bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discriminating Bacterial and Viral Infection Using a Rapid Host Gene Expression Test*
Authors: Tsalik Ephraim L. , Henao Ricardo , Montgomery Jesse L. , Nawrocki Jeff W. , Aydin Mert , Lydon Emily C. , Ko Emily R. , Petzold Elizabeth , Nicholson Bradly P. , Cairns Charles B. , Glickman Seth W. , Quackenbush Eugenia , Kingsmore Stephen F. , Jaehne Anja K. , Rivers Emanuel P. , Langley Raymond J. , Fowler Vance G. , McClain Micah T. , Crisp Robert J. , Ginsburg Geoffrey S. , Burke Thomas W. , Hemmert Andrew C. , Woods Christopher W. 
Published: April 2021

OBJECTIVES:
Host gene expression signatures discriminate bacterial and viral infection but have not been translated to a clinical test platform. This study enrolled an independent cohort of patients to describe and validate a first-in-class host response bacterial/viral test.

DESIGN:
Subjects were recruited from 2006 to 2016. Enrollment blood samples were collected in an RNA preservative and banked for later testing. The reference standard was an expert panel clinical adjudication, which was blinded to gene expression and procalcitonin results.

SETTING:
Four U.S. emergency departments.

PATIENTS:
Six-hundred twenty-three subjects with acute respiratory illness or suspected sepsis.

INTERVENTIONS:
Forty-five–transcript signature measured on the BioFire FilmArray System (BioFire Diagnostics, Salt Lake City, UT) in ~45 minutes.

MEASUREMENTS AND MAIN RESULTS:
Host response bacterial/viral test performance characteristics were evaluated in 623 participants (mean age 46 yr; 45% male) with bacterial infection, viral infection, coinfection, or noninfectious illness. Performance of the host response bacterial/viral test was compared with procalcitonin. The test provided independent probabilities of bacterial and viral infection in ~45 minutes. In the 213-subject training cohort, the host response bacterial/viral test had an area under the curve for bacterial infection of 0.90 (95% CI, 0.84–0.94) and 0.92 (95% CI, 0.87–0.95) for viral infection. Independent validation in 209 subjects revealed similar performance with an area under the curve of 0.85 (95% CI, 0.78–0.90) for bacterial infection and 0.91 (95% CI, 0.85–0.94) for viral infection. The test had 80.1% (95% CI, 73.7–85.4%) average weighted accuracy for bacterial infection and 86.8% (95% CI, 81.8–90.8%) for viral infection in this validation cohort. This was significantly better than 68.7% (95% CI, 62.4–75.4%) observed for procalcitonin (p < 0.001). An additional cohort of 201 subjects with indeterminate phenotypes (coinfection or microbiology-negative infections) revealed similar performance.

CONCLUSIONS:
The host response bacterial/viral measured using the BioFire System rapidly and accurately discriminated bacterial and viral infection better than procalcitonin, which can help support more appropriate antibiotic use.
Profiloplasty in One Session Versus Single Treatment Areas
Authors: Romeo Francesco 
Published: April 2021

BACKGROUND
Fillers have been widely used to improve facial profile, and a better result is obtained if the entire profile is treated at the same time.

OBJECTIVE
To compare the outcomes of 2 groups of patients: the former undergoing a treatment in a single area to improve the facial profile, and the latter undergoing a total profiloplasty reharmonization in 1 session.

MATERIALS AND METHODS
The outcomes of this study have been evaluated using both the angle of convexity and the Global Aesthetic Improvement Scale method.

RESULTS
This study demonstrates that the approval rating increases by 56.3% for patients, 81.3% for the practitioner, and 76.3% for an independent practitioner when a synchronous treatment is used to improve the facial profile as compared with a single treatment of 1 profile area.

CONCLUSION
The profiloplasty treatment in 1 session allows the achievement of a more harmonic facial profile and increases the patient's approval as compared with treatments of a single facial area.
Estimating the Effectiveness of Rotavirus Vaccine Schedules
Authors: Butler Anne M. , Breskin Alexander , Sahrmann John M. , Brookhart M. Alan 
Published: April 2021

Background:
Important questions exist regarding the comparative effectiveness of alternative childhood vaccine schedules; however, optimal approaches to studying this complex issue are unclear.

Methods:
We applied methods for studying dynamic treatment regimens to estimate the comparative effectiveness of different rotavirus vaccine (RV) schedules for preventing acute gastroenteritis-related emergency department (ED) visits or hospitalization. We studied the effectiveness of six separate protocols: one- and two-dose monovalent rotavirus vaccine (RV1); one-, two-, and three-dose pentavalent rotavirus vaccine (RV5); and no RV vaccine. We used data on all infants to estimate the counterfactual cumulative risk for each protocol. Infants were censored when vaccine receipt deviated from the protocol. Inverse probability of censoring-weighted estimation addressed potentially informative censoring by protocol deviations. A nonparametric group-based bootstrap procedure provided statistical inference.

Results:
The method yielded similar 2-year effectiveness estimates for the full-series protocols; weighted risk difference estimates comparing unvaccinated children to those adherent to either full-series (two-dose RV1, three-dose RV5) corresponded to four fewer hospitalizations and 12 fewer ED visits over the 2-year period per 1,000 children. We observed dose–response relationships, such that additional doses further reduced risk of acute gastroenteritis. Under a theoretical intervention to fully vaccinate all children, the 2-year risk differences comparing full to observed adherence were 0.04% (95% CI = 0.03%, 0.05%) for hospitalizations and 0.17% (95% CI = 0.14%, 0.19%) for ED visits.

Conclusions:
The proposed approach can generate important evidence about the consequences of delaying or skipping vaccine doses, and the impact of interventions to improve vaccine schedule adherence.
Perimesencephalic Subarachnoid Hemorrhage in Pregnancy: A Case Report
Authors: Ruggieri Stefania , Gatto Maurizia , Gentile Maria Annunziata , D’Oria Salvatore , Tamma Filippo , Caringella Domenico , Giocolano Alessandra , Taccaliti Chiara , Guido Maurizio 
Published: April 2021

Abstract
Perimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.
Improvement of Vision and Ocular Surface Symptoms With a Scleral Lens After Microbial Keratitis
Authors: Macedo-de-Araújo Rute J. , McAlinden Colm , van der Worp Eef , González-Méijome José M. 
Published: April 2021

Abstract:
A 38-year-old woman, previous daily disposable soft contact lens wearer, reported an episode of microbial keratitis positive for Pseudomonas aeruginosa 11 months before contacting the investigators. After acute treatment, she was left with a degree of opacity in the pupillary area, corneal scar, and an irregular corneal profile, with a best spectacle visual acuity of +0.48 logarithm of the minimum angle of resolution. A scleral lens was able to mask those corneal sequelae and, even considering the corneal opacity, the visual acuity recovered to +0.06 logarithm of the minimum angle of resolution. The patient was fitted with a 16.4-mm scleral lens and attended several appointments over a 12-month follow-up period. After 12 months of scleral lens wear, the improvement of both high-contrast and low-contrast visual acuities remained stable and a clearing of the corneal opacity was observed. The comfort was assessed with the Ocular Surface Disease Index questionnaire, which depicted a comfort enhancement from 75.0 to 47.9 over the short term. The Quality of Vision questionnaire was also administrated and showed an improvement on frequency, severity, and bothersome of the vision-related symptoms over time. Scleral lens may be a good option to improve vision, comfort, and restore the ocular surface function in patients with corneal scars and opacities secondary to microbial keratitis.
Evaluation of the Quality, Reliability, and Educational Content of YouTube Videos as an Information Source for Soft Contact Lenses
Authors: Yildiz Merve Beyza , Yildiz Elvin , Balci Sevcan , Özçelik Köse Alev 
Published: April 2021

Objectives:
To evaluate the quality, reliability, and educational content of YouTube videos related to soft contact lenses (CL).

Methods:
An online YouTube search was performed for the terms contact lens and other common CL-related terms contact lens insertion and removal, contact lens wearing, and contact lens care. The first 50 videos were evaluated for each term. Videos were evaluated using three checklists (the modified DISCERN criteria, the Journal of the American Medical Association [JAMA] criteria, and Global Quality Score [GQS]). Video popularity was also evaluated using the video power index (VPI). Videos were classified into three groups according to the source of the upload; group 1: universities/occupational organizations, group 2: medical ad/profit-oriented companies, and group 3: independent users.

Results:
From among the 200 videos analyzed, 79 were included. The mean mDISCERN score of the videos was 2.34±1.39, the mean JAMA score was 1.20±0.99, and the mean GQS value was 3.47±1.28. There were positive correlations between the three checklists (P<0.001). Video power index was not correlated with each score. The videos in group 1 (13.9%) had the highest scores whereas videos in group 3 (41.8%) had the lowest scores. There was no significant difference between the video sources according to the VPI.

Conclusion:
Although some YouTube videos contain useful information for CL wearers, most videos have poor quality and reliability and contain insufficient information. Eye care providers should be aware of these sources and steer CL users to information sources that provide accurate and reliable information and do not contain misleading information.
Investigation of the Peripapillary Choriocapillaris in Normal Tension Glaucoma, Primary Open-angle Glaucoma, and Control Eyes
Authors: Bhalla Mahadev , Heisler Morgan , Mammo Zaid , Ju Myeong Jin , Sarunic Marinko V. , Navajas Eduardo V. , Warner Simon , Schendel Steven , Gill Kulbir S. 
Published: April 2021

Precis:
The peripapillary choriocapillaris (CC) was observed to be significantly impaired in normal tension glaucoma (NTG) subjects compared with normal controls using optical coherence tomography angiography (OCTA).

Purpose:
The aim was to quantitatively evaluate the peripapillary CC in NTG, primary open-angle glaucoma (POAG), and control eyes using OCTA.

Materials and Methods:
Ninety eyes (30 controls, 30 NTG, and 30 POAG) from 73 patients were imaged using the Zeiss Plex Elite 9000. Five repeat 3×3 mm OCTA scans were acquired both nasally and temporally to the optic disc and subsequently averaged. Four CC flow deficit (FD) measures were calculated using the fuzzy C-means approach: FD density (FDD), mean FD size (MFDS), FD number (FDN), and FD area (FDA).

Results:
Temporal NTG CC parameters were associated with visual field index and mean deviation (P<0.05). The control group showed a significantly lower nasal FDD (nasal: 3.79±1.26%, temporal: 4.48±1.73%, P=0.03), FDN (nasal: 156.43±38.44, temporal: 178.40±45.68, P=0.02), and FDA (nasal: 0.22±0.08, temporal: 0.26±0.10, P=0.03) when compared with temporal optic disc. The NTG group showed a significantly higher FDD (NTG: 5.04±2.38%, control: 3.79±1.26%, P=0.03), FDN (NTG: 185.90±56.66, control: 156.43±38.44, P=0.04), and FDA (NTG: 0.30±0.14 mm2, control: 0.22±0.08 mm2, P=0.03) nasal to the optic disc compared with controls.

Conclusions:
Association between CC parameters and glaucoma severity in NTG, but not POAG subjects, suggests vascular abnormalities may be a potential factor in the multifactorial process of glaucoma damage in NTG patients.
A Case Report of Methylobacterium radiotolerans Bacteremia and Brain Abscesses
Authors: Tang Wesley , Desai Alpa , Desai Kunal 
Published: April 2021

Abstract

Methylobacterium radiotolerans is a ubiquitous organism found in the environment and is considered an opportunistic pathogen of low virulence in humans. Most human infections from M. radiotolerans have been reported in immunocompromised hosts and have been reported mainly as bloodstream infections related to central venous catheters. We present the first known case of M. radiotolerans as a causative agent of multiple brain abscesses in an immunocompromised host.
Leadership in Healthcare: Transitioning From Clinical Professional to Healthcare Leader
Authors: Perez Jessica 
Published: April 2021

EXECUTIVE SUMMARY
Clinical professionals may not have the necessary evidence-based knowledge regarding specific leadership styles to succeed in a leadership role. This article examines the various leadership styles that can be adopted by a clinical professional who transitions into a leadership role. The Path-Goal theory developed by Robert House in 1971 was used as the theoretical lens for this study. Twenty scholarly, peer-reviewed articles written in English and published between 2015 and 2020 were analyzed and synthesized to develop the findings. The findings showed that employee retention was positively associated with transformational and authentic leadership styles; organizational commitment was positively associated with transformational, transactional, and authentic leadership styles; and job satisfaction was positively associated with transformational and authentic leadership styles. In particular, a transformational leadership style demonstrated higher rates of employee retention and job satisfaction than did transactional and laissez-faire leadership styles. The authentic and transformational leadership styles each saw increased job satisfaction and commitment, but a correlation between the authentic leadership style and those benefits was less evident. Clinical professionals should apply the transformational leadership style to become effective leaders.
Association of Parent Workplace Injury With Emotional and Behavioral Problems in Children
Authors: Asfaw Abay , Sauter Steven L. , Swanson Naomi , Beach Cheryl M. , Sauter Diana L. 
Published: April 2021

Objective:Investigate associations between occupational injury to parents and the psychological well-being of their children.Methods:We used multiple logistic regression to examine effects of occupational injury to parents on measures of psychological well-being among their children using National Health Interview Survey data from 2012 through 2016.Results:Children of injured workers exhibited greater impairment than children of workers who had not sustained injuries for four of five measures of emotional and behavioral functioning that were hypothesized to differentiate these two child groups. A significant group difference was not observed for a sixth behavioral measure that was expected to be insensitive to parent occupational injury.Conclusion:Study findings heighten concern over downstream effects of occupational injury and signal need for more expansive investigation of these effects and mitigation strategies among children of injured workers.
Brief Report: Prevalence Trend of Transmitted Drug Resistance in a Prospective Cohort of Thai People With Acute HIV Infection
Authors: Muccini Camilla , Pinyakorn Suteeraporn , Sirivichayakul Sunee , Kroon Eugene , Sacdalan Carlo , Crowell Trevor A. , Trichavaroj Rapee , Ananworanich Jintanat , Vasan Sandhya , Phanuphak Nittaya , Colby Donn J. ,   On Behalf of the RV254 Study Group
Published: April 2021

Background:
The greater availability of different antiretroviral therapy regimens in developing countries may influence the emergence of transmitted drug resistance (TDR). People with acute HIV infection (AHI) represent the best opportunity for real-time monitoring of TDR. This study assessed the TDR prevalence trends over time in a Thai cohort of predominantly men who have sex with men (MSM) with AHI.

Methods:
At the time of RV254/SEARCH010 study (NCT00796146) enrollment and before starting ART, HIV genotyping was used to identify mutations in the reverse transcriptase and protease genes. Testing for TDR mutations was obtained by a validated in-house method with TRUGENE assay in a subset. Genotype sequences were analyzed using the Stanford University HIV Drug Resistance Database.

Results:
Genotyping was performed for 573 participants with AHI. Their median age was 26 years (interquartile range 22–31), 97.4% were men, and 94.1% were MSM. Overall TDR prevalence was 7.0%, declining from 12.5% in 2009–2010 to 4.8% in 2017–2018. A declining resistance prevalence to nonnucleoside reverse transcriptase inhibitor emerged from 9.4% in 2009–2010 to 3.5% in 2017–2018 and to nucleoside reverse transcriptase inhibitor from 6.3% to 2.1%. Protease inhibitor resistance showed a decreased TDR level from 3.1% in 2009–2010 to 1.4% in 2017–2018.

Conclusions:
We report an encouraging declining trend in TDR prevalence in a Thai cohort of mainly MSM from 2009 to 2018; in 2017–2018, we observed a low TDR prevalence according to the World Health Organization definition.
Brief Report: “I Didn't Really Have a Primary Care Provider Until I Got PrEP”: Patients' Perspectives on HIV Preexposure Prophylaxis as a Gateway to Health Care
Authors: Sewell Whitney C. , Powell Victoria E. , Ball-Burack Maya , Mayer Kenneth H. , Ochoa Aileen , Marcus Julia L. , Krakower Douglas S. 
Published: April 2021

Background:
HIV prevention is the primary goal of preexposure prophylaxis (PrEP); however, ancillary benefits may exist, including PrEP as an entry point to primary care.

Objective:
To explore PrEP users' perspectives on how PrEP use relates to broader engagement in health care.

Design:
In-depth qualitative interviews.

Participants:
We recruited PrEP users aged 18 years or older from a social media group for people interested in PrEP information and a Boston community health center specializing in health care for sexual and gender minorities.

Approach:
Inductive content analysis to identify emergent themes.

Key results:
All 25 participants were men who have sex with men, whose mean age was 34 years, and 84% were White. Three major themes emerged: (1) accessing PrEP was a strong motivator for initial and continued engagement in health care, which for some evolved over time into accessing comprehensive primary care; (2) provider awareness and attitudes about PrEP influenced participants' ongoing engagement in health care; and (3) PrEP engendered a positive sense of control over users' personal health, giving them agency in reducing their risk of HIV and engaging in other aspects of their health. Quarterly PrEP visits helped participants establish and maintain a relationship with a primary care provider, access non–HIV-related care services, and feel empowered to keep themselves healthy.

Conclusions:
The benefits of PrEP extend beyond HIV prevention to broader engagement in health care, including new relationships with primary care providers and use of other preventive health care services. To maximize those benefits, efforts are needed to ensure that providers are aware, nonjudgmental, and supportive of PrEP use.
Therapeutically Targeting Microvascular Leakage in Experimental Hemorrhagic SHOCK: A Systematic Review and Meta-Analysis
Authors: van Leeuwen Anoek L.I. , Borgdorff Marieke P. , Dekker Nicole A.M. , van den Brom Charissa E. 
Published: April 2021

ABSTRACT

Background:
Microvascular leakage is proposed as main contributor to disturbed microcirculatory perfusion following hemorrhagic shock and fluid resuscitation, leading to organ dysfunction and unfavorable outcome. Currently, no drugs are available to reduce or prevent microvascular leakage in clinical practice. We therefore aimed to provide an overview of therapeutic agents targeting microvascular leakage following experimental hemorrhagic shock and fluid resuscitation.

Methods:
PubMed, EMBASE.com, and Cochrane Library were searched in January 2021 for preclinical studies of hemorrhagic shock using any therapeutic agent on top of standard fluid resuscitation. Primary outcome was vascular leakage, defined as edema, macromolecule extravasation, or glycocalyx degradation. Drugs were classified by targeting pathways and subgroup analyses were performed per organ.

Results:
Forty-five studies, published between 1973 and 2020, fulfilled eligibility criteria. The included studies tested 54 different therapeutics mainly in pulmonary and intestinal vascular beds. Most studies induced trauma besides hemorrhagic shock. Forty-four therapeutics (81%) were found effective to reduce microvascular leakage, edema formation, or glycocalyx degradation in at least one organ. Targeting oxidative stress and apoptosis was the predominantly effective strategy (SMD: −2.18, CI [−3.21, −1.16], P < 0.0001). Vasoactive agents were found noneffective in reducing microvascular leakage (SMD: −0.86, CI [−3.07, 1.36], P = 0.45).

Conclusion:
Pharmacological modulation of pathways involved in cell metabolism, inflammation, endothelial barrier regulation, sex hormones and especially oxidative stress and apoptosis were effective in reducing microvascular leakage in experimental hemorrhagic shock with fluid resuscitation. Future studies should investigate whether targeting these pathways can restore microcirculatory perfusion and reduce organ injury following hemorrhagic shock.

Systematic review registration number:
CRD42018095432.
Central vein sign and iron rim in multiple sclerosis: ready for clinical use?
Authors: Preziosa Paolo , Rocca Maria A. , Filippi Massimo 
Published: April 2021

Purpose of review
To summarize recent evidence from the application of susceptibility-based MRI sequences to investigate the ‘central vein sign’ (CVS) and ‘iron rim’ as biomarkers to improve the diagnostic work-up of multiple sclerosis (MS) and predict disease severity.

Recent findings
The CVS is a specific biomarker for MS being detectable from the earliest phase of the disease. A threshold of 40% of lesions with the CVS can be optimal to distinguish MS from non-MS patients. Iron rim lesions, reflecting chronic active lesions, develop in relapsing-remitting MS patients and persist in progressive MS. They increase in size in the first few years after their formation and then stabilize. Iron rim lesions can distinguish MS from non-MS patients but not the different MS phenotypes. The presence of at least four iron rim lesions is associated with an earlier clinical disability, higher prevalence of clinically progressive MS and more severe brain atrophy. Automated methods for CVS and iron rim lesion detection are under development to facilitate their quantification.

Summary
The assessment of the CVS and iron rim lesions is feasible in the clinical scenario and provides MRI measures specific to MS pathological substrates, improving diagnosis and prognosis of these patients.