bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to healthy lifestyle improved clinical outcomes in coronary artery disease patients after coronary intervention
Authors: Yang Ya-Ling , Leu Hsin-Bang , Yin Wei-Hsian , Tseng Wei-Kung , Wu Yen-Wen , Lin Tsung-Hsien , Yeh Hung-I , Chang Kuan-Cheng , Wang Ji-Hung , Wu Chau-Chung , Chen Jaw-Wen 
Published: April 2021

Background:
Lifestyle modification is suggested for patients with coronary artery disease (CAD), but the impact of adherence to a healthy lifestyle remains undetermined. The aim of this study is to investigate the association of adherence to a healthy lifestyle with future outcomes and biochemical markers in CAD patients.

Methods:
The Biosignature CAD study examined 716 CAD patients who underwent a percutaneous coronary intervention (PCI). Information was collected on whether these patients adhered to a healthier lifestyle after PCI, including healthy diet, not smoking, and exercise. The clinical outcomes included major cardiovascular events and unplanned revascularization procedures, hospitalization for refractory or unstable angina, and other causes

Results:
The average follow-up period was 26.8 ± 8.1 months, during which 175 (24.4%) patients experienced at least one event. The combination of healthy lifestyle factors was associated with lower risk, and the maximum risk reduction reached 50% (hazard ratio: 0.50, 95% confidence interval: 0.25-0.99). As the number of healthy lifestyle factors increased, there were decreases in inflammatory markers, C-reactive protein, waist circumference, low-density lipoprotein cholesterol, and the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (p < 0.05). The benefits of modifiable healthy lifestyle factors were especially observed in the younger population, males, patients with HDL <40 mg/dL, those with reduced left ventricular ejection fraction, and those receiving statin therapy.

Conclusion:
Adherence to a healthy lifestyle is independently associated with a lower risk of future adverse events in CAD patients and plays an important role in secondary prevention in the era of interventional cardiology.
The Association of Psoriasis and Obesity: Focusing on IL-17A-Related Immunological Mechanisms
Authors: Xu Cheng , Ji Jie , Su Ting , Wang Hong-Wei , Su Zhong-Lan 
Published: April 2021

Abstract
Psoriasis is a chronic, recurrent, inflammatory skin disease that is often accompanied by obesity. An increasing amount of research has elucidated the pathophysiological link between psoriasis and obesity. Since 2005, interleukin (IL)-17-producing T helper 17 cells and their main effector cytokine IL-17A have been considered to play a critical role in the pathogenesis of psoriasis; the marked effect of biotherapies targeting IL-17A on moderate and severe psoriasis has further established its role in psoriasis. Recent studies have found that obesity induces T helper 17 cells to secrete IL-17A and participate in the pathogenesis of psoriasis. IL-17A may be a crucial element in the association between psoriasis and obesity. This review discusses the association between psoriasis and obesity, with a focus on and the implications regarding the need to treat psoriasis.
Effects of Nursing Education Using Films on Perception of Nursing, Satisfaction With Major, and Professional Nursing Values
Authors: PARK Hyangjin , CHO Haeryun 
Published: April 2021

ABSTRACT

Background
Cinenurducation, a film-based approach to nursing education that incorporates student-centered, problem-solving, experiential, and reflective learning strategies, allows students to experience a variety of indirect experiences and improves critical thinking and self-reflection through discussion.

Purpose
The aims of this study were, first, to employ a cinenurducation approach to help instill a proper professional nursing identity in second-year nursing students and, second, to examine the effects of this approach on the perception of nursing, satisfaction with major, and professional nursing values of the participants.

Methods
An experimental, pretest-and-posttest design was used to test the primary variables, including perception of nursing, satisfaction with major, and professional nursing values. The nursing educational program was developed based on the learning concepts of cinenurducation and the core concepts of nursing. The program, which included six films, addressed the following concepts: Me Before You (problem solving and professionalism), Testament of Youth (nursing management and professionalism), Girl, Interrupted (interpersonal skills and nursing knowledge), Hungry Heart (interpersonal skills and problem solving), Iris (nursing knowledge and problem solving), and Chronic (nursing knowledge and cooperation). The experimental group (n = 14) participated in the 8-week educational program, and the control group (n = 15) did not.

Results
Perception of nursing, satisfaction with major, and professional nursing values all improved significantly more in the experimental group than in the control group, with large effects observed.

Conclusions
Cinenurducation is an effective approach to promoting professional nursing identity in nursing students. Educators should incorporate films into nursing education. In addition, nursing education should incorporate a variety of educational materials to provide students with opportunities for reflective learning.
The prevalence of symptomatic uncomplicated diverticular disease could be lower than expected: a single-center colonoscopy-based cohort study
Authors: Tursi Antonio , Elisei Walter , Franceschi Marilisa , Picchio Marcello , Di Mario Francesco , Brandimarte Giovanni 
Published: April 2021

Aim
The real prevalence of symptomatic uncomplicated diverticular disease (SUDD) is still unknown. The aim of this study was to assess the prevalence of SUDD, post-diverticulitis SUDD (PD-SUDD) and irritable bowel syndrome (IBS)-like symptoms in a real-life population.

Methods
A cohort of patients, submitted to colonoscopy from 1st January 2012 to 30th April 2018 was revised.

Results
A cohort of 5451 patients with diverticulosis was identified during the study period. Abdominal pain was recorded in 1141 patients (20.93%), diarrhea in 288 (5.28%) and constipation in 536 (9.83%) patients. SUDD was recorded in 371 patients (6.81% of the patients having diverticulosis and 32.51% of the patients experiencing abdominal pain), PD-SUDD was recorded in 103 patients (1.89% of the patients having diverticulosis and 9.03% of the patients experiencing abdominal pain) and IBS-like was recorded in 348 patients (6.38% of the patients having diverticulosis and 30.5% of the patients experiencing abdominal pain). Three hundred and nineteen patients were not part of any of the previous categories (5.85% of the patients having diverticulosis and 27.96% of the patients experiencing abdominal pain). SUDD and PD-SUDD were more frequent in older ages (>60 years), while IBS-like symptoms were more frequent in younger. Nonspecific abdominal pain was equally distributed in through the ages.

Conclusion
The prevalence of SUDD seems to be lower than expected, and most of patients with diverticulosis and abdominal symptoms may suffer from IBS-like or other causes.
Self-Efficacy, Outcome Expectations, Group Social Support, and Adherence to Physical Activity in African American Women
Authors: Garland Meghan , Wilbur JoEllen , Fogg Louis , Halloway Shannon , Braun Lynne , Miller Arlene 
Published: April 2021

Background
African American women have lower levels of leisure time physical activity compared to White American women. Interventions to improve physical activity have mixed benefits for African American women, even when guided by theory. Understanding how theoretical constructs used in physical activity interventions relate to changing behavior may provide direction for more successful interventions.

Objective
The study aimed to examine the relationships among social cognitive constructs (self-efficacy, social support from group behavioral meetings, outcome expectations/realizations), and change in physical activity from baseline to 48 weeks in African American women participating in a lifestyle physical activity program.

Methods
A secondary data analysis of longitudinal data using a correlational design was conducted using data from a 48-week physical activity randomized controlled trial (RCT). The RCT included a group behavioral meeting component with one of three telephone intervention conditions (no calls, personal motivation calls, or automated motivational calls) randomly assigned across six community healthcare sites. The participants were 260 sedentary, midlife African American women with no major signs or symptoms of cardiovascular disease who completed baseline and 48-week assessments of the RCT. Measures included self-efficacy for change in overcoming barriers to physical activity at 24 weeks, physical and psychological outcome realizations at 24 weeks, social support from group behavioral meetings at 24 weeks, and physical activity (self-report and device-measured) change from baseline to 48 weeks.

Results
In a hierarchical regression model predicting change in self-reported time spent in weekly moderate–vigorous physical activity at 48 weeks, psychological outcome realizations at 24 weeks were significant positive predictors. In a hierarchical regression model for change in device-measured daily steps at 48 weeks, a self-efficacy change at 24 weeks was a significant positive predictor.

Discussion
Attention should be given to increasing self-efficacy to overcome physical activity barriers and achieve self-identified physical and psychological outcomes in physical activity programs.
Parking Meters to Touch Screens
Authors: Norman Jensine’ , Stowers Jared , Verduzco-Gutierrez Monica 
Published: April 2021

Abstract
Greater than 25% of annual healthcare expenditures in the United States are associated with the medical needs of people with disabilities. People with disabilities often experience inequalities with access to healthcare services, resulting in increased costs of living with disability. The economic burden of living with a disability results in nearly US $400 billion spent annually from combined public and private payor sources. Historically, disparities in health care are associated with intersections between race, culture, and environmental factors. Minority status also plays a significant role in health outcomes, and studies have highlighted the additional burdens faced at the junction of race and disability status. COVID-19 changed the landscape of healthcare delivery in the United States, resulting in a drastic increase in telehealth utilization. Traditional nonmedical barriers to persons with disability, such as unforeseen parking fees, are documented in the literature. However, conditions surrounding access to the necessary technology required to participate in a telehealth-driven medical landscape are less clear. This article addresses the nonmedical barriers and costs associated with living with a disability and discusses potential solutions in the evolving healthcare system.
Decreasing Foot Traffic in the Orthopedic Operating Room: A Narrative Review of the Literature
Authors: Buckner Laura , Lacy Jordan , Young Kasey , Dishman Deniz 
Published: April 2021

Introduction
Surgical site infections (SSIs) are implicated in poor outcomes in orthopedic surgical patients. Decreasing foot traffic in orthopedic surgical suites is correlated with the reduction of SSI risk. This review aims to understand the background and significance of the problem, isolate factors contributing to the movement in and out of operating rooms, and identify interventions that decrease traffic in procedure areas.

Methods
A comprehensive search was completed using the databases Embase and Medline (Ovid). A PICOT question was used in the literature search to evaluate the efficacy of a standardized guideline on operating room door opening frequency. The Mixed Methods Appraisal Tool was used to appraise the literature critically, and conventional content analysis methodology identified themes within the publications.

Results
The literature search yielded 18 articles providing 3 different themes of evidence: airborne bacterial counts and their association with foot traffic; specific personnel, namely, nurses demonstrating the greatest amount of foot traffic; and interventions aimed at minimizing this foot traffic.

Conclusions
Implementing multiple evidence-based interventions can decrease foot traffic and reduce the risk of SSIs in orthopedic patients. Further studies are needed to directly link airborne bacterial counts to SSIs, increase the level of evidence, and isolate interventions.
The Perfect Storm: Exam of a Medical Error and Factors Contributing to Its Possible Escalation
Authors: Walters Gerald K. 
Published: April 2021

Objective
After an initial medical misadventure, failure of recognition and continuing factors that could perpetuate the error are examined.

Methods
A critical evaluation of the continuum of care after the initial error was conducted through chart review and comparison to published standards.

Results
Analysis of the continuum of care after the original error demonstrated numerous system failures that should have alerted the providers to the initial error.

Discussion
Technology, electronic medical records, lack of critical communications, and short cuts have the potential to not recognize patient care safety issues and potential harm.

Conclusions
Medical errors are multifactorial. Blame casting and accusations are not productive. Critical analysis of systems/processes, current technology, eliminating shortcuts, and critical communications may increase patient safety.
A Collision Intrathyroidal Tumor Causing Primary Hyperparathyroidism
Authors: Foppiani Luca , Sola Simona , Pitto Francesca , Ansaldo Gianluca , Piccardo Arnoldo 
Published: April 2021

Abstract
A 67-year-old man was diagnosed with primary hyperparathyroidism and normofunctioning left nodular goiter. Fine-needle aspiration cytology showed thyroid (Thy) 4 (suspicious of malignancy). After first-line imaging proved negative, integrated 18F-choline PET/4D contrast-enhanced CT revealed uptake by the thyroid nodule and by 3 nodules of the left central compartment. Thyroidectomy and lymphadenectomy were performed. Histopathology revealed a collision tumor (ie, 2 histologically distinct tumors occurring at the same anatomic site) composed of both PTC (papillary thyroid carcinoma) and parathyroid carcinoma within the left thyroid nodule. Lymph nodes showed PTC metastases. Primary hyperparathyroidism and calcium levels normalized, and the patient underwent radioiodine therapy.
Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty
Authors: Erdur Zülküf Burak , Öktem Fatih , Inci Ender , Yener Haydar Murat , Üstündağ Ahmet 
Published: April 2021

Objective:
Understanding the postoperative dynamics of the nasal soft-tissue envelope (NSTE) is necessary to obtain the desired cosmetic results after rhinoplasty. This study was conducted to determine the changes of NSTE thickness and its effects on periorbital edema and ecchymosis following rhinoplasty.

Methods:
Thirty-five patients who underwent rhinoplasty were included in the study. Nasal skin and subcutaneous tissue thickness at the tip, supratip, rhinion, and nasion were measured using ultrasonography preoperatively and at the postoperative 3rd and 10th months. Periorbital edema and ecchymosis were evaluated at postoperative days 1, 3, and 7. The patients were categorized as the thick NSTE group (n = 17) and the thin NSTE group (n = 18) according to the preoperative median NSTE thickness.

Results:
In the thin NSTE group, supratip skin, subcutaneous tissue, and total NSTE thickness were lowest on the preoperative day but no statistically significant difference was found for the thick NSTE group. In the thin NSTE group, total NSTE thickness of the rhinion was highest at the postoperative 3rd month, but in the thick NSTE group, there was no statistically significant difference between postoperative 3rd and 10th months. In both groups, total NSTE thickness of the nasion was highest at the postoperative 3rd month and lowest at the postoperative 10th month.

Conclusions:
Supratip fullness occurs more prominent in patients with thin NSTE. Postoperative edema in the rhinion is greater in patients with thin NSTE for the early postoperative period but it lasts longer in patients with thick NSTE. Soft-tissue envelope atrophy at the nasion occurs in both groups in the late postoperative period. Periorbital edema and ecchymosis severity are not affected by NSTE thickness.
Novel Trauma Composite Score is a more reliable predictor of mortality than Injury Severity Score in pediatric trauma
Authors: Keskey Robert C. , Hampton David A. , Biermann Henry , Cirone Justin , Zakrison Tanya L. , Cone Jennifer T. , Wilson Ken L. , Slidell Mark B. 
Published: April 2021

BACKGROUND
The equivalent Injury Severity Score (ISS) cutoffs for severe trauma vary between adult (ISS, >16) and pediatric (ISS, >25) trauma. We hypothesized that a novel injury severity prediction model incorporating age and mechanism of injury would outperform standard ISS cutoffs.

METHODS
The 2010 to 2016 National Trauma Data Bank was queried for pediatric trauma patients. Cut point analysis was used to determine the optimal ISS for predicting mortality for age and mechanism of injury. Linear discriminant analysis was implemented to determine prediction accuracy, based on area under the curve (AUC), of ISS cutoff of 25 (ISS, 25), shock index pediatric adjusted (SIPA), an age-adjusted ISS/abbreviated Trauma Composite Score (aTCS), and our novel Trauma Composite Score (TCS) in blunt trauma. The TCS consisted of significant variables (Abbreviated Injury Scale, Glasgow Coma Scale, sex, and SIPA) selected a priori for each age.

RESULTS
There were 109,459 blunt trauma and 9,292 penetrating trauma patients studied. There was a significant difference in ISS (blunt trauma, 9.3 ± 8.0 vs. penetrating trauma, 8.0 ± 8.6; p < 0.01) and mortality (blunt trauma, 0.7% vs. penetrating trauma, 2.7%; p < 0.01). Analysis of the entire cohort revealed an optimal ISS cut point of 25 (AUC, 0.95; sensitivity, 0.86; specificity, 0.95); however, the optimal ISS ranged from 18 to 25 when evaluated by age and mechanism. Linear discriminant analysis model AUCs varied significantly for each injury metric when assessed for blunt trauma and penetrating trauma (penetrating trauma–adjusted ISS, 0.94 ± 0.02 vs. ISS 25, 0.88 ± 0.02 vs. SIPA, 0.62 ± 0.03; p < 0.001; blunt trauma–adjusted ISS, 0.96 ± 0.01 vs. ISS 25, 0.89 ± 0.02 vs. SIPA, 0.70 ± 0.02; p < 0.001). When injury metrics were assessed across age groups in blunt trauma, TCS and aTCS performed the best.

CONCLUSION
Current use of ISS in pediatric trauma may not accurately reflect injury severity. The TCS and aTCS incorporate both age and mechanism and outperform standard metrics in mortality prediction in blunt trauma.

LEVEL OF EVIDENCE
Retrospective review, level IV.
Neuro-Ophthalmic Phenotype of OPA3
Authors: Huna-Baron Ruth , Yahalom Gilad , Anikster Yair , Ben Zeev Bruria , Hoffmann Chen , Hassin-Baer Sharon 
Published: April 2021

Background:
Type III 3-methylglutaconic aciduria (OPA 3) is a neuro-ophthalmologic syndrome consisting of early-onset bilateral optic atrophy. Since Costeff described the phenotype of 19 patients in 1989, several reports described approximately 50 patients, but most of them lack details about neuro-ophthalmic phenotype. Our aim was to characterize the clinical neuro-ophthalmic phenotype of this syndrome.

Methods:
Nine patients underwent meticulous visual function history and medical documents' review. Results of best-corrected visual acuity (VA), color vision, visual field (VF), ocular motility, pupillary reaction, slit-lamp, and dilated fundus examinations were recorded. Optical coherence tomography (OCT) was performed whenever possible.

Results::
The average VA was 1.4 ± 0.8 logarithm of the minimum angle of resolution. Poor vision was the presenting symptom in 5 patients. Six patients had decreased VA and variable degrees of optic atrophy. Humphrey VF testing of 7 patients revealed generalized depression in 5 and a cecocentral defect in 2. All patients demonstrated dysmetric saccades. Four patients had strabismus, 3 with exotropia, and one with esotropia. Seven patients had nystagmus. Ocular motility abnormality is possibly the result of cerebellar atrophy that was found in MRI studies of our patients. OCT of the retina was possible in 6 patients and revealed retinal nerve fiber layer (RNFL) thinning as well as average retinal thinning. Three patients, in whom ganglion cell layer–inner plexiform layer (IPL) measurement was possible, also showed diffused thinning.

Conclusions:
This study compiled data regarding neuro-ophthalmic manifestation of OPA 3 Type III patients. Contrary to established literature, poor vision was the presenting symptom in only 50% of our patients. This is the first report of OCT findings in 3MGA patients. The results demonstrated diffused thinning of the RNFL and ganglion cell complex-IPL with correlation to VA, which is in contrast to OPA1 patients in whom the most severe thinning is at the level of the papillomacular bundle. Average retinal thinning was identified at second and third decades of life, possibly resulting from early ganglion cell loss. These results may contribute to visual prognosis, and OCT may help monitor experimental therapies.
Sero-monitoring of health care workers reveals complex relationships between common coronavirus antibodies and SARS-CoV-2 severity
Authors: Gouma Sigrid , Weirick Madison E. , Bolton Marcus J. , Arevalo Claudia P. , Goodwin Eileen C. , Anderson Elizabeth M. , McAllister Christopher M. , Christensen Shannon R. , Dunbar Debora , Fiore Danielle , Brock Amanda , Weaver JoEllen , Millar John , DerOhannessian Stephanie ,   The UPenn COVID Processing Unit, Frank Ian , Rader Daniel J. , Wherry E. John , Hensley Scott E. 
Published: April 2021

AbstractRecent common coronavirus (CCV) infections are associated with reduced COVID-19 severity upon SARS-CoV-2 infection, however the immunological mechanisms involved are unknown. We completed serological assays using samples collected from health care workers to identify antibody types associated with SARS-CoV-2 protection and COVID-19 severity. Rare SARS-CoV-2 cross-reactive antibodies elicited by past CCV infections were not associated with protection; however, the duration of symptoms following SARS-CoV-2 infections was significantly reduced in individuals with higher common betacoronavirus (βCoV) antibody titers. Since antibody titers decline over time after CCV infections, individuals in our cohort with higher βCoV antibody titers were more likely recently infected with common βCoVs compared to individuals with lower antibody titers. Therefore, our data suggest that recent βCoV infections potentially limit the severity of SARS-CoV-2 infections through mechanisms that do not involve cross-reactive antibodies. Our data are consistent with the emerging hypothesis that cellular immune responses elicited by recent common βCoV infections transiently reduce disease severity following SARS-CoV-2 infections.