (81%) in hospital settings (62%), national orthopaedic societies (45%), and/or clinical settings (40%). Sixty-three percent had never attended a leadership course due to lack of opportunities/invitations (69%), difficulty missing work (24%), and costs (21%). Ninety-seven percent expressed interest in attending a leadership course. No difference in needs was determined between respondents from MICs and HICs. Professional Ethics, Crisis Management/Organizational Change Management, and High Performing Team-Building were identified as the most important leadership topics.

Conclusion:
Orthopaedic surgeons in Latin America demonstrate an interest in acquiring additional leadership skills but have few opportunities. Identifying interests, knowledge gaps, and core competencies can guide the development of such opportunities.
“Palliative Syringe Driver”? A Mixed-Methods Study in Different Hospital Departments on Continuous Infusions of Sedatives and/or Opioids in End-of-Life Care
Authors: Meesters Sophie , Grüne Bettina , Bausewein Claudia , Schildmann Eva 
Published: October 2021

Objectives
Continuous infusions of sedatives and/or opioids (continuous infusions) are frequently used in end-of-life care. Available data indicate challenges in nonspecialist palliative care settings. We aimed to assess the use of continuous infusions during the last week of life in different hospital departments.

Methods
In a sequential mixed-methods design, a retrospective cohort study was followed by consecutive qualitative interviews in 5 German hospital departments. Medical records of 517 patients who died from January 2015 to December 2017 were used, and 25 interviews with physicians and nurses were conducted. Recorded sedatives were those recommended in guidelines for “palliative sedation”: benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. Exploratory statistical analysis (R 3.6.1.) and framework analysis of interviews (MAXQDA 2018.2) were performed.

Results
During the last week of life, 359 of 517 deceased patients (69%) received continuous infusions. Some interviewees reported that continuous infusions are a kind of standard procedure for “palliative” patients. According to our interviewees’ views, equating palliative care with continuous infusion therapy, insufficient experience regarding symptom control, and fewer care needs may contribute to this approach. In addition, interviewees reported that continuous infusions may be seen as an “overall-concept” for multiple symptoms. Medical record review demonstrated lack of a documented indication for 80 of 359 patients (22%). Some nurses experienced concerns or hesitations among physicians regarding the prescription of continuous infusions.

Conclusions
Continuous infusions seem to be common practice. Lack of documented indications and concerns regarding the handling and perception of a “standard procedure” in these highly individual care situations emphasize the need for further exploration and support to ensure high quality of care.
Eight-Year Trends in Direct-Acting Oral Anticoagulant Dosing, Based on Age and Kidney Function, in Patients With Atrial Fibrillation
Authors: Bezabhe Woldesellassie M. , Bereznicki Luke R. , Radford Jan , Wimmer Barbara C. , Salahudeen Mohammed S. , Peterson Gregory M. 
Published: October 2021

Objective
Concerns have been raised over the appropriateness of dosing of direct-acting oral anticoagulants (DOACs) in clinical practice. We investigated this issue in patients who were initiated on a DOAC in Australian general practices.

Methods
This was a retrospective study among patients newly diagnosed with atrial fibrillation (AF) who were prescribed DOACs, using data obtained from 417 general practice sites across Australia over 8 years (2011–2019). Direct-acting oral anticoagulant dosing was compared with published recommendations, in relation to age and kidney function.

Results
A total of 11,251 patients (mean age, 72.8 y; 46.8% female) newly diagnosed with AF were prescribed a DOAC. Of these, 2667 patients (23.7%) had a recorded prescription of a potentially inappropriate DOAC dosage, of whom 2304 (86.4%) and 283 (10.6%) were prescribed lower and higher than the recommended dosage, respectively. The remaining 80 patients (3.0%) were initiated on DOACs when contraindicated based on renal function. Overall, the proportion of patients who seemed to be initiated on a potentially inappropriate DOAC dose decreased from 38.3% (95% confidence interval, 26.1%–51.8%) in 2012 to 22.7% (95% confidence interval, 19.8%–26.0%; P < 0.001) in 2019. By 2019, 19.4%, 20.3%, and 9.3% of the patients with a recorded prescription of apixaban, rivaroxaban, and dabigatran, respectively, received a lower-than-guideline-recommended dose. The patients were more likely to be prescribed a potentially inappropriate dosage if they were elderly with multiple comorbidities.

Conclusions
Potential inappropriate DOAC dosing is a problem in the prevention of stroke associated with AF. Nearly 1 in 5 patients received a lower-than-guideline-recommended dose, indicating a need for strategies to raise awareness among prescribers.
Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review
Authors: Driesen Babiche E.J.M. , Baartmans Mees , Merten Hanneke , Otten René , Walker Camilla , Nanayakkara Prabath W.B. , Wagner Cordula 
Published: October 2021

Objectives
Unintended events (UEs) are prevalent in healthcare facilities, and learning from them is key to improve patient safety. The Prevention and Recovery Information System for Monitoring and Analysis (PRISMA)-method is a root cause analysis method used in healthcare facilities. The aims of this systematic review are to map the use of the PRISMA-method in healthcare facilities worldwide, to assess the insights that the PRISMA-method offers, and to propose recommendations to increase its usability in healthcare facilities.

Methods
PubMed, EMBASE.com, CINAHL, and The Cochrane Library were systematically searched from inception to February 26, 2020. Studies were included if the PRISMA-method for analyzing UEs was applied in healthcare facilities. A quality appraisal was performed, and relevant data based on an appraisal checklist were extracted.

Results
The search provided 2773 references, of which 25 articles reporting 10,816 UEs met our inclusion criteria. The most frequently identified root causes were human-related, followed by organizational factors. Most studies took place in the Netherlands (n = 20), and the sample size ranged from 1 to 2028 UEs. The study setting and collected data used for PRISMA varied widely. The PRISMA-method performed by multiple persons resulted in more root causes per event.

Conclusions
To better understand UEs in healthcare facilities and formulate optimal countermeasures, our recommendations to further improve the PRISMA-method mainly focus on combining information from patient files and reports with interviews, including multiple PRISMA-trained researchers in an analysis, and modify the Eindhoven Classification Model if needed.
Fast Quantitative Low-Field Magnetic Resonance Imaging With OPTIMUM—Optimized Magnetic Resonance Fingerprinting Using a Stationary Steady-State Cartesian Approach and Accelerated Acquisition Schedules
Authors: Sarracanie Mathieu 
Published: October 2021

Objective
The aim of the proposed work is to develop model-based, fast multiparametric magnetic resonance imaging (MRI) in field regimes where signal-to-noise ratio is poor, such as encountered at low-field and in low γ nuclei.

Materials and Methods
A custom, optimized MRI pipeline was developed at low field (0.1 T) that relies on the magnetic resonance fingerprinting framework, called OPTIMUM. An optimization algorithm was used to select a short acquisition schedule (n = 18 images) that favors maximal discrimination across varying magnetic properties (T
1, T
2) and off-resonance effects while maintaining high transverse magnetization at the steady state. In the presented study, a stationary balanced steady-state approach was investigated that allows for Cartesian (used here) and non-Cartesian acquisition schemes. Images were collected in calibrated samples containing different concentrations of manganese(II) chloride (MnCl2) in deionized water and compared with gold standard techniques (ie, inversion recovery for T
1, Carr-Purcell-Meiboom-Gill for T
2). Images were then collected in vivo in the human hand and wrist.

Results
OPTIMUM successfully provided sets of quantified maps (T
1, T
2, T
2*, M
0, ΔB
0, B
1

+
) in calibrated samples and in vivo in the human hand and wrist in 3 dimensions, in ~8.5 minutes, with a voxel resolution of [1.5 ×1.5 × 6.5] mm3. Relaxation parameters (T
1, T
2) scale linearly with [MnCl2] and are in good agreement with the calibrations performed for T
1, with a consistent trend to underestimate T
2.

Conclusion
We show that low-field MRI can benefit from innovative multiparametric approaches to gain speed and become realistic in clinical environments. For the first time, we report simultaneous, multiparametric imaging (6 quantitative maps) in 3 dimensions, in vivo in the human hand and wrist, obtained in just 8.5 minutes. It is sometimes overlooked that low magnetic fields provide higher dispersion of nuclear spin relaxation rates. Rapid quantification such as offered by OPTIMUM could be an enabling technology to explore new metrics and contrasts in point-of-care MRI diagnosis, making it an important step toward broad democratization.
Intracavernous Schwannoma Characterized With 18F-FDG, 68Ga-DOTATOC, and 18F-Choline PET
Authors: Farce Julien , Lecouillard Isabelle , Carsin Nicol Béatrice , Bretonnier Maxime , Girard Antoine 
Published: October 2021

Abstract
We report the case of a 75-year-old man with history of prostate cancer whose left intracavernous lesion was successfully characterized by 3 PETs performed successively with different tracers. This poorly characterized tumor was initially discovered on an MRI conducted to investigate an acute diplopia and slowly growing during follow-up. On 18F-FDG PET, the lesion showed no significant uptake, and no extracranial lesion was found nor did it have increased 68Ga-DOTATOC uptake. Finally, this tumor displayed a high 18F-choline uptake, and no extracranial lesion was revealed with this tracer. The diagnosis of schwannoma without malignancy criterion was proven by biopsy.
Sagittal Cephalometric Evaluation Without Point Nasion: Sagittal G-Triangle Analysis
Authors: Li Boxiu , Zhang Zhuomin , Lin Xinping , Dong Yan 
Published: October 2021

Abstract
This study aims to introduce a new sagittal cephalometric measurement, the sagittal G-triangle analysis, to accurately and reproducibly assess the sagittal jaw relationship. Sagittal G-triangle analysis, which consists of angles AXK and BXK, is based on an equilateral triangle (Bo–X–K) constructed using 5 cephalometric landmarks (Ba, Bo, Po, Or, and G). To test the diagnostic efficiency of this analysis, pretreatment cephalometric radiographs of 120 female and 120 male Chinese patients were randomly selected. For each enlisted subject, angles SNA and SNB as well as angles AXK and BXK were measured and recorded. On the basis of the SNA and SNB results, subjects were categorized into 6 groups: maxillary retrognathism, normal maxilla, maxillary prognathism, mandibular retrognathism, normal mandible, and mandibular prognathism. The diagnostic efficiency of angles AXK and BXK were evaluated using various statistical tests. A high correlation was detected between angles SNA and AXK as well as between angles SNB and BXK. Female patients with angle AXK between −2.255° and 2.860° and male patients with angle AXK between −2.615° and 2.120° were considered to have a normal maxilla position. Female patients with angle BXK between −2.61° and 2.93° and male patients with angle BXK between −2.275° and 0.610° were considered to have a normal mandible position. In conclusion, sagittal G-triangle analysis could be used as an alternative method for the evaluation of the sagittal position of the maxilla and mandible in cephalometric analysis.
SARS-CoV-2 variant transmission in a community-health population (Mexico City, Mexico)
Authors: Zhang Wenjuan , Martinez Marcela , Davis Brian D , Chen Stephanie S , Martinez Jorge Sincuir , Corona Clara , Diaz Guadalupe , Makhoul Elias , Heneidi Saleh , Goldberg Jorge , Plummer Jasmine T , Vail Eric 
Published: October 2021

AbstractThe SARS-CoV-2 variant, B.1.1.519, arose in North and Central America, circulating primarily in Mexico. We demonstrate that this variant peaked during the second wave of COVID-19 in Mexico City in the spring of 2021. This variant is likely more infectious, attributed to mutation in the RBD of the spike protein T478K also seen in the alpha variant (B.1.1.7). However the time dynamics of the spread of this variant drastically changed upon the introduction of delta (B.1.617.2) to the country in which we observe a shift from 0% in May 2021 to 55% delta in the span of one month. Since the delta variant has dominantly spread across the globe, we investigated the increasing frequency of the Mexico variant, B.1.1.519, in the public community within Mexico City. Once present, the delta variant was 78% of the Mexico City catchment in July 2021, a time which marked the commencement of Mexico’s third wave. Our data supports the growing concern that the delta variant is closely associated with the massive infection spread of the VOC in Central and South America. While the T478K mutation, also seen in the alpha variant, has evidence for increased transmissibility, these data suggest that the delta variant shows overall increased fitness seeing as it outcompeted the B.1.1519 this Mexico community.
Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a multilevel analysis
Authors: Hussien Mohammed , Azage Muluken , Bayou Negalign Berhanu 
Published: October 2021

ABSTRACTObjectivesThe purpose of this study was to examine how clients perceived about the quality of health care they received and to identify associated factors at the individual and facility-level.DesignA community-based, cross-sectional studySettingHealth centers in two districtsParticipants1081 rural households who had ever been enrolled in a community-based health insurance and had visited a health center at least once in the previous 12 months, as well as 194 health care providers working in 12 health centers.Outcome measuresThe outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with health care in the outpatient departments of nearby health centers. A multilevel linear regression analysis was used to identify predictors of perceived quality of care.ResultsThe mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness, time to a recent health center visit, work experience of health care providers and patient volume were the factors significantly associated with perceived quality of care. An interaction term between patient volume and staff job satisfaction also showed significant association.ConclusionsMuch work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimize the patient-provider ratio, and enhance staff job satisfaction.Strengths and limitations of this study▸The study tried to assess the quality of care from the clients’ point of view using a validated multidimensional scale.▸This is the first cross-sectional study in Ethiopia, which considered health center (cluster) level variables that have association with perceived quality of care.▸We tested for the existence of endogeneity between current insurance status and quality of care. Although the results indicated no evidence of endogeneity, it is still possible due to omitted variables. Active insurance members may report a higher perception score quality of care as a result of their desire to stay in the scheme.▸Because of the cross-sectional nature of the study, it is impossible to establish a cause- and-effect relationship.
Transcriptome data from human nasal epithelial cells infected by H3N2 influenza virus indicate early unbalanced ROS/RNA levels, temporarily increased aerobic fermentation linked to enhanced α-tubulin and rapid energy-dependent IRF9-marked immunization
Authors: Costa José Hélio , Aziz Shahid , Noceda Carlos , Arnholdt-Schmitt Birgit 
Published: October 2021

AbstractBackgroundTranscriptome studies of a selected gene set (ReprogVirus) had identified unbalanced ROS/RNS levels, which connected to increased aerobic fermentation that linked to alpha-tubulin-based cell restructuration and cell cycle control, as a major complex trait for early de novo programming (CoV-MAC-TED) upon SARS-CoV-2 infection. Recently, CoV-MAC-TED was confirmed as promising marker by using primary target human nasal epithelial cells (NECs) infected by two SARS-CoV-2 variants with different effects on disease severity. To further explore this marker/cell system as a standardized tool for identifying anti-viral targets in general, testing of further virus types is required. Results: Transcriptome level profiles of H3N2 influenza-infected NECs indicated ROS/RNS level changes and increased transcript accumulation of genes related to glycolysis, lactic fermentation and α-tubulin at 8 hours post infection. These early changes linked to energy-dependent, IRF9-marked rapid immunization. However, ReprogVirus-marker genes indicated the absence of initial cell cycle progress, which contrasted our findings during infections with two SARS-CoV-2 variants, where cell cycle progress was linked to delayed IRF9 response. Our results point to the possibility of CoV-MAC-TED-assisted, rapid individual host cell response identification upon virus infections. Conclusion: The complex trait CoV-MAC-TED can identify similar and differential early responses of SARS-CoV-2 and influenza H3N2 viruses. This indicates its appropriateness to search for anti-viral targets in view of therapeutic design strategies. For standardization, human NECs can be used. This marker/cell system is promising to identify differential early cell responses upon viral infections also depending on cell origins.
Ochratoxin A induces behavioral and neurochemical changes in adult zebrafish
Authors: Valadas Jéssica , Sachett Adrieli , Marcon Matheus , Bastos Leonardo M. , Piato Angelo 
Published: October 2021

ABSTRACTOchratoxin A (OTA) is a mycotoxin produced by species of filamentous fungi widely found as a contaminant in food and with high toxic potential. Studies have shown that this toxin cause kidney and liver damage, however, data on the effects of exposure to OTA on the central nervous system are still scarce. Zebrafish (Danio rerio) is a teleost often used in translational research due to its physiological, genetic, and behavioral homology with mammals, in addition to being useful as an environmental bioindicator. Thus, this study aimed to investigate the effects of exposure to OTA on behavioral and neurochemical parameters in adult zebrafish. The animals were treated with different doses of OTA (1.38, 2.77, and 5.53 mg/kg) and submitted to behavioral evaluations in the open tank and social interaction tests. Subsequently, they were euthanized, and the brains were used to assess markers associated with oxidative status. In the open tank test OTA induced changes in distance, absolute turn angle, mean speed, and time-freezing. However, no significant effects were observed in the social interaction test. Moreover, OTA also induced alterations in neurochemical parameters with changes in non-protein thiols (NPSH), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and glutathione reductase (GR). This study showed that OTA can affect neurobiological aspects in zebrafish even at low doses.
Functional connectome of arousal and motor brainstem nuclei in living humans by 7 Tesla resting-state fMRI
Authors: Singh Kavita , Cauzzo Simone , García-Gomar María Guadalupe , Stauder Matthew , Vanello Nicola , Passino Claudio , Bianciardi Marta 
Published: October 2021

AbstractBrainstem nuclei play a pivotal role in many functions, such as arousal and motor control. Nevertheless, the connectivity of arousal and motor brainstem nuclei is understudied in living humans due to the limited sensitivity and spatial resolution of conventional imaging, and to the lack of atlases of these deep tiny regions of the brain. For a holistic comprehension of sleep, arousal and associated motor processes, we investigated in 20 healthy subjects the resting-state functional connectivity of 18 arousal and motor brainstem nuclei in living humans. To do so, we used high spatial-resolution 7 Tesla resting-state fMRI, as well as a recently developed in-vivo probabilistic atlas of these nuclei in stereotactic space. Further, we verified the translatability of our brainstem connectome approach to conventional (e.g. 3 Tesla) fMRI. Arousal brainstem nuclei displayed high interconnectivity, as well as connectivity to the thalamus, hypothalamus, basal forebrain and frontal cortex, in line with animal studies and as expected for arousal regions. Motor brainstem nuclei showed expected connectivity to the cerebellum, basal ganglia and motor cortex, as well as high interconnectivity. Comparison of 3 Tesla to 7 Tesla connectivity results indicated good translatability of our brainstem connectome approach to conventional fMRI, especially for cortical and subcortical (non-brainstem) targets and to a lesser extent for brainstem targets. The functional connectome of 18 arousal and motor brainstem nuclei with the rest of the brain might provide a better understanding of arousal, sleep and accompanying motor function in living humans in health and disease.