bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-Reported Autonomic Dysregulation in Gulf War Illness
Authors: Avery Timothy J , Mathersul Danielle C , Schulz-Heik R Jay , Mahoney Louise , Bayley Peter J 
Published: December 2021

ABSTRACT

Introduction
Autonomic nervous system dysregulation is commonly observed in Gulf War illness (GWI). Using a new sample, we sought to replicate and extend findings from a previous study that found autonomic symptoms predicted physical functioning in Veterans with GWI.

Materials and Methods
A linear regression model was used to predict physical functioning (36-item Short Form Health Survey (SF-36); n = 73, 75% male). First, we examined the predictive value of independent variables individually in the model including: the 31-item Composite Autonomic Symptom Score (COMPASS-31) total score, body mass index (BMI), mental health burden (i.e., post-traumatic stress disorder [PTSD] and/or depression), and COMPASS-31 subscales: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor. Next, we estimated linear regression models containing the three variables (autonomic symptoms, BMI, and mental health burden) identified as predictors of physical functioning from the prior study.

Results
These linear regression models significantly predicted physical functioning and accounted for 15% of the variance with COMPASS-31, 36.6% of variance with COMPASS-31 and BMI, and 38.2% of variance with COMPASS-31, BMI, and mental health burden. Then, forward step-wise linear regressions were applied to explore new models including COMPASS-31 subscales. Two new models accounted for more of the variance in physical functioning: 39.3% with added gastrointestinal symptoms (β = −2.206, P = .001) and 43.4% of variance with both gastrointestinal (β = −1.592, P = .008) and secretomotor subscales (β = −1.533, P = .049). Unlike the previous study we intended to replicate, mental health burden was not a significant predictor in any of our models.

Conclusions
Treatments that address autonomic dysregulation should be prioritized for research and clinical recommendations for Veterans with GWI who experience chronic pain.
Dynamo activity of the K dwarf KOI-883 from transit photometry mapping
Authors: Zaleski S M , Valio A , Carter B D , Marsden S C 
Published: December 2021

ABSTRACT
The Kepler mission target star KOI-883 is notable in being a low-mass K2V dwarf with moderately fast 8.99-d rotation and hosting a single transiting hot Jupiter in a 2.69-d orbit. This combination thus presents a particular opportunity to study star-spot activity by using the many deep planetary transits apparent in the light curve to map the stellar surface. The data have been analysed using spot modelling and temporal mapping methods we have used for other Kepler host stars, and a search for flares was conducted. Our results indicate a low-latitude region of the photosphere marked by distinct areas of individual or grouped star-spots with moderately high solar-type differential rotation of 0.102 ± 0.011 rad d−1, but with just two major flares observed across 400 d. These results imply a rotational shear significantly greater than that of our slower rotating Sun. The observed flares are more energetic than typical solar flares, but similar to those of other magnetically active cool dwarfs.
Binary AGNs simulations with radiation pressure reveal a new duty cycle, and a reduction of gravitational torque, through ‘minitori’ structures
Authors: Williamson David J , Bösch Lars H , Hönig Sebastian F 
Published: December 2021

ABSTRACT
We produce the first set of radiation hydrodynamics simulations of binary active galactic nuclei (AGNs) at parsec-scale separation in scale-model simulations. We use SPH for hydrodynamics, and raytracing to calculate optical depths and radiation pressure from the two AGNs. We confirm that, without radiation pressure, the sign of gravitational torque is sensitive to the binary parameters, although in one of our two orbital configurations the binary should coalesce in a time-scale of &lt;109 yr. However, radiation pressure quickly destroys the ‘minitori’ around each supermassive black hole (SMBH), drastically reducing gravitational torques and accretion, and greatly increasing the coalescence time-scale. Our simulations suggest a new ‘minitorus’ duty cycle with a time-scale of ∼10 binary periods (∼106 yr when scaling our models to a total binary mass of 2 × 107 M⊙). The growth and blow-out phases of the ‘minitori’ are of similar time-scales, and thus we expect about half of observed binary SMBHs to be active, in at least one component. The ‘minitorus’ structure provides asymmetries that could be observed by infrared interferometry.
Lithium abundances as a tracer of asymptotic giant branch star pollution in the globular cluster NGC 6752
Authors: Schiappacasse-Ulloa J , Lucatello Sara , Rain M J , Pietrinferni Adriano 
Published: December 2021

ABSTRACT
This paper presents a chemical abundance analysis of 217 stars in the metal-poor globular cluster NGC 6752, distributed from the turn-off to the lower red giant branch. Al and Li abundances were derived through spectral synthesis applied to spectra collected with FLAMES, in both GIRAFFE and UVES modes. The work aims to gain insight into the nature of the polluter(s) responsible for the abundance variations and the C-N, Na-O, Al-Mg anticorrelations associated with the multiple-population phenomenon. We found a plateau at A(Li) = 2.33 ± 0.06 dex in unevolved stars, with the average Li content decreasing continuously down to ∼1.25 dex at the bottom of the red giant branch. As expected in the classic anticorrelation scenario, we found stars low in Al and high in Li abundance, and stars high in Al and low in Li. However, in addition, we also found evidence of Al-rich, second-generation stars with high Li content. This finding suggests the need for Li production, known to happen in intermediate-mass (∼4–8 M⊙) asymptotic giant branch stars through the Cameron–Fowler mechanism. It is worth noting that the Li abundance observed in Al-rich stars never exceeds that in Al-poor stars.
Strengthening Critical Thinking Skills in Associate Degree Nursing Students Through Combined Pedagogies of Concept Mapping Using the Nursing Process and Simulation
Authors: O'Halloran Bernadette 
Published: December 2021

Abstract
Combining the utility of concept maps using the nursing process with simulation in associate degree nursing programs may help develop the critical thinking and reasoning skills of novice learners. This qualitative case study explored the learning experiences of students enrolled in the first nursing course. Although results showed initial feelings of uncertainty, confusion, and an overwhelming experience, students found the combined pedagogies beneficial in developing essential competencies of critical thinking when utilized consistently across the program. Integrating concept maps into the simulation design as a framework for immersive learning presented both challenges and opportunities.
Bringing Clinical Context to the Classroom in Nursing Pharmacology: A Case Study
Authors: Mauldin Betsy 
Published: December 2021

Abstract
Patient safety is part and parcel of nursing care and is taught throughout nursing education, particularly in core pharmacology, first-semester courses. This timing does not allow for clinical application and fosters a theory-practice gap. Transformational learning theory explains how teachers can engage students in active learning and introduce clinical context into a didactic classroom. To that end, an innovative pharmacology assignment, using a real-time nurse case study, was a structured, in-class activity. Post-class reflection focused on contextualizing learning for nursing students without clinical experience. Students reported transformed thinking regarding the importance of meaningful learning in nursing pharmacology.
Gamification of Primary Care in a Baccalaureate Nursing Education Program
Authors: Pollio E. Whitney , Patton Emily M. , Nichols Lynn S. , Bowers Deborah A. 
Published: December 2021

Abstract
A grant-funded undergraduate nursing elective was designed to increase the bachelor of science in nursing-prepared nursing workforce in primary care. We created a board game to engage students to address complex needs of clients in primary care. Using patient scenario game cards, students identify and discuss levels of prevention, social determinants of health, and resiliency principles as they move along the board. Gamification challenges students to think critically and make decisions about primary care patient scenarios in a safe learning environment. Potential uses for gamification to teach students management of complex patient scenarios are identified.
Operationalizing Programmatic Assessment: The CBME Programmatic Assessment Practice Guidelines
Authors: Rich Jessica V. , Luhanga Ulemu , Fostaty Young Sue , Wagner Natalie , Dagnone J. Damon , Chamberlain Sue , McEwen Laura A. 
Published: December 2021

Problem
Assessing the development and achievement of competence requires multiple formative and summative assessment strategies and the coordinated efforts of trainees and faculty (who often serve in multiple roles, such as academic advisors, program directors, and competency committee members). Operationalizing programmatic assessment (PA) in competency-based medical education (CBME) requires comprehensive practice guidelines, written in accessible language with descriptions of stakeholder activities, to move assessment theory into practice and to help guide the trainees and faculty who enact PA.

Approach
Informed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, the authors used a multiphase, multimethod approach to develop the CBME Programmatic Assessment Practice Guidelines (PA Guidelines). The 9 guidelines are organized by phases of assessment and include descriptions of stakeholder activities. A user guide provides a glossary of key terms and summarizes how the guidelines can be used by different stakeholder groups across postgraduate medical education (PGME) contexts. The 4 phases of guideline development, including internal stakeholder consultations and external expert review, occurred between August 2016 and March 2020.

Outcomes
Local stakeholders and external experts agreed that the PA Guidelines hold potential for guiding initial operationalization and ongoing refinement of PA in CBME by individual stakeholders, residency programs, and PGME institutions. Since July 2020, the PA Guidelines have been used at Queen’s University to inform faculty and resident development initiatives, including online CBME modules for faculty, workshops for academic advisors/competence committee members, and a guide that supports incoming residents’ transition to CBME.

Next Steps
Research exploring the use of the PA Guidelines and user guide in multiple programs and institutions will gather further evidence of their acceptability and utility for guiding operationalization of PA in different contexts.
Association of Brain Injury Biomarkers and Circulatory Shock Following Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study
Authors: Toro Camilo , Jain Sonia , Sun Shelly , Temkin Nancy , Barber Jason , Manley Geoffrey , Komisarow Jordan M. , Ohnuma Tetsu , Foreman Brandon , Korley Frederick , James Michael L. , Laskowitz Daniel , Vavilala Monica S. , Hernandez Adrian , Mathew Joseph P. , Markowitz Amy J. , Krishnamoorthy Vijay ,   the TRACK-TBI Investigators
Published: December 2021

Introduction:
Early circulatory shock following traumatic brain injury (TBI) is a multifactorial process; however, the impact of brain injury biomarkers on the risk of shock has not been evaluated. We examined the association between neuronal injury biomarker levels and the development of circulatory shock following moderate-severe TBI.

Methods:
In this retrospective cohort study, we examined adults with moderate-severe TBI (Glasgow Coma Scale score <13) enrolled in the TRACK-TBI study, an 18-center prospective TBI cohort study. The exposures were day-1 levels of neuronal injury biomarkers (glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1 [UCH-L1], S100 calcium-binding protein B [S100B], neuron-specific enolase), and of an inflammatory biomarker (high-sensitivity C-reactive protein). The primary outcome was the development of circulatory shock, defined as cardiovascular Sequential Organ Failure Assessment Score ≥2 within 72 hours of admission. Association between day-1 biomarker levels and the development of circulatory shock was assessed with regression analysis.

Results:
The study included 392 subjects, with a mean age of 40 years; 314 (80%) were male and 165 (42%) developed circulatory shock. Median (interquartile range) day-1 levels of UCH-L1 (994.8 [518.7 to 1988.2] pg/mL vs. 548.1 [280.2 to 1151.9] pg/mL; P<0.0001) and S100B (0.47 μg/mL [0.25 to 0.88] vs. 0.27 [0.16 to 0.46] μg/mL; P<0.0001) were elevated in those who developed early circulatory shock compared with those who did not. In multivariable regression, there were associations between levels of both UCH-L1 (odds ratio, 1.63 [95% confidence interval, 1.25-2.12]; P<0.0005) and S100B (odds ratio, 1.73 [95% confidence interval 1.27-2.36]; P<0.0005) with the development of circulatory shock.

Conclusion:
Neuronal injury biomarkers may provide the improved mechanistic understanding and possibly early identification of patients at risk for early circulatory shock following moderate-severe TBI.
Are the Arbeitsgemeinschaft Für Osteosynthesefragen (AO) Principles for Long Bone Fractures Applicable to 3-Column Osteotomy to Reduce Rod Fracture Rates?
Authors: Virk Sohrab , Lafage Renaud , Bess Shay , Shaffrey Christopher , Kim Han J. , Ames Christopher , Burton Doug , Gupta Munish , Smith Justin S. , Eastlack Robert , Klineberg Eric , Mundis Gregory , Schwab Frank , Lafage Virginie ,   the International Spine Study Group
Published: December 2021

Objective:
The aim was to determine whether applying Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles for external fixation of long bone fracture to patients with a 3-column osteotomy (3CO) would be associated with reduced rod fracture (RF) rates.

Summary of Background Data:
AO dictate principles to follow when fixating long bone fractures: (1) decrease bone-rod distance; (2) increase the number of connecting rods; (3) increase the diameter of rods; (4) increase the working length of screws; (5) use multiaxial fixation. We hypothesized that applying these principles to patients undergoing a 3CO reduces the rate of RF.

Methods:
Patients were categorized as having RF versus no rod fracture (non-RF). Details on location and type of instrumentation were collected. Dedicated software was used to calculate the distance between osteotomy site and adjacent pedicle screws, angle between screws and the distance between the osteotomy site and rod. Classic sagittal spinopelvic parameters were evaluated.

Results:
The study included 170 patients (34=RF, 136=non-RF). There was no difference in age (P=0.224), sagittal vertical axis correction (P=0.287), or lumbar lordosis correction (P=0.36). There was no difference in number of screws cephalad (P=0.62) or caudal (P=0.31) to 3CO site. There was a lower rate of RF for patients with >2 rods versus 2 rods (P<0.001). Patients with multiplanar rod fixation had a lower rod fracture rate (P=0.01). For patients with only 2 rods (N=68), the non-RF cohort had adjacent screws that trended to have less angulation to each other (P=0.06) and adjacent screws that had a larger working length (P=0.03).

Conclusions:
A portion of AO principles can be applied to 3CO to reduce RF rates. Placing more rods around a 3CO site, placing rods in multiple planes, and placing adjacent screws with a larger working length around the 3CO site is associated with lower RF rates.
Impact of the Coronavirus Disease 2019 Pandemic on Moral Distress Among Nurses and Physicians in Spanish ICUs
Authors: Rodriguez-Ruiz Emilio , Campelo-Izquierdo Maitane , Boga Veiras Paula , Mansilla Rodríguez Montserrat , Estany-Gestal Ana , Blanco Hortas Andrés , Rodríguez-Calvo María Sol , Rodríguez-Núñez Antonio 
Published: December 2021

OBJECTIVES:
To assess the impact of COVID-19 pandemic on moral distress (MD) among healthcare professionals (HCPs) (physicians and nurses) in Spanish ICUs.

DESIGN:
Cross-sectional, prospective study.

SETTING:
ICUs in Spain.

PARTICIPANTS:
HCPs currently working in Spanish ICUs.

INTERVENTIONS:
Data were collected via electronic survey with the use of a 50-item questionnaire in two different periods: prepandemic (October-December 2019) and during the second wave of COVID-19 (September-November 2020).

MEASUREMENTS AND MAIN RESULTS:
During the prepandemic and pandemic periods, 1,065 (57.1% nurses) and 1,115 (58.5% nurses) HCPs completed the questionnaire, respectively. Higher MD levels were reported during COVID-19 pandemic, particularly among ICU nurses, when compared with the prepandemic period. Before COVID-19, physicians reported significantly higher levels of MD than ICU nurses (80.0 [interquartile range {IQR}, 40.0–135.0] vs 61.0 [IQR, 35.0–133.0]; p = 0.026). These differences disappeared during the pandemic period (81.0 [IQR, 39.0–138.5] vs 74.0 [IQR, 41.0–143.0]; p = 0.837). During the pandemic, younger and less experienced HCPs working in hospital areas that were converted in ICU or in ICUs with multiple occupancy rooms reported higher MD levels. In addition, HCPs who were off work for psychologic burden reported higher MD levels (108.0 [IQR, 66.0–139.0] vs 76.0 [IQR, 40.0–141.0]; p < 0.05). In the prepandemic period, patient-level root causes were the most morally distressing for nurses, whereas physicians reported higher MD on system-level root causes. During the pandemic, both groups reported higher MD on system-level root causes. During COVID-19, significantly more HCPs considered leaving their job due to MD.

CONCLUSIONS:
MD has increased among ICU HCPs in Spain during COVID-19 pandemic. Physicians reported higher MD levels than nurses in the prepandemic period, whereas both HCPs groups reported similar MD levels in the pandemic period. Strategies are needed and should be implemented to mitigate MD among HCPs.
Prognostic value of high-frequency oscillations combined with multimodal imaging methods for epilepsy surgery
Authors: Yan Xiaoming , Yin Fangzhao , Xu Cuiping , Yu Tao , Li Xiaonan , Wang Wei , Zhang Xi , Ma Kai , Zhang Guojun 
Published: December 2021

Abstract

Background:
The combination of high-frequency oscillations (HFOs) with single-mode imaging methods has been proved useful in identifying epileptogenic zones, whereas few studies have examined HFOs combined with multimodal imaging methods. The aim of this study was to evaluate the prognostic value of ripples, an HFO subtype with a frequency of 80 to 200 Hz is combined with multimodal imaging methods in predicting epilepsy surgery outcome.

Methods:
HFOs were analyzed in 21 consecutive medically refractory epilepsy patients who underwent epilepsy surgery. All patients underwent positron emission tomography (PET) and deep electrode implantation for stereo-electroencephalography (SEEG); 11 patients underwent magnetoencephalography (MEG). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting surgical outcome were calculated for ripples combined with PET, MEG, both PET and MEG, and PET combined with MEG. Kaplan-Meier survival analyses were conducted in each group to estimate prognostic value.

Results:
The study included 13 men and 8 women. Accuracy for ripples, PET, and MEG alone in predicting surgical outcome was 42.9%, 42.9%, and 81.8%, respectively. Accuracy for ripples combined with PET and MEG was the highest. Resection of regions identified by ripples, MEG dipoles, and combined PET findings was significantly associated with better surgical outcome (P
< 0.05).

Conclusions:
Intracranial electrodes are essential to detect regions which generate ripples and to remove these areas which indicate good surgical outcome for medically intractable epilepsy. With the assistance of presurgical noninvasive imaging examinations, PET and MEG, for example, the SEEG electrodes would identify epileptogenic regions more effectively.
Treatment and disease management patterns for bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer in North America, Europe and Asia: A real-world data analysis
Authors: Broughton Edward I. , Chun Danielle S. , Gooden Kyna M. , Mycock Katie L. , Rajkovic Ivana , Taylor-Stokes Gavin 
Published: December 2021

Abstract

Background
This study examined real-world treatment and management of bacillus Calmette-Guérin (BCG)-unresponsive patients across 3 continents, including patients unable or unwilling to undergo cystectomy.

Materials and methods
Physicians actively involved in managing patients with nonmuscle invasive bladder cancer completed online case report forms for their 5 consecutive patients from the broad BCG-unresponsive population and a further 5 consecutive BCG-unresponsive patients who did not undergo cystectomy (in Japan, physicians provided a total of 5 patients across both cohorts).

Results
Most patients had received 1 (37%) or 2 (24%) maintenance courses of BCG. Five or more maintenance BCG courses were received by patients in Japan (59%) and China (31%), while in Germany 76% of patients received only 1 course. Most patients became BCG-unresponsive during their first (44%) or second (22%) treatment course; in Germany, 77% became BCG-unresponsive during their first treatment course. Most countries did not provide another course of BCG after a patient first became unresponsive, whereas unresponsive patients in Japan and China were most likely to be retreated with BCG. “Untreated - on watch and wait” was the main treatment/management approach received post-BCG treatment for 42% or more of patients in most countries except China (39%) and the United States (36%). “Following treatment guidelines” was consistently the top reason for post-BCG treatment selection across all treatment options.

Conclusions
This study confirmed the global unmet need for patients with nonmuscle invasive bladder cancer, and found that many patients experienced periods of no treatment after not responding to BCG therapy.
Meningothelial Hamartoma of the Scalp in a Child With Gorlin Syndrome
Authors: Legaspi Christiana , Riesel Johanna N. , Putra Juan 
Published: December 2021

Abstract:
Meningothelial hamartoma of the scalp is a rare entity characterized by a mix of meningothelial tissue and various connective tissue elements. To the best of the authors' knowledge, there has only been one reported case of meningothelial hamartoma of the scalp in the setting of Gorlin syndrome in the literature. In this report, we describe the case of a 3-year-old boy with Gorlin syndrome who presented with a congenital scalp lesion. Histologic examination revealed scattered islands of meningothelial cells in a background of dense fibrous and vascular tissue, in keeping with meningothelial hamartoma of the scalp. The differential diagnoses of congenital scalp lesions and the association between Gorlin syndrome and meningothelial hamartoma of the scalp are discussed.