bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Trans Enough”: Examining the Boundaries of Transgender-Identity Membership
Authors: Sutherland David Kyle 
Published: June 2021

AbstractThe term “transgender” (trans) has no singular or fixed meaning; instead, it represents a broad umbrella of non-traditional gender identities. Although the term is useful in the sense of inclusion, outsider recognition, and social activism, individuals and groups under the trans umbrella are not without internal ideological differences and contention about the boundaries of their collective identity. Taking a cyber-ethnographic approach with a transgender forum on the popular website Reddit, I offer insights into the complex membership debates that occur under this broad umbrella. In doing so, I present three distinct identity membership strategies, entitled “unbounded,” “socio-biological,” and “medically-based.” Each identity strategy showcases a mix of social and biological considerations that underlie trans-identity formations while highlighting differences in authenticity claims used within and between each group. My findings show a unique interplay between cultural definitions of trans-identities, lived experiences, and the explicit expulsion of some members in developing and maintaining internal symbolic boundaries of what constitutes a “trans enough” identity. More broadly, I generate new theoretical insights into the intracommunity “policing” strategies, shifting identity politics, and power dynamics that shape and inform interactions within the evolving category of transgender.
Pharmacokinetics, Metabolite Measurement, and Biomarker Identification of Dermal Exposure to Permethrin Using Accelerator Mass Spectrometry
Authors: Buchholz Bruce A , Ahn Ki Chang , Huang Huazhang , Gee Shirley J , Stewart Benjamin J , Ognibene Ted J , Hammock Bruce D 
Published: June 2021

Abstract
Impregnating military uniforms and outdoor clothing with the insecticide permethrin is an approach to reduce exposure to insect borne diseases and to repel pests and disease vectors such as mosquitos and sandflies, but the practice exposes wearers to prolonged dermal exposure to the pesticide. Key metabolite(s) from a low dose dermal exposure of permethrin were identified using accelerator mass spectrometry. Metabolite standards were synthesized and a high performance liquide chromatography (HPLC) elution protocol to separate individual metabolites in urine was developed. Six human subjects were exposed dermally on the forearm to 25 mg of permethrin containing 1.0 µCi of 14C for 8 h. Blood, saliva and urine samples were taken for 7d. Absorption/elimination rates and metabolite concentrations varied by individual. Average absorption was 0.2% of the dose. Serum concentrations rose until 12–24 h postdermal application then rapidly declined reaching predose levels by 72 h. Maximum saliva excretion occurred 6 h postdosing. The maximum urinary excretion rate occurred during 12–24 h; average elimination half-life was 56 h. 3-Phenoxybenzyl alcohol glucuronide was the most abundant metabolite identified when analyzing elution fractions, but most of the radioactivity was in still more polar fractions suggesting extensive degradative metabolism and for which there were no standards. Analyses of archived urine samples with the ultra performance liquid chromatography-accelerator mass spectrometry-mass spectrometry (UPLC-AMS-MS) system isolated a distinct polar metabolite but it was much diminished from the previous analyses a decade earlier.
Clinical Profile and Risk Factors for Severe Disease in 402 Children Hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID Study Group
Authors: Jat Kana Ram , Sankar Jhuma , Das Rashmi Ranjan , Ratageri Vinod H , Choudhary Bharat , Bhat Javeed Iqbal , Mishra Baijayantimala ,   Collaborative Indian Pediatric COVID study group:, Bhatnagar Sushma , Behera Bijayini , Charoo Bashir Ahmad , Goyal Jagdish P , Gupta Aditya Kumar , Gulla Krishna Mohan , Gera Rani , Illalu Shivanand , Kabra S K , Khera Daisy , Kumar Balbir , Lodha Rakesh , Mohan Anant , Mohanty Pankaj Kumar , Satapathy Amit Kumar , Singh Kuldeep , Singh Amitabh , Sharma Sumant Vinayak , Tiwari Pawan , Trikha Anjan , Wari Prakash K 
Published: June 2021

Abstract

Introduction
There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India.

Methods
In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome.

Results
We included 402 children with a median (IQR) age of 7 (2–11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease.

Conclusion
Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.
Prospective collection of clinical data on cystic echinococcosis: experience with the European Registry of Cystic Echinococcosis in Pavia, Italy
Authors: Vola Ambra , Mariconti Mara , Lissandrin Raffaella , Cuzzocrea Fabrizio , Bortolotto Chandra , Sammarchi Luigi , Vercelli Alessandro , Rinaldi Pietro , Maestri Marcello , Manciulli Tommaso , Brunetti Enrico 
Published: June 2021

Abstract

Background
Cystic echinococcosis (CE) is a chronic, complex and neglected infection that may cause serious disease in humans. Given its peculiar epidemiologic and clinical features, collection of clinical data is challenging. Notification systems, when available, fail to record important clinical features, available data are mostly retrospectively collected and no prospectively enrolled uniform surveillance systems exist. The European Register of Cystic Echinococcosis database (ERCE) is the first systematic attempt to address these issues.

Methods
Here, we describe the demographics and clinical characteristics of 436 patients who accessed the CE clinic at the University of Pavia–San Matteo Hospital Foundation, in Pavia, Italy, from March 2012 to February 2020.

Results
Overall, 436 patients, consisting of 204 (46.8%) males and 232 (53.2%) females were enrolled; the mean age at enrollment was 50 (range 4–88) y. Of the 436 patients, 248 (56.9%) were born in Italy while 188 (43.1%) were foreign-born. In total, 638 CE cysts were counted, most of them in the CE4 (230; 36.1%) and CE3b (131; 20.5%) stages.

Conclusions
This is the largest cohort of CE patients with detailed clinical and demographic data published to date. We strongly encourage colleagues caring for CE patients in the European Union to join the ERCE.
The endocannabinoid system, cannabis, and cannabidiol: Implications in urology and men's health
Authors: Capodice Jillian L. , Kaplan Steven A. 
Published: June 2021

Abstract

Background:
The endocannabinoid system is a neuromodulatory system responsible for partial regulation of cognitive and emotional processes in the human central nervous system such as behavior, mood disorders, and neurologic disorders such as epilepsy. The endocannabinoid system is also prevalent throughout the peripheral nervous system and human body and its receptors and signaling pathways are present and active in areas including the male and female reproductive tracts and organ systems such as the urologic and gastrointestinal system.

Summary:
The purpose of this article is to provide the reader with a brief background on the endocannabinoid system and to discuss the implications of the endocannabinoid system in urology as it applies to the male reproductive system, risk of urologic malignancy, and impact on the lower urinary tract, voiding, and urologic pain. It also summaries and discusses the epidemiology and research on cannabis and cannabidiol products.

Key message:
The endocannabinoid system affects the urologic and reproductive systems. Cannabis products and inhibitors targeting endocannabinoid pathways are being studied for their potential use as treatments for lower urinary tract symptoms and other urologic symptoms. Cannabis use adversely affects spermatogenesis and semen parameters and may be a risk factor for testicular germ cell tumors, however, it may be useful as a potential treatment for urologic symptoms. Cannabidiol products are popular in the consumer marketplace but there is still a paucity of scientific data on their potential medicinal use.
Pediatric Emergency Department Discharge Instructions for Spanish-Speaking Families
Authors: Isbey Sarah , Badolato Gia , Kline Jaclyn 
Published: June 2021

Objectives
Patients who speak Spanish are less likely to comply with discharge instructions, adhere to appointments, and take medications than English-speaking patients. However, adherence is improved when discharge instructions are provided in Spanish. This study was designed to assess the frequency of providing written discharge instructions in Spanish to patients who speak Spanish and request interpretation services, and to determine factors associated with receiving written discharge instructions in the preferred language in a pediatric emergency department (ED).

Methods
This was a retrospective cross-sectional study of all discharges of Spanish-speaking patients who requested an interpreter in 1 year from a large urban pediatric ED and an associated community ED. Multivariable logistic regression was used to identify patient and visit level characteristics associated with receiving written discharge instructions in Spanish.

Results
Sixty-one percent of 11,545 patient encounters where a Spanish interpreter was requested received written discharge instructions in Spanish. Patients aged 1 to 3 years (adjusted odds ratio [aOR], 2.87; 95% CI, 2.18–3.77) and aged 4 to 12 years (aOR, 2.06; 95% CI, 1.6–2.65), those seen without a trainee (aOR, 1.37; 95% CI, 1.25–1.5), and those with low acuity triage levels (aOR, 1.6; 95% CI, 1.29–1.97) were more likely to receive discharge instruction in Spanish. Female patients were less likely to receive Spanish discharge instructions (aOR, 0.9; 95% CI, 0.83–0.97).

Conclusions
Discharged pediatric ED patients often do not receive written instructions in the preferred language. Patient and provider factors are associated with receiving written instructions in Spanish. Quality improvement efforts are needed to ensure appropriate language discharge education.
Racial/Ethnic Differences in Pediatric Emergency Department Wait Times
Authors: Johnson Tiffani J. , Goyal Monika K. , Lorch Scott A. , Chamberlain James M. , Bajaj Lalit , Alessandrini Evaline A. , Simmons Timothy , Casper T. Charles , Olsen Cody S. , Grundmeier Robert W. , Alpern Elizabeth R. 
Published: June 2021

Objectives
Wait time for emergency care is a quality measure that affects clinical outcomes and patient satisfaction. It is unknown if there is racial/ethnic variability in this quality measure in pediatric emergency departments (PEDs). We aim to determine whether racial/ethnic differences exist in wait times for children presenting to PEDs and examine between-site and within-site differences.

Methods
We conducted a retrospective cohort study for PED encounters in 2016 using the Pediatric Emergency Care Applied Research Network Registry, an aggregated deidentified electronic health registry comprising 7 PEDs. Patient encounters were included among all patients 18 years or younger at the time of the ED visit. We evaluated differences in emergency department wait time (time from arrival to first medical evaluation) considering patient race/ethnicity as the exposure.

Results
Of 448,563 visits, median wait time was 35 minutes (interquartile range, 17–71 minutes). Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB), Hispanic, and other race children waited 27%, 33%, and 12% longer, respectively. These differences were attenuated after adjusting for triage acuity level, mode of arrival, sex, age, insurance, time of day, and month [adjusted median wait time ratios (95% confidence intervals): 1.11 (1.10–1.12) for NHB, 1.12 (1.11–1.13) for Hispanic, and 1.05 (1.03–1.06) for other race children compared with NHW children]. Differences in wait time for NHB and other race children were no longer significant after adjusting for clinical site. Fully adjusted median wait times among Hispanic children were longer compared with NHW children [1.04 (1.03–1.05)].

Conclusions
In unadjusted analyses, non-White children experienced longer PED wait times than NHW children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for NHB and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children. Additional research is needed to understand structures and processes of care contributing to wait time differences between sites that disproportionately impact non-White patients.
The ripple effect of evidence implementation: a descriptive evaluation of JBI's Evidence-based Clinical Fellowship Program
Authors: McArthur Alexa , Munn Zachary , Lizarondo Lucylynn , Porritt Kylie , Stephenson Matthew , Stern Cindy , Lockwood Craig , Moola Sandeep , Pearson Alan , Jordan Zoe 
Published: June 2021

ABSTRACT

Background:
Across healthcare there are acknowledged gaps in the translation of evidence into clinical practice. Undertaking a structured implementation program may assist clinicians to achieve this in their clinical practice setting.

Aims/Methods:
The current study descriptively evaluates and analyzes the impact of JBI's (formerly known as the Joanna Briggs Institute) Evidence-based Clinical Fellowship program, since its inception in 2005.

Results:
Since its inception the JBI Evidence-based Clinical Fellowship Program has trained over 560 Clinical Fellows. The program consists of two 1-week intensive training workshops at JBI, collaborating with a JBI Research Fellow facilitator, with each participant then conducting a workplace evidence implementation project over the intervening 6 months in their own clinical setting. A ‘train-the-trainer’ program was established to provide accredited trainers to run the program through established JBI Collaborating Entities.

Conclusion:
Implementation of research evidence into the clinical setting is challenging for health professionals. A pragmatic approach adopted through the JBI Evidence-based Clinical Fellowship Program ensures that the Clinical Fellow remains central as the program leader, but has direction and support from their team of various stakeholders, and ongoing collaboration with a JBI facilitator. This ensures increased capacity for engagement and ongoing sustainability of future implementation programs.
Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs
Authors: Déry Julien , Ruiz Angel , Routhier François , Gagnon Marie-Pierre , Côté André , Ait-Kadi Daoud , Bélanger Valérie , Lamontagne Marie-Eve 
Published: June 2021

ABSTRACT

Introduction and aims:
Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs.

Methods:
We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research.

Results:
Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process.

Conclusion:
This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers’ perspective.
Individual Reference Intervals for Personalized Interpretation of Clinical and Metabolomics Measurements
Authors: Pusparum Murih , Ertaylan Gökhan , Thas Olivier 
Published: June 2021

AbstractThe Population Reference Interval (PRI) refers to the range of outcomes that are expected in a healthy population for a clinical or a diagnostic measurement. This interval is widely used in daily clinical practice and is essential for assisting clinical decision making in diagnosis and treatment. In this study, we demonstrate that each individual indeed has a range for a given variable depending on personal biological traits. This Individual Reference Intervals (IRI) can be calculated and be utilized in clinical practice, in combination with the PRI for improved decision making where multiple data points are present per variable. As calculating IRI requires several data points from the same individual to determine a personal range, here we introduce novel methodologies to obtain the correct estimates of IRI. We use Linear Quantile Mixed Models (LQMM) and Penalized Joint Quantile Models (PJQM) to estimate the IRI’s upper and lower bounds. The estimates are obtained by considering both the within and between subjects’ variations. We perform a simulation study designed to benchmark both methods’ performance under different assumptions, resulted in PJQM giving a better empirical coverage than LQMM. Finally, both methods were evaluated on real-life data consisting of eleven clinical and metabolomics parameters from the VITO IAM Frontier study. The PJQM method also outperforms LQMM on its predictive accuracy in the real-life data setting. In conclusion, we introduce the concept of IRI and demonstrate two methodologies for calculating it to complement PRIs in clinical decision making.
Working in a care home during the COVID-19 pandemic: How has the pandemic changed working practices?
Authors: Giebel Clarissa , Hanna Kerry , Cannon Jacqueline , Shenton Justine , Mason Stephen , Tetlow Hilary , Marlow Paul , Rajagopal Manoj , Gabbay Mark 
Published: June 2021

AbstractThe aim of this research was to explore the impact of COVID-19 on the working practices of care home staff, caring for people living with dementia. Remote qualitative, semi-structured interviews were conducted with care home staff caring for people living with dementia (PLWD) in the UK. Participants were recruited to the larger programme of research via convenience sampling. Interviews were conducted via telephone or online platforms. This research employed inductive thematic analysis. Sixteen care home staff were included in this study. Three overarching themes were developed from the analysis that conveyed changes to the everyday working practices of the care home workforce and the impact such changes posed to staff wellbeing: (1) Practical implications of working in a care home during the COVID-19 pandemic; (2); Staff values and changes to the staff roles (3): Impact to the care home staff and concerns for the care sector. The COVID-19 pandemic has significantly disrupted the daily working practices of care home staff, with staff forced to adopt additional roles on top of increased workloads to compensate for the loss of external agencies and support. Support and guidance must be offered urgently to inform care home staff on how to best adapt to their new working practices, ensuring that they are adequately trained.
Social networking service, patient-generated health data, and population health informatics: patterns and implications for using digital technologies to support mental health
Authors: Ye Jiancheng , Wang Zidan , Hai Jiarui 
Published: June 2021

ABSTRACTObjectiveTo describe and compare characteristics of the population with and without mental health issues (depression or anxiety disorder), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, patient-generated health data on the digital platforms, and health information sharing attitudes and activities.MethodsWe drew data from the National Cancer Institute’s 2019 Health Information National Trends Survey (HINTS). Participants were divided into two groups by mental health status. Then, we described and compared the characteristics of social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the two groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All analyses were weighted to provide nationally representative estimates.ResultsParticipants with mental health issues are significantly more likely to be younger, White, female, have a lower income, have a history of chronic diseases, less capable of taking care of their own health; regarding behavioral health, they sleep less than six hours on average, have worse sleep quality, consume more alcohol; meanwhile, they are more likely to visit and share health information on social networking sites, write online diary blogs, participate online forum or support groups, watch health-related videos.Discussion and ConclusionThis study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and behavioral health. However, they are more likely to use social network platforms and services, share their health information, and have active engagements with patient-generated health data (PGHD). Leveraging these digital technologies and services could be beneficial to develop tailored and effective strategies for self-monitoring and self-management, thus supporting mental health.