bluuebunny/crossref_metadata_2025_split huggingface dataset:
Properly Collected Plasma Metanephrines Excludes PPGL After False-Positive Screening Tests
Authors: Kline Gregory A , Boyd Jessica , Polzin Brenda , Harvey Adrian , Pasieka Janice L , Sadrzadeh Hossein S M , Leung Alexander A 
Published: April 2021

Abstract

Context
False-positive results are common for pheochromocytoma/paraganglioma (PPGL) real-world screening.

Objective
Determine the correlation between screening urine and seated plasma metanephrines in outpatients where PPGL was absent, compared to meticulously prepared and supine-collected plasma metanephrines with age-adjusted references.

Design
Retrospective cohort study.

Setting
Databases from a single-provider provincial laboratory (2012-2018), a validated PPGL registry, and a manual chart review from a specialized endocrine testing unit.

Patients
PPGL registry data excluded known PPGL cases from the laboratory database. Outpatients having both urine and plasma metanephrines &lt;90 days apart.

Methods
The correlation between urine and seated plasma measures along with the total positivity rate. All cases of plasma metanephrines drawn in the endocrine unit were reviewed for test indication and test positivity rate.

Results
There were 810 non-PPGL pairs of urine and plasma metanephrines in the laboratory database; 46.1% of urine metanephrines were reported high. Of seated outpatient plasma metanephrines drawn a median of 5.9 days later, 19.2% were also high (r = 0.33 and 0.50 for normetanephrine and metanephrine, respectively). In contrast, the meticulously prepared and supine collected patients (n = 139, 51% prior high urine metanephrines) had &lt;3% rate of abnormal high results in patients without known PPGL/adrenal mass.

Conclusions
There was a poor-to-moderate correlation between urine and seated plasma metanephrines. Up to 20% of those with high urine measures also had high seated plasma metanephrines in the absence of PPGL. Properly prepared and collected supine plasma metanephrines had a false-positive rate of &lt;3% in the absence of known PPGL/adrenal mass.
An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola
Authors: Odinkemelu Didi S. , Sonah Aaron K. , Nsereko Etienne T. , Dahn Bernice T. , Martin Marie H. , Moon Troy D. , Niconchuk Jonathan A. , Walters Camila B. , Kynes J. Matthew 
Published: April 2021

BACKGROUND:
The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014–2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country’s maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

METHODS:
Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible.

RESULTS:
Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1–3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided.

CONCLUSIONS:
Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.
Preclinical Proficiency-Based Model of Ultrasound Training
Authors: Fatima Huma , Mahmood Feroze , Mufarrih Syed Hamza , Mitchell John D. , Wong Vanessa , Amir Rabia , Hai Ting , Montealegre Mario , Jones Stephanie B. , Knio Ziyad O. , Matyal Robina 
Published: April 2021

BACKGROUND:
Graduate medical education is being transformed from a time-based training model to a competency-based training model. While the application of ultrasound in the perioperative arena has become an expected skill set for anesthesiologists, clinical exposure during training is intermittent and nongraduated without a structured program. We developed a formal structured perioperative ultrasound program to efficiently train first-year clinical anesthesia (CA-1) residents and evaluated its effectiveness quantitatively in the form of a proficiency index.

METHODS:
In this prospective study, a multimodal perioperative ultrasound training program spread over 3 months was designed by experts at an accredited anesthesiology residency program to train the CA-1 residents. The training model was based on self-learning through web-based modules and instructor-based learning by performing perioperative ultrasound techniques on simulators and live models. The effectiveness of the program was evaluated by comparing the CA-1 residents who completed the training to graduating third-year clinical anesthesia (CA-3) residents who underwent the traditional ultrasound training in the residency program using a designed index called a “proficiency index.” The proficiency index was composed of scores on a cognitive knowledge test (20%) and scores on an objective structured clinical examination (OSCE) to evaluate the workflow understanding (40%) and psychomotor skills (40%).

RESULTS:
Sixteen CA-1 residents successfully completed the perioperative ultrasound training program and the subsequent evaluation with the proficiency index. The total duration of training was 60 hours of self-based learning and instructor-based learning. There was a significant improvement observed in the cognitive knowledge test scores for the CA-1 residents after the training program (pretest: 71% [0.141 ± 0.019]; posttest: 83% [0.165 ± 0.041]; P < .001). At the end of the program, the CA-1 residents achieved an average proficiency index that was not significantly different from the average proficiency index of graduating CA-3 residents who underwent traditional ultrasound training (CA-1: 0.803 ± 0.049; CA-3: 0.823 ± 0.063, P = .307).

CONCLUSIONS:
Our results suggest that the implementation of a formal, structured curriculum allows CA-1 residents to achieve a level of proficiency in perioperative ultrasound applications before clinical exposure.
Systems Exercise Genetics Research Design Standards
Authors: Lightfoot J. Timothy , Roth Stephen M. , Hubal Monica J. 
Published: April 2021

ABSTRACT

It is clear, based on a deep scientific literature base, that genetic and genomic factors play significant roles in determining a wide range of sport and exercise characteristics including exercise endurance capacity, strength, daily physical activity levels, and trainability of both endurance and strength. Although the research field of exercise systems genetics has rapidly expanded over the past two decades, many researchers publishing in this field are not extensively trained in molecular biology or genomics techniques, sometimes creating gaps in generating high-quality and cutting-edge research for publication. As current or former Associate Editors for Medicine and Science in Sports and Exercise that have handled the majority of exercise genetics articles for Medicine and Science in Sports and Exercise in the past 15 yr, we have observed a large number of scientific manuscripts submitted for publication review that have exhibited significant flaws preventing their publication; flaws that often directly stem from a lack of knowledge regarding the “state-of-the-art” methods and accepted literature base that is rapidly changing as the field evolves. The purpose of this commentary is to provide researchers—especially those coming from a nongenetics background attempting to publish in the exercise system genetics area—with recommendations regarding best-practice research standards and data analysis in the field of exercise systems genetics, to strengthen the overall literature in this important and evolving field of research.
Surgical site infection in a Greek general surgery department: who is at most risk?
Authors: Bekiari Anna , Pappas-Gogos George , Dimopoulos Dimitrios , Priavali Efthalia , Gartzonika Konstantina , Glantzounis Georgios K 
Published: April 2021

Objective: Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. Method: In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. Results: Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. Conclusion: This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.
Downwind Spray Drift Assessment for Airblast Sprayer Applications in a Modern Apple Orchard System
Authors: Rathnayake Anura P. , Khot Lav R. , Hoheisel Gwen A. , Thistle Harold W. , Teske Milt E. , Willett Mike J. 
Published: April 2021

HighlightsAirblast sprayer drift potential was evaluated up to 183 m (600 ft) downwind from an orchard edge.A central leader apple orchard was sprayed at dormant and full canopy stage.Higher drift at full canopy stage was likely due to higher wind speeds and lower humidity.String and artificial foliage samplers had higher collection efficiencies than Mylar cards.Abstract. Risk assessment of orchard pesticide spraying is currently based on spray drift estimation using a worst-case scenario (dormant stage). However, most spray applications are conducted during non-dormant canopy growth stages. Such overestimation leads to restrictive operational regulations in pest management activities. Therefore, field data were generated and studied for a mechanistic model that will predict spray drift from airblast spray applications in tree fruit orchards. Spray trials were conducted at dormant and full canopy growth stages in a central leader trained apple orchard. An axial-fan airblast sprayer sprayed fluorescent tracer in the third row from the orchard’s downwind edge, with four passes being one run. A total of 20 runs, i.e., 17 spray runs and three blanks, were performed during each of the two crop growth stages. Mylar cards, artificial foliage (AF), and horizontal strings (HS) were used to quantify drifting spray deposition up to 183 m (600 ft) downwind. Within the orchard, the deposition on card samplers 3 m upwind of the sprayed row was 21.94% ±4.63% (mean ± standard deviation) of applied dose (AD) at dormant stage and 16.02% ±2.86% AD at full canopy stage. Deposition downwind and adjacent (-3 m) to the sprayed row was 17.92% ±2.70% AD and 7.15% ±1.78% AD at dormant and full canopy stages, respectively. Spray drift decreased substantially at the orchard edge to 3.18% ±1.30% AD at dormant stage and 2.30% ±1.16% AD at full canopy stage. Spray drift was very low at 183 m (600 ft) downwind of the orchard, with deposition of 0.002% ±0.003% AD at dormant stage and 0.003% ±0.004% AD at full canopy stage. Deposition data collected at common sampler locations showed that HS and AF samplers collected significantly (p &lt; 0.05) more drifting spray than card samplers. Downwind speeds had a strong linear relationship with spray drift at both growth stages (dormant: R2= 0.80, full canopy: R2= 0.86), while the influence of temperature and humidity could not be directly observed from the collected data. Keywords: Airblast spraying, Deposit samplers, Dormant and full canopy, Drift, Modern orchard systems.
High-speed interband cascade infrared photodetectors: photo-response saturation by a femtosecond oscillator
Authors: Krüger L. M. , Hillbrand J. , Heidrich J. , Beiser M. , Weih R. , Koeth J. , Phillips C. R. , Schwarz B. , Strasser G. , Keller U. 
Published: April 2021

Interband cascade infrared photodetectors (ICIPs) combine interband optical transitions with fast intraband transport to achieve high-frequency and broad-wavelength operation at room temperature. Here we study the bias-dependent electronic impulse response of ICIPs with a mid-infrared synchronously pumped optical parametric oscillator (OPO). Since the OPO produces ultrashort 104-fs pulses, it is possible to probe the impulse response of the ICIP. From this impulse response, we identify two characteristic decay times, indicating the contribution of electron as well as hole carriers. A reverse bias voltage applied to the ICIP reduces both time scales and leads to an increased electrical cut-off frequency. The OPO emits up to 500 mW average power, of which up to 10 mW is directed to the ICIP in order to test its saturation characteristics under short-pulse illumination. The peak of the impulse response profile as well as the average photocurrent experience a gradual saturation behavior, and we determine the corresponding saturation powers by measuring the photo-response as a function of average power directed to the ICIP. We demonstrate that an increasing reverse bias increases the saturation power as well as the responsivity of the ICIP.
Supercontinuum generation in As2S3 waveguides fabricated without direct etching
Authors: Hwang Joonhyuk , Kim Dae-Gon , Han Sangyoon , Jeong Dongin , Lee Yong-Hee , Choi Duk-Yong , Lee Hansuek 
Published: April 2021

We report a supercontinuum generation (SCG) in a waveguide that spontaneously forms without an etching process during the deposition of a core material on a preformed

S
i

O

2

substructure. The mechanism of dispersion control for this new, to the best of our knowledge, type of waveguide is analyzed by numerical simulation, which results in a design rule to achieve a target dispersion profile by adjusting the substructure geometry. SCG is experimentally demonstrated with a waveguide made of

A

s

2

S

3

, chalcogenide glass, which has low material absorption over the mid-IR range. A dispersion-controlled waveguide with a length of 10 mm pumped with 77 pJ pulses at a telecommunication wavelength of 1560 nm resulted in a supercontinuum that extends by more than 1.5 octaves.
A review of reported network degree and recruitment characteristics in respondent driven sampling implications for applied researchers and methodologists
Authors: Avery Lisa , Macpherson Alison , Flicker Sarah , Rotondi Michael 
Published: April 2021

Objective
Respondent driven sampling (RDS) is an important tool for measuring disease prevalence in populations with no sampling frame. We aim to describe key properties of these samples to guide those using this method and to inform methodological research.

Methods
In 2019, authors who published respondent driven sampling studies were contacted with a request to share reported degree and network information. Of 59 author groups identified, 15 (25%) agreed to share data, representing 53 distinct study samples containing 36,547 participants across 12 countries and several target populations including migrants, sex workers and men who have sex with men. Distribution of reported network degree was described for each sample and characteristics of recruitment chains, and their relationship to coupons, were reported.

Results
Reported network degree is severely skewed and is best represented by a log normal distribution. For participants connected to more than 15 other people, reported degree is imprecise and frequently rounded to the nearest five or ten. Our results indicate that many samples contain highly connected individuals, who may be connected to at least 1000 other people.

Conclusion
Because very large reported degrees are common; we caution against treating these reports as outliers. The imprecise and skewed distribution of the reported degree should be incorporated into future RDS methodological studies to better capture real-world performance. Previous results indicating poor performance of regression estimators using RDS weights may be widely generalizable. Fewer recruitment coupons may be associated with longer recruitment chains.
Clinical risk factors for preeclampsia in twin pregnancies
Authors: Chantanahom Nipp , Phupong Vorapong 
Published: April 2021

Background
Preeclampsia is a common obstetric complication. The rate of preeclampsia is increased in twin pregnancies. The aim of this study was to assess the clinical risk factors for developing preeclampsia in twin pregnancies.

Methods
A case-control study was carried out among women with twin pregnancies who delivered at gestational age more than 23 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, from 2003 to 2019. The data were retrieved from electronic medical records. Multivariate logistic regression analysis was used to find the risk factors.

Results
A total of 1,568 twin pregnancies were delivered during the study period and 182 cases (11.6%) developed preeclampsia. 172 cases with preeclampsia and 516 controls were selected for analysis. After certain variables were adjusted in the multivariate logistic regression analysis, the clinical factors associated with preeclampsia in twin pregnancies were nulliparity (adjusted odds ratio (OR) 1.57, 95% confidence interval (CI) 1.02–2.41) and chronic hypertension (adjusted OR 6.22, 95%CI 1.98–19.57). Low gestational weight gain was a significant protective factor against the development of preeclampsia (adjusted OR 0.50; 95%CI 0.32–0.77).

Conclusion
The clinical risk factors for developing preeclampsia in twin pregnancies were nulliparity and chronic hypertension. These risk factors are of value to identify twin pregnant women at risk for preeclampsia and in implementing primary prevention.
Cost of pre-exposure prophylaxis delivery in family planning clinics to prevent HIV acquisition among adolescent girls and young women in Kisumu, Kenya
Authors: Wanga Valentine , Peebles Kathryn , Obiero Alfred , Mogaka Felix , Omollo Victor , Odoyo Josephine B. , Morton Jennifer F. , Bukusi Elizabeth A. , Celum Connie , Baeten Jared M. , Barnabas Ruanne V. 
Published: April 2021

IntroductionOral pre-exposure prophylaxis (PrEP) is increasingly being implemented in sub-Saharan Africa. Adolescent girls and young women (AGYW) in Kenya contribute more than half of all new infections among young people aged 15–24 years, highlighting the need for evidence on the cost of PrEP in real-world implementation to inform the budget impact, cost-effectiveness, and financial sustainability of PrEP programs.MethodsWe estimated the cost of delivering PrEP to AGYW enrolled in a PrEP implementation study in two family planning clinics in Kisumu county, located in western Kenya. We derived total annual costs and the average cost per client-month of PrEP by input type (variable or fixed) and visit type (initiation or follow-up). We estimated all costs as implemented in the study, and under implementation by the Kenyan Ministry of Health (MoH), both at the program volume observed and if the facilities were delivering PrEP at full capacity (scaled-MoH).ResultsFor the costing period between March 2018 and March 2019, 615 HIV-negative women contributed 1,128 (502 initiation and 626 follow-up) visits. The average cost per client-month of PrEP dispensed per study protocol and per the MoH scenario was $28.92 and $14.52, respectively. If the MoH scaled the program so that facilities could see PrEP clients at capacity, the average cost per client-month of PrEP was $10.88. Medication costs accounted for the largest proportion of the total annual costs (48% in MoH scenario and 65% in the scaled-MoH scenario).ConclusionsUsing data from a PrEP implementation program, we found that the cost per client-month of PrEP dispensed is reduced by 62% if PrEP delivery at the two clinics is scaled up by the MoH. Our findings are valuable for informing local resource allocation and budgetary cost projections for scale-up of PrEP delivery to AGYW. Additionally, previous cost-effectiveness studies have been limited by the use of fixed assumptions of the cost of PrEP per person-month. Our study provides cost estimates from practical data which will better inform cost-effectiveness and budget impact analyses.