bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Summary of Residential Radon Surveys and the Influence of Housing Characteristics on Indoor Radon Levels in Canada
Authors: Chen Jing 
Published: September 2021

Abstract
Based on community and nationwide radon surveys with long-term radon measurements in a total of 21,818 homes, radon distribution characteristics in Canada have been reassessed with the population-weighted arithmetic mean radon concentration of 82 Bq m−3, geometric mean radon concentration of 55 Bq m−3, and geometric standard deviation of 2.45. The major pathway for the influx of radon into Canadian homes is from the surrounding soil. Statistical analysis has shown that radon levels in houses with a basement are, on average, about twice the radon levels in houses without a basement, and houses with private wells also tend to have higher radon concentrations than houses with municipal water supply.
Guidelines for the Diagnosis and Treatment of Dengue in China
Authors: Zhang Fuchun , He Jianfeng , Peng Jie , Tang Xiaoping , Qin Chengfeng , Lu Hongzhou , Li Xingwang , Liu Qingquan , Zhao Hong , Sheng Jifang , Wang Guiqiang 
Published: September 2021

Abstract
Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. As a dengue non-endemic country, China has experienced several dengue outbreaks in recent years. However, dengue patients in China display clinical characteristics that are distinct from those of patients in dengue-endemic countries. To standardize the diagnosis and treatment of dengue fever, the experts at the Society of Infectious Diseases, Society of Tropical Medicine and Parasitology of the Chinese Medical Association, and the Society of Emergency Medicine of China Association of Chinese Medicine have developed a guideline after reviewing the following guidelines and data: guidelines for diagnosis, treatment, prevention, and control of dengue (World Health Organization, 2009); the guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China, 2014, Edition 2); health industry standard of the People's Republic of China “diagnosis for dengue fever (WS216-2018)”; and systemic reports on dengue. The new guideline includes eight aspects: introduction, terminology, epidemiology and prevention, etiology and pathogenesis, clinical features, diagnosis, treatment, and problems to be solved.
Learning From the Lived Experiences of People With Opioid Use Disorder
Authors: Manganti Jamie K. , Mahmoud Khadejah F. , Mitchell Ann M. , Germack Hayley D. 
Published: September 2021

Abstract

Background
Opioid use disorder (OUD) is a national public health crisis causing more than 130 daily deaths and costing over $78 billion annually. Medication-assisted treatment is one of the available treatments for OUD. However, stigma associated with opioid use is a main barrier to patients’ access to treatment and recovery. It is critical to address OUD-related stigma and its impact on interdisciplinary undergraduate students’ knowledge and attitudes.

Objective
The purpose of this pilot study was to examine the impact of a recovery-oriented educational intervention highlighting individuals who have lived experiences with OUD to address OUD-related stigma among undergraduate students.

Methods
A pretest–posttest design was utilized. Before and after this intervention, students received a questionnaire derived from three established tools related to exposure, personal stigma, and perceptions of public stigma toward opioids and people who use them. These categories were also assessed qualitatively using open-ended questions.

Results
Nine students completed the pretest and posttest. Overall, there were small positive changes in students’ personal stigma and public stigma perceptions. Students displayed prior knowledge and exposure to people with OUD through clinical experience, personal relationships, and the media.

Conclusion
Further studies should evaluate the impact of learning from the lived experiences of individuals with OUD on larger undergraduate student populations with the goal of incorporating these educational interventions utilizing lived experiences in college-level curriculum.
Effectiveness of a Nurse-Led Web-Based Health Management in Preventing Women With Gestational Diabetes From Developing Metabolic Syndrome
Authors: SU Mei-Chen , CHAO An-Shine , CHANG Min-Yu , CHANG Yao-Lung , CHEN Chien-Lan , SUN Jui-Chiung 
Published: September 2021

ABSTRACT

Background
Women with gestational diabetes mellitus (GDM) are more likely to develop metabolic syndrome (MS). However, the effectiveness of web-based health management in preventing women at high risk of GDM from developing MS has rarely been studied.

Purpose
The aim of this study was to evaluate the longitudinal effects of nurse-led web-based health management on maternal anthropometric, metabolic measures, and neonatal outcomes.

Methods
A randomized controlled trial was conducted from February 2017 to February 2018, in accordance with the Consolidated Standards of Reporting Trials guidelines. Data were collected from 112 pregnant women at high risk of GDM who had been screened from 984 potential participants in northern Taiwan. Participants were randomly assigned to the intervention group (n = 56) or the control group (n = 56). The intervention group received a 6-month nurse-led, web-based health management program as well as consultations conducted via the LINE mobile app. Anthropometric and metabolic measures were assessed at baseline (Time 0, prior to 28 weeks of gestation), Time 1 (36–40 weeks of gestation), and Time 2 (6–12 weeks of postpartum). Maternal and neonatal outcomes were assessed at delivery. Clinical trial was registered.

Results
Analysis using the general estimating equation models found that anthropometric and metabolic measures were significantly better in the intervention group than the control group and varied with time. At Time 1, the levels of diastolic pressure (β = −4.981, p = .025) and triglyceride (TG; β = −33.69, p = .020) were significantly lower in the intervention group than the control group, and at Time 2, the incidence of MS in the intervention group was lower than that in the control group (χ2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (χ2 = 6.729, p = .012).

Conclusion/Implications for Practice
This nurse-led, web-based health management was shown to be effective in improving MS outcomes and may play an important role and show feasible clinical value in changing the current pregnancy care model.
Interreader agreement in evaluation of 68Ga-PSMA PET/CT at the time of initial staging: comparison of the three evaluation criteria in the pretreatment risk groups
Authors: Karahan Şen Nazli Pinar , Aksu Ayşegül , Bozkurt Ozan , Tuna Emine Burçin , Çapa Kaya Gamze 
Published: September 2021

Objective
The aim of this study was to assess the interreader agreement in evaluation 68Ga-prostate-specific membrane antigen (PSMA) PET/CT according to three current criteria European association of nuclear medicine, PROMISE with miTNM, and PSMA-RADS in newly diagnosed prostate cancer (PC) patients.

Methods
The images of 101 patients who had been diagnosed with PC and underwent 68Ga-PSMA PET/CT at the time of initial staging were evaluated according to the three interpretation criteria by two nuclear medicine specialists. Local tumor, pelvic lymph node metastasis and distant metastasis were evaluated separately. Abdominal lymph nodes, bone and visceral organ metastases were additionally evaluated as subregions of distant metastatic sites. Patients were evaluated in subgroups Gleason score ≥8 or prostate-specific antigen ≥20 ng/mL as the high-risk group (HR) and prostate-specific antigen ≤ 20 ng/mL and Gleason score <8 as the low-risk group (LR). To measure interreader agreement for each judgment site Cohen’s Kappa statistic coefficient (κ) was calculated.

Results
All three criteria European association of nuclear medicine, PROMISE with miTNM and PSMA-RADS exhibit substantial and almost perfect agreement between the readers in all sites except for PSMA-RADS in bone and visceral metastasis (κ = 0.495, κ = 0.506, respectively). According to the risk groups, a remarkable difference in interreader agreement for bone metastasis for all three criteria (especially in PSMA-RADS) between the HR and LR patients was detected.

Conclusions
In low-risk patients especially PSMA-RADS criteria leads to increased interreader reporting differences. While evaluating 68Ga-PSMA PET/CT images it should be considered that pretreatment risk levels of PC patients could affect the interreader agreement.
Comparison of Static Retinal Vessel Caliber Measurements by Different Commercially Available Platforms
Authors: French Christian , Heitmar Rebekka 
Published: September 2021

SIGNIFICANCE
Commercially available platforms show good agreement in clinical outcomes for retinal vessel caliber measurements, despite differing absolute values. Tighter agreement is observed when right and left eye data are averaged, suggesting an approach suitable for clinical practice.

PURPOSE
The purpose of this study was to compare the retinal vessel caliber measurements generated by different commercially available platforms and their associations with systemic blood pressure and age.

METHODS
A total of 209 participants were recruited from a UK optometric practice. After a routine eye examination, participants had disc-centered retinal photographs and systemic blood pressure taken. Retinal vessel calibers (central retinal artery equivalent, central retinal vein equivalent, and arteriovenous ratio) were calculated using both MONA REVA and VesselMap.

RESULTS
An inverse Pearson correlation was observed between central retinal artery equivalent and mean arterial blood pressure on both platforms (r = −0.275 [P ≤ .001] and r = −0.388 [P ≤ .001] for MONA REVA and VesselMap, respectively); this correlation was also observed with arteriovenous ratio and blood pressure. An inverse correlation was observed between central retinal artery equivalent and age (r = −0.362 [P ≤ .001] and r = −0.404 [P ≤ .001] for MONA REVA and VesselMap, respectively); this was also seen between central retinal vein equivalent and age (r = −0.322 [P ≤ .001] and r = −0.369 [P ≤ .001]). Arteriovenous ratio remained independent from age for both platforms. Bland-Altman plots demonstrated good agreement between the platforms for all three variables.

CONCLUSIONS
Although absolute caliber measurements differed between the platforms, the correlations observed were of similar magnitudes, with good agreement between the two platforms. Tighter spaced limits of agreement were observed when right and left eye data were averaged for each subject. In the absence of localized ocular pathology, this approach should be used.
Disparities in Pediatric Emergency Department Length of Stay and Utilization Associated With Primary Language
Authors: Lowe Jeremiah T. , Monteiro Kristina A. , Zonfrillo Mark R. 
Published: September 2021

Objective
The aim of the study was to investigate the association between primary language and length of stay (LOS) in the pediatric emergency department (ED) within the context of known disparities impacting healthcare experiences and outcomes for patients with language barriers.

Methods
We conducted a retrospective cohort study of consecutive encounters of patients presenting to, and discharged from, an urban pediatric ED from May 2015 through April 2018. Encounters were grouped into English primary language (EPL), Spanish (SPL), and other (OPL). Mean LOS comparisons were stratified by Emergency Severity Index (ESI). Bivariate and multivariate analyses were used to examine the relationship between LOS and variables, including age, sex, race/ethnicity, insurance, and time of presentation.

Results
A total of 139,163 encounters were included. A higher proportion of SPL and OPL encounters were characterized as lower ESI acuity compared with EPL. Significantly longer LOS for SPL and OPL encounters was observed in the 2 lower acuity strata. The ESI 4–5 stratum demonstrated the greatest LOS disparity between EPL, SPL, and OPL (94 vs 103 vs 103 minutes, respectively, P < 0.001). In the highest acuity stratum, ESI 1–2, there was a nonsignificant trend toward longer LOS among EPL encounters (P = 0.08). The multivariate model accounted for 24% of LOS variance, but effect sizes were small for all variables except for ESI and age.

Conclusions
Patients with Spanish or other non-EPL who were triaged to lower acuity ESI levels experienced longer LOS in the pediatric ED than English-speaking counterparts. They also used the ED more frequently for low acuity issues, possibly reflecting disparities in access to primary care.
Therapeutic Response Assessment of High-Grade Gliomas During Early-Phase Drug Development in the Era of Molecular and Immunotherapies
Authors: Ellingson Benjamin M. , Wen Patrick Y. , Cloughesy Timothy F. 
Published: September 2021

Abstract
Several new therapeutic strategies have emerged over the past decades to address unmet clinical needs in high-grade gliomas, including targeted molecular agents and various forms of immunotherapy. Each of these strategies requires addressing fundamental questions, depending on the stage of drug development, including ensuring drug penetration into the brain, engagement of the drug with the desired target, biologic effects downstream from the target including metabolic and/or physiologic changes, and identifying evidence of clinical activity that could be expanded upon to increase the likelihood of a meaningful survival benefit. The current review article highlights these strategies and outlines how imaging technology can be used for therapeutic response evaluation in both targeted and immunotherapies in early phases of drug development in high-grade gliomas.
The Challenges and Future of Immunotherapy for Gliomas
Authors: Wu Adela , Lim Michael 
Published: September 2021

Abstract
Gliomas and glioblastoma comprise the majority of brain malignancies and are difficult to treat despite standard of care and advances in immunotherapy. The challenges of controlling glioma growth and recurrence involve the uniquely immunosuppressive tumor microenvironment and systemic blunting of immune responses. In addition to highlighting key features of glioma and glioblastoma composition and immunogenicity, this review presents several future directions for immunotherapy, such as vaccines and synergistic combination treatment regimens, to better combat these tumors.
Hemodialysis Bleeding Events and Deaths: An 18-Year Retrospective Analysis of Patient Safety and Root Cause Analysis Reports in the Veterans Health Administration
Authors: Walton Edward , Charles Maureen , Morrish Wendy , Soncrant Christina , Mills Peter , Gunnar William 
Published: September 2021

Objectives
Eighteen years of patient safety (PS) and root cause analysis reports for hemodialysis bleeding events and deaths in the Veterans Health Administration were analyzed with dual purpose: to determine the impact of a 2008 Veterans Health Administration Patient Safety Advisory on event reporting rates and to identify actions to mitigate risk and inform policy.

Methods
From 2002 to 2020, 281 bleeding events (248 PS reports and 33 root cause analyses) including 14 deaths during hemodialysis treatments were identified. Events were characterized by the type of vascular access, patient mental status, and whether the access site was visible or obscured from view by staff.

Results
Of the 281 bleeding events reviewed, 188 (67%) were unwitnessed and 54 (19%) were associated with an alteration in mental status. Most deaths (n = 11; 79%) were associated with central venous catheter access. Root cause analyses reported 83 root causes, of which 33% identified physical barriers to direct observation or an equipment issue.
Action plans addressed policy/procedures (30%), training/education (20%), and changes to environment/equipment (19%). Patient Safety Advisory publication was associated with a significant increase in low-harm PS reports, from 9 to 18 per year (P = 0.001).

Conclusions
Bleeding events during hemodialysis treatments occur and may be fatal. Heightened vigilance is required when physical barriers obscure continuous direct observation, the patient exhibits an altered mental status, and vascular access is through a central venous catheter.
Provider staff should consider a safety checklist and training on equipment operation. Patient Safety Advisory publication was associated with increased low-harm event reporting.
You’re Worried, We’re Listening: Online Testing of the Effectiveness of Education Materials to Improve Consumer Knowledge and Confidence in Reporting Patient Deterioration
Authors: King Lindy , Ullah Shahid , Belan Ingrid , Clark Robyn A. , Young Tom , Grantham Hugh , Peacock Guy , Kidd Michael R. 
Published: September 2021

Objectives
Early identification of patient deterioration in hospital is important to reduce mortality, avoidable morbidity, length of stay, and associated healthcare costs. By closely observing physical and behavioral changes, deteriorating patients are more likely to be identified. Patients and family at the bedside can play an important role in reporting deterioration if made aware of how to do so. Therefore, the objective of this study was to undertake an online evaluation of educational materials designed to improve consumers’ knowledge and confidence to report patient deterioration.

Methods
A convenience sample was used to recruit community-based participants for an online survey. A self-designed validated instrument was used to undertake a preintervention and postintervention test involving 3 types of educational materials. Quantitative data were analyzed with Wilcoxon signed rank test to compare participants’ knowledge and confidence before and after exposure to the intervention. Conventional content analyses examined responses on key messages and recommendations to improve the educational materials.

Results
A total of 84 respondents completed both prequestionnaires and postquestionnaires. After exposure to the education materials, analyses confirmed that knowledge and confidence scores were significantly higher than baseline measures. Content analyses indicated a clear understanding of the key messages presented in the materials. Four main recommendations were made regarding the education materials.

Conclusions
Participants readily identified the key messages in the educational materials and demonstrated increased knowledge and confidence to report concerns about deterioration. Further research is required to determine the efficacy of the educational materials in relation to consumer behavior.
Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access
Authors: Amick Ashley E. , Feinsmith Sarah E. , Sell Jordan , Davis Evan M. , Wayne Diane B. , Feinglass Joseph , Barsuk Jeffrey H. 
Published: September 2021

Objectives
Difficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients.

Methods
We performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period.

Results
One hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period.

Conclusions
A hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.
Challenges and Barriers to Adverse Event Reporting in Clinical Trials: A Children’s Oncology Group Report
Authors: Miller Tamara P. , Marx Melissa Z. , Henchen Christopher , DeGroote Nicholas P. , Jones Sally , Weiland Jenny , Fisher Beth , Esbenshade Adam J. , Aplenc Richard , Dvorak Christopher C. , Fisher Brian T. 
Published: September 2021

Objective
Adverse event (AE) reporting is crucial for determining safety of trials. Adverse events are captured manually by clinical research associates (CRAs) and research nurses (RNs), and prior studies show underreporting. It is necessary to understand AE reporting training, processes, and institution-level differences to improve AE capture.

Methods
A 26-item questionnaire regarding AE reporting training, identification, tracking, and challenges was distributed to all Children’s Oncology Group (COG) CRAs and RNs from February 15 to March 11, 2019, regardless of if they report AEs based on limitations of COG rosters. Results were tabulated. Institutions were grouped by self-reported full-time equivalents and compared using χ2 tests.

Results
Of 1315 CRAs and 2703 RNs surveyed, 509 (12.7%) responded. Of those, 369 (64.9%) representing 71.8% of COG institutions report AEs. Only data from respondents who report AEs were collected and analyzed. There was a range in AE training; COG training modules were most common (79.7%). There was wide variability in AE ascertainment; only 51.2% use standardized approaches at their site. There was no standard AE tracking method; larger sites more commonly use spreadsheets (P = 0.002) and smaller sites more commonly use paper (P = 0.028). The greatest AE reporting challenges were differences between protocols (70%) and between AE definitions and documentation (53%). Half of the respondents endorsed 6 of 13 proposed tools for improving reporting including online AE reporting modules (75.3%), tip sheets for interpreting Common Terminology Criteria for Adverse Events definitions (67.5%), and standardized AE tracking forms (66.9%). Only half of the respondents reported that all colleagues at their site followed the same AE reporting practices, and there was no dominant AE tracking approach across the respondents.

Discussion
There is wide variability in AE reporting training and practices. Numerous challenges exist, including differences between trials, challenges in interpreting AE definitions, and engaging clinicians.

Conclusions
Respondents are eager for additional central resources. These results provide a roadmap for areas of potential improvement.