bluuebunny/crossref_metadata_2025_split huggingface dataset:
Menopause Is Associated With Immune Activation in Women With HIV
Authors: Peters Brandilyn A , Xue Xiaonan , Sheira Lila A , Qi Qibin , Sharma Anjali , Santoro Nanette , Alcaide Maria L , Ofotokun Igho , Adimora Adaora A , McKay Heather S , Tien Phyllis C , Michel Katherine G , Gustafson Deborah , Turan Bulent , Landay Alan L , Kaplan Robert C , Weiser Sheri D 
Published: June 2021

Abstract

Background
Persistent immune activation due to gut barrier dysfunction is a suspected cause of morbidity in HIV, but the impact of menopause on this pathway is unknown.

Methods
In 350 women with HIV from the Women’s Interagency HIV Study, plasma biomarkers of gut barrier dysfunction (intestinal fatty acid binding protein; IFAB), innate immune activation (soluble CD14 and CD163; sCD14, sCD163), and systemic inflammation (interleukin-6 and tumor necrosis factor receptor 1; IL-6, TNFR1) were measured at 674 person-visits spanning ≤2 years.

Results
Menopause (post- vs premenopausal status) was associated with higher plasma sCD14 and sCD163 in linear mixed-effects regression adjusting for age and other covariates (β = 161.89 ng/mL; 95% confidence interval [CI], 18.37–305.41 and 65.48 ng/mL, 95% CI, 6.64–124.33, respectively); but not with plasma IFAB, IL-6, or TNFR1. In piece-wise linear mixed-effects regression of biomarkers on years before/after the final menstrual period, sCD14 increased during the menopausal transition by 250.71 ng/mL per year (95% CI, 16.63–484.79; P = .04), but not in premenopausal or postmenopausal periods.

Conclusions
In women with HIV, menopause may increase innate immune activation, but data did not support an influence on the gut barrier or inflammation. Clinical implications of immune activation during menopausal transition warrant further investigation.
The cross-national applicability of lean implementation measures and hospital performance measures: a case study of Finland and the USA
Authors: Reponen Elina , Rundall Thomas G , Shortell Stephen M , Blodgett Janet C , Jokela Ritva , MÄkijÄrvi Markku , Torkki Paulus 
Published: June 2021

Abstract

Background
Health-care organizations around the world are striving to achieve transformational performance improvement, often through adopting process improvement methodologies such as lean management. Indeed, lean management has been implemented in hospitals in many countries. But despite a shared methodology and the potential benefit of benchmarking lean implementation and its effects on hospital performance, cross-national lean benchmarking is rare. Health-care organizations in different countries operate in very different contexts, including different health-care system models, and these differences may be perceived as limiting the ability of improvers to benchmark lean implementation and related organizational performance. However, no empirical research is available on the international relevance and applicability of lean implementation and hospital performance measures. To begin understanding the opportunities and limitations related to cross-national benchmarking of lean in hospitals, we conducted a cross-national case study of the relevance and applicability of measures of lean implementation in hospitals and hospital performance.

Methods
We report an exploratory case study of the relevance of lean implementation measures and the applicability of hospital performance measures using quantitative comparisons of data from Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital in Finland and a sample of 75 large academic hospitals in the USA.

Results
The relevance of lean-related measures was high across the two countries: almost 90% of the items developed for a US survey were relevant and available from HUS. A majority of the US-based measures for financial performance (66.7%), service provision/utilization (100.0%) and service provision/care processes (60.0%) were available from HUS. Differences in patient satisfaction measures prevented comparisons between HUS and the USA. Of 18 clinical outcome measures, only four (22%) were not comparable. Clinical outcome measures were less affected by the differences in health-care system models than measures related to service provision and financial performance.

Conclusions
Lean implementation measures are highly relevant in health-care organizations operating in the USA and Finland, as is the applicability of a variety of performance improvement measures. Cross-national benchmarking in lean healthcare is feasible, but a careful assessment of contextual factors, including the health-care system model, and their impact on the applicability and relevance of chosen benchmarking measures is necessary. The differences between the US and Finnish health-care system models is most clearly reflected in financial performance measures and care process measures.
Differential Effects of Information and Communication Technology on (De-) Democratization of Authoritarian Regimes
Authors: Choi Changyong , Jee Sang Hoon 
Published: June 2021

AbstractUtilizing state–society relations as a theoretic framework, this study investigates whether the Internet is used to facilitate or impede democratization in authoritarian regimes. The present paper uses governance practice as the mediating mechanism, along with a regime's degree of authoritarianism as a moderator, to measure the direct and indirect effects of the Internet on democratization. This research found that the Internet can be mobilized to suppress political freedom in authoritarian regimes, while at the same time reinforcing the legitimacy of the regime's basis—both of these deter democratization. The Internet, as a tool, must be complemented by democratic deliberation to fully generate democratization.
Sexual Violence by the State: The Role of Political Institutions in Sexual Violence Perpetration
Authors: Willis Christopher P 
Published: June 2021

Abstract
What explains the variation in sexual violence perpetrated by state-security forces? Prior research has suggested sexual violence is an explicit strategy of violence. More recent work has suggested sexual violence in certain contexts acts as a tolerated practice. I argue that the type of regime institutions influences the perpetration of sexual violence by deterring behavior of individuals and providing pathways to accountability. Authoritarian regimes in general have weaker institutional accountability compared to democracies. Institutions in personalist regimes in particular are geared toward preservation of personal power, rather than accountability for the regime. Regimes with higher accountability will experience lower sexual violence, while those with lower accountability experience higher perpetration. Moreover, the gendered nature of regime institutions influences perpetration of sexual violence where masculine institutions predominate. I test these predictions using cross-national data on the incidence of sexual violence, during both peace and conflict. The results suggest that personalist regimes, and especially regimes with weaker female empowerment or higher levels of corruption, experience more sexual violence. This analysis links political institutions to the toleration of sexual violence by state-security forces, underscoring the importance of institutional structure and behavior in the perpetration of sexual violence.
Use of Electronic Cigarettes and Other Tobacco Products Among Active Component Services Members
Authors: Smucker Sierra , Meadows Sarah O , Beckman Robin 
Published: June 2021

ABSTRACT

Introduction
e-cigarettes have been touted as a safer alternative to classic cigarettes and other combustible tobacco products. However, a growing body of evidence finds that any risk reduction associated with e-cigarette use is eliminated when individuals use “both” e-cigarettes and other tobacco products. Recent analyses from the Health Related Behaviors Survey suggest that rates of e-cigarette use are higher among active component service members than in the general population. However, little is known about the frequency and health behaviors associated with the dual use of e-cigarettes and other tobacco products among service members.

Data and Method
Using data from the 2018 Health Related Behaviors Survey, this paper investigates whether active component service members who use both e-cigarettes and other tobacco products are more likely to engage in other types of substance use or negative health behaviors.

Results
We find that the dual use of e-cigarettes and other tobacco products is associated with poorer physical and mental health, higher rates of alcohol misuse, and higher rates of insufficient sleep.

Conclusion
The association between the dual use of e-cigarettes and tobacco products suggests that these individuals represent an important target group for health-related resources and attention in DoD.
A fundamental Christian argument for vaccine promotion
Authors: Galang Joseph Renus F , Galang Justine Renus F 
Published: June 2021

Abstract
A recent correspondence highlighted the need to change the COVID-19 vaccine narrative to combat vaccine hesitancy by stressing that vaccination is a moral act. The said article was in response to another correspondence which said that science and religion must work together for vaccine promotion. This article presents a fundamental Christian argument for vaccine promotion by saying that God may have provided an answer to the pandemic through the COVID-19 vaccine.
Impact of barrier tissue inflammation and physical activity on joint homeostasis in mice
Authors: Van Mechelen Margot , Martens Tobie , Vanden Berghe Pieter , Lories Rik , Gulino Giulia R 
Published: June 2021

Abstract

Objectives
To investigate whether physical activity interferes with joint homeostasis in the presence of distant inflammation originating at barrier tissues such as skin or gut.

Methods
Eight-week-old male C57/Bl6 mice were treated with imiquimod cream on a shaved area of the back skin or with dextran sodium sulphate dissolved in the drinking water to induce psoriasis-like skin or inflammatory bowel disease-like gut inflammation. Afterwards, one group of mice was subjected to a 4-week forced running routine (n = 10 per group). Severity of cutaneous or intestinal inflammation was assessed clinically, by histology and by quantitative PCR. Knees and paws were analysed by micro-CT, histology, immunohistochemistry, second-harmonic generation microscopy and quantitative PCR.

Results
Local induction of inflammation triggered a systemic response with splenomegaly, loss of bone mass and bone marrow changes. Psoriasis- but not inflammatory bowel disease-like inflammation led to synovial lining layer hyperplasia, an increase in infiltrating CD45+ synovial cells, and suppressed entheseal extracellular matrix gene expression levels. Mechanical loading decreased the amount of F4/80+ synovial macrophages in untreated mice only and led to morphological alterations in the collagen fibres of the enthesis.

Conclusion
Systemic inflammation and mechanical loading act independently of each other. The former, originating from distant sites, can trigger mild synovial inflammation in mice, a propensity that may also impact the development of arthritis in patients; the latter has no impact on the severity of systemic inflammation, but independently affects joint homeostasis.
The Dilution of Parents’ Nonmaterial Resources in Stepfamilies: The Role of Complex Sibling Configurations in Parental Involvement
Authors: de Leeuw Suzanne G , Kalmijn Matthijs , van Gaalen Ruben 
Published: June 2021

Abstract
It has been argued that an increase in the number of siblings means that there are fewer parental investments made per child (resource dilution hypothesis). Yet, these studies are mostly based on biological two-parent families in which it can be assumed that parental resources are distributed more or less equally across siblings. This assumption does not hold in the complex family structure of a stepfamily where not all siblings are biologically related and living in the same household. Since more and more children are growing up in stepfamilies, a distinction between sibling types (full/half/step) is needed. In this study, we focus on the dilution of nonmaterial resources (i.e., parental involvement) and use the OKiN dataset to examine paternal (n = 1,077) and maternal (n = 1,369) resources separately. In this way, this study provides the first comprehensive overview of the dilution of parental resources in stepfamilies. While maternal resources are mostly diluted by full siblings, paternal resources are diluted by all sibling types (full, half, and step). We reflect on the implications of these results for the literature on sibship size as well as the literature on social mobility.
Adaptation and feasibility of a multimodal mindfulness-based intervention to promote sexual health in cancer survivorship
Authors: Gorman Jessica R , Drizin Julia H , Al-Ghadban Fatima A , Rendle Katharine A 
Published: June 2021

Abstract
Sexual health concerns after cancer are common and distressing, and mindfulness-based interventions (MBIs) are effective in supporting women experiencing these concerns. The goals of this study were to: (i) systematically adapt and document modifications to a mindfulness-based sexual health intervention for cancer survivors in a community setting and (ii) assess feasibility, appropriateness, and acceptability, and to identify strategies to increase reach for future implementation and dissemination. Following the ADAPT-ITT model, we first conducted key informant interviews with 10 female cancer survivors and four healthcare providers to obtain feedback on perceived need and feasibility of the intervention approach, and preferences for content, structure, and delivery format. This feedback informed initial intervention adaptations, which we then pretested with five female cancer survivors. We tracked and coded intervention adaptations. Key informant cancer survivors and providers confirmed the lack of sexual health services, acceptability of a sexual health MBI, and identified initial adaptations including modifying the intervention for delivery in a community, rather than clinical, setting. Pretest participants (aged 48–57) were survivors of breast (n = 4) and cervical (n = 1) cancer. All participants completed the intervention attending an average of 7.2 of 8 weekly sessions. Qualitative and quantitative results suggest the intervention was feasible, appropriate and acceptable. Engaging stakeholders in the adaptation process is essential for creating a feasible, appropriate, and acceptable intervention. Tracking intervention modifications contributes to our overall understanding of how MBIs can be adapted for new populations and contexts.
A 20-year perspective on the Ottawa Ankle Rules
Authors: Herman Lawrence 
Published: June 2021

ABSTRACT
The Ottawa Ankle Rules, finalized in 1995, are a clinical decision directive for the use of radiographs in patients with traumatic ankle and foot injuries. The researchers who developed the rules defined clinically insignificant ankle fractures as distal fibular or malleolar chip fractures of 3 mm or less. They concluded that at least one-third of all ankle and foot radiographs could be eliminated by using their rules, which have since been adopted as the standard of care in EDs. This article explores whether, after more than 20 years in use, the Ottawa Ankle Rules are still valid, and whether they should continue to be used or be replaced by a superior protocol.
Can loratadine help in treating granulocyte-colony stimulating factor-induced bone pain?
Authors: Gajarawala Shilpa N. , Pelkowski Jessica N. , DeStephano Christopher C. 
Published: June 2021

ABSTRACT
Febrile neutropenia is an oncologic emergency with serious consequences. Granulocyte colony stimulating factors (G-CSFs), used to stimulate neutrophil production to prevent febrile neutropenia, can cause bone pain in more than 25% of patients. Severe bone pain may not respond to acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or dose reduction of the G-CSF agent. A study found that patients taking loratadine had fewer treatment-associated adverse reactions and discontinuations than those on naproxen. Although more research is needed, loratadine's tolerability, ease of administration, and potential benefit mean that it should be considered for management of pegfilgrastim-associated bone pain. This article describes a patient whose G-CSF-induced bone pain was completely alleviated by loratadine.
Comparing physicians and PAs as solo providers in a rural ED
Authors: Moore S. Jason 
Published: June 2021

ABSTRACT

Objective:
To examine the use of physician assistants (PAs) as solo providers in rural EDs.

Methods:
This study compared ED metrics and patient characteristics between physicians and PAs at a critical access hospital in Arizona.

Results:
Nearly 26,000 patient encounters from the ED of the host institution were analyzed. Although minor variances in metrics were appreciated, transfers, 72-hour returns, and death rates were all similar among provider types. Results from this work do not demonstrate a clinically meaningful difference among ED metrics between physicians and PAs.

Conclusions:
Results from this study suggest that an appropriately trained and experienced PA can meet commonly used metrics in the care of patients presenting to this rural ED.
Discontinuation of the USMLE Step 2 Clinical Skills Examination: Studying the Past to Define the Future
Authors: Howley Lisa D. , Engle Deborah L. 
Published: June 2021

The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) was discontinued in January 2021, marking a significant milestone in assessment of clinical skills. In this commentary, the authors trace the history of the Step 2 CS exam—beginning with its early roots in the 1960s up to its discontinuation in 2021. In this new era, the medical education community is replete with opportunities for advancing methodology and content associated with clinical skills assessment. The authors propose 3 main lessons gleaned from this rich history and modern evolution, which are aimed at defining a future that includes creative collaboration toward development of comprehensive, equitable, student-focused, and patient-centered clinical performance assessment.
First, as it has done throughout history, the medical education community should continue to innovate, collaborate, and improve upon methods of clinical skills assessment. Second, medical educators should continue to shift to more complex and student-driven approaches of assessment, that is, assessments that provide an unstructured environment, are realistic with respect to the natural conditions, and do not limit students to lists of options or force them to take a certain path of reasoning. Third, medical educators should continue to rethink the role of assessment and ensure that all assessments, regardless of stakes or type, provide sufficient feedback for the student to identify areas of strength and weakness.
Clinical Characteristics and Histologic Features of Hysterectomy Specimens From Transmasculine Individuals
Authors: Cao Connie D. , Amero Molly A. , Marcinkowski Katrina A. , Rosenblum Norman G. , Chan Joanna S. Y. , Richard Scott D. 
Published: June 2021

OBJECTIVE:
To describe the clinical characteristics of transmasculine individuals who underwent hysterectomy and characterize surgical pathology findings.

METHODS:
Under an institutional review board-approved protocol, transmasculine individuals who were undergoing hysterectomy and bilateral salpingectomy or bilateral salpingo-oophorectomy were retrospectively identified from a single institution. Past medical, surgical, obstetric, and gynecologic history were collected, including prior testosterone use, cervical cancer screening status, and preoperative pelvic imaging. Surgical pathologic findings of the endometrium, ovaries, and cervix were collected.

RESULTS:
A total of 72 individuals were included. The median age was 30 years (range 19–51). The majority of patients had private insurance (n=53, 74%) and were on testosterone at time of the preoperative visit (n=63, 88%). Forty-two patients (58%) reported anxiety, depression, or bipolar disorder, and 34 patients (47%) were taking an antidepressant or mood stabilizer. Of the 68 patients eligible for cervical cancer screening, 33 (49%) were up to date before their surgical consultation visits. Pelvic pain was the leading indication for surgery (n=65, 90%), and 29 patients (40%) had multiple listed indications for surgery. Surgical pathology results included cervical intraepithelial neoplasia 2–3 in three patients (4%), endometrial or cervical atrophy in 13 patients (18%), and ovarian or paratubal cysts in 16 patients (22%).

CONCLUSION:
This study describes the distinct clinical characteristics and surgical pathology findings that health care professionals should consider when caring for this unique patient population, including a relatively high rate of mental health conditions, pelvic pain as the leading indication for surgery, and the presence of endometrial or cervical atrophy and ovarian or paratubal cysts on surgical pathology.
Pregnancy Outcomes Associated With a Single Elevated Blood Pressure Before 20 Weeks of Gestation
Authors: Duffy Jennifer Y. , Getahun Darios , Chen Qiaoling , Fong Alex 
Published: June 2021

OBJECTIVE:
To evaluate maternal and fetal outcomes among women with a single elevated blood pressure before 20 weeks of gestation.

METHODS:
We conducted a retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals between January 1, 2008, and December 31, 2019. Participants were divided into two groups: normotensive (all systolic blood pressures lower than 130 mm Hg and diastolic pressures lower than 80 mm Hg) compared with single elevated blood pressure (single systolic pressure 130 mm Hg or higher, diastolic pressure 80 mm Hg or higher, or both). Women with chronic hypertension were excluded. Maternal comorbidities and maternal and neonatal outcomes were extracted from electronic health records using International Classification of Diseases codes. Adjusted odds ratios (aORs) derived from logistic regression were used to describe the magnitude of association.

RESULTS:
Of 303,689 women who delivered during the study period, 23% had a single elevated blood pressure. Rates of hypertensive disorders of pregnancy differed between the two groups (10.6% for single elevated blood pressure, 4.5% for normotensive group; aOR 2.06, 95% CI 2.00–2.13), as did iatrogenic preterm delivery (3.7% vs 2.7%, respectively; aOR 1.27, 95% CI 1.21–1.33).

DISCUSSION:
Women with a single elevated blood pressure before 20 weeks of gestation are at increased risk for hypertensive disorders of pregnancy and iatrogenic preterm delivery.