bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of HIV Acquisition Among Men Who Have Sex With Men Infected With Bacterial Sexually Transmitted Infections: A Systematic Review and Meta-Analysis
Authors: Malekinejad Mohsen , Barker Erin K. , Merai Rikita , Lyles Cynthia M. , Bernstein Kyle T. , Sipe Theresa Ann , DeLuca Julia B. , Ridpath Alison D. , Gift Thomas L. , Tailor Amrita , Kahn James G. 
Published: March 2021

Background
Men who have sex with men (MSM) who have bacterial sexually transmitted infections (STIs) are at increased risk for HIV infection. We enhanced and updated past summary risk estimates.

Methods
We systematically reviewed (PROSPERO No. CRD42018084299) peer-reviewed studies assessing the risk of HIV infection among MSM attributable to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and/or Trichomonas vaginalis (TV). We searched 3 databases through December 2017. We excluded studies with self-reported data or simultaneous STI and HIV assessment. We conducted dual screening and data extraction, meta-analytically pooled risk ratios (RRs), and assessed potential risk of bias.

Results
We included 26 studies yielding 39 RR (k) for HIV acquisition due to one of TP, NG, or CT. We did not identify eligible data for MG or TV, or for HIV transmission. HIV acquisition risk increased among MSM infected with TP (k = 21; RR, 2.68, 95% confidence interval [CI], 2.00–3.58), NG (k = 11; RR, 2.38; 95% CI, 1.56–3.61), and CT (k = 7; RR, 1.99; 95% CI, 1.59–2.48). Subanalysis RRs for all 3 pathogens were ≥1.66 and remained statistically significant across geography and methodological characteristics. Pooled RR increased for data with the lowest risk of bias for NG (k = 3; RR, 5.49; 95% CI, 1.11–27.05) and TP (k = 4; RR, 4.32; 95% CI, 2.20–8.51). We observed mostly moderate to high heterogeneity and moderate to high risk of bias.

Conclusions
Men who have sex with men infected with TP, NG, or CT have twice or greater risk of HIV acquisition, although uncertainties exist because of data heterogeneity and risk of bias.
The Availability of HIV and Sexually Transmitted Infection Testing and Treatment Services at Crisis Pregnancy Centers in the United States
Authors: Swartzendruber Andrea , Solsman Amy , Lambert Danielle N. 
Published: March 2021

Background
Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to prevent abortion and promote sexual abstinence before marriage only often using misinformation and deceptive tactics. We sought to describe the availability of HIV and sexually transmitted infection (STI) testing, treatment, and referral services at CPCs in the United States.

Methods
We used CPC Map, an online geocoded directory, to identify US CPCs. From December 2018 to August 2019, we assessed HIV/STI services advertised on CPC Web sites and used a standard script to call CPCs about the availability of services. Referrals were not requested but recorded.

Results
Of 2400 CPCs (96.3%) with accessible Web sites, 507 (21.1%) advertised STI testing, 291 (12.1%) STI treatment, and 114 (4.8%) HIV testing. Of 2467 (99.0%) CPCs reached by telephone, 552 (22.4%) offered STI testing, 377 (15.3%) STI treatment, and 208 (8.4%) HIV testing. At centers where services were unavailable, 795 (41.5%) proactively referred for STI testing, 170 (8.1%) for STI treatment, and 170 (7.5%) for HIV-related services. Nearly one-quarter (22.8%) of centers that offered STI testing did not offer treatment or provide a referral.

Conclusions
A minority but substantial number of CPCs advertised and offered HIV/STI services. People at risk for pregnancy who seek CPC services likely have outstanding need for HIV/STI services.
Recurrent Bacterial Vaginosis: An Unmet Therapeutic Challenge. Experience With a Combination Pharmacotherapy Long-Term Suppressive Regimen
Authors: Surapaneni Sarvani , Akins Robert , Sobel Jack D. 
Published: March 2021

Background
Recurrence of bacterial vaginosis (RBV) is a major challenge to effective therapy. Women experiencing intractable and frequent recurrences are ill-served by available treatment options, such as both antimicrobial and use of probiotics.

Methods
One hundred five women with RBV failing all recommended regimens seen in the clinic were prescribed combination oral nitroimidazole 500 mg twice a day for 7 days and simultaneous boric acid 600 mg daily per vagina therapy for 30 days; thereafter, they were prescribed twice-weekly vaginal metronidazole gel for 5 months in an attempt to prevent recurrence and followed by a 6-month observation period. Results reflect standard of clinic care in this uncontrolled retrospective cohort analysis.

Results
An initial regimen of nitroimidazole and simultaneous but prolonged vaginal boric acid achieved a satisfactory response (BV cure ≤2 Amsel criteria) in 92 of 93 available patients. Thereafter, a maintenance metronidazole gel prevented symptomatic BV recurrence in 69.6% of compliant patients at 6-month follow-up. Long-term cure at a 12-month follow-up was demonstrated in almost 69% of women reaching the 6-month observation phase. Vaginal candidiasis frequently complicated prolonged antibiotic prophylaxis requiring frequent antifungal rescue or prophylaxis. Frequent loss to follow-up in this long-term study influenced efficacy evaluation.

Conclusions
In the absence of new antimicrobials or proven probiotic regimens, women with RBV may benefit from a prolonged drug-intensive antimicrobial regimen incorporating antibiofilm activity until newer measures are available. Additional randomized, control studies are needed.
Medicaid Expansion and Rates of Reportable Sexually Transmitted Infections in the United States: A County-Level Analysis
Authors: Rietmeijer Cornelis A. , Hauschild Benjamin C. , Burnside Helen C. , Wendel Karen A. 
Published: March 2021

Abstract
Chlamydia, gonorrhea, and primary/secondary syphilis rates in 2018 were significantly higher in counties located in states without Medicaid expansion compared with those with Medicaid expansion. For sexually transmitted infections combined, 59.9% of counties without Medicaid expansion were in the highest 2 sexually transmitted infection rate quartiles compared with 42.2% of counties with Medicaid expansion (P < 0.0001).
The Impact of the COVID-19 Pandemic on Sexually Transmitted Infection/Human Immunodeficiency Virus Testing Among Adolescents in a Large Pediatric Primary Care Network
Authors: Bonett Stephen , Petsis Danielle , Dowshen Nadia , Bauermeister José , Wood Sarah M. 
Published: March 2021

Abstract
Disruptions in sexually transmitted infection (STI) testing infrastructure during the COVID-19 pandemic threaten to impact STI service delivery for adolescents. Within a large pediatric primary care network, we compared STI testing encounters between the pandemic period and an analogous prepandemic period. The STI test counts decreased and test positivity increased during the pandemic period.
Intestinal Fatty Acid Binding Protein Levels in Pediatric Celiac Patients in Transition From Active Disease to Clinical and Serological Remission
Authors: Hoofien Assaf , Guz-Mark Anat , Zevit Noam , Tsadok Perets Tsachi , Assa Amit , Layfer Olga , Matar Manar , Nachmias-Friedler Vered , Silbermintz Ari , Shamir Raanan 
Published: March 2021

Objectives:
Celiac disease (CD) is increasingly diagnosed without endoscopy. As such, the need for accurate serological markers to aid in the diagnosis and follow-up of CD has increased. Intestinal fatty acid binding protein (I-FABP) is a cytosolic protein present in enterocytes, whose blood levels reflect mucosal damage in a reliable and quantifiable way. The aim of this study was to compare I-FABP levels in newly diagnosed patients with CD and to examine changes in levels following 6 months of gluten-free diet (GFD).

Methods:
A prospective observational case control study of pediatric patients diagnosed with CD, with measurements of tissue transglutaminase IgA (TTG-IgA) and I-FABP levels at diagnosis and after 6 months of gluten free diet were compared to a control group of nonceliac patients.

Results:
This study included 35 patients and 32 controls. The CD group had higher I-FABP levels at diagnosis compared with the control group (median 641.7 pg/mL versus 334 pg/mL; P < 0.05). I-FABP levels significantly differed between patients presenting with TTG-IgA level 3–10 times the upper limit of normal (ULN) compared with those presenting with values >10 times ULN (median 432.2 pg/mL versus 796.2 pg/mL; P < 0.05). Patients with CD had a significant decrease in median I-FABP levels after 6 months of GFD (median 268.2 pg/mL), paralleling a decrease in TTG-IgA and GFD adherence.

Conclusions:
I-FABP levels are increased in patients with CD at diagnosis compared with controls and decrease significantly while patients adhere to GFD.
Comparing 2 Appointment Scheduling Policies Using Discrete-Event Simulation
Authors: Abdoli Mohsen , Bahadori Mohammadkarim , Ravangard Ramin , Babaei Mansour , Aminjarahi Mohammad 
Published: March 2021

Background and Objectives:
Two of the most important policies for dealing with the negative effects of high rates of no-show patients and appointment cancellations include double-booking and walk-in admission policies. This study aimed to compare these policies to identify their differences and their effects as well as the best circumstances for using each one.

Methods:
The main approach used in this study was discrete-event simulation using the Arena software application. Moreover, the average waiting time (considering patients' lateness) and the number of missed patients (considering no-show and cancelled patients) were accounted for in the performance evaluation criteria for both of the selected policies.

Results:
When the patients' arrival rate was high, the double-booking system resulted in higher productivity, while when it was low, the walk-in admission policy was the best policy for patient admission. The successful appointment rates of the current system, the walk-in admission system, and the double-booking system were 61.18%, 89.45%, and 93.24%, respectively.

Conclusions:
Although both double-booking and walk-in policies reduced the negative effects of cancelled and no-show patients, they had significantly different results in different situations. In general, there is no best system for appointment scheduling, and the choice of the superior system depends on the demand rate and its fluctuations.
Quality Improvement of Bowel Preparation for Screening Colonoscopies: A Study of Hospital Team Resource Management in Taiwan
Authors: Chung Chen-Shuan , Lin Chih-Ming , Chen Ming-Shu 
Published: March 2021

Background and Objectives:
This study aimed to investigate the impact of patient education using a medical team resource management (TRM) method on the adequacy of bowel preparation.

Methods:
The study setting was a single hospital in northern Taiwan, and a total of 2104 (884 female, 1220 male) healthy subjects who underwent a health checkup colonoscopy screening were enrolled before and after the application of the TRM program intervention. The efficacy of the TRM intervention and the factors affecting bowel preparation were estimated using multivariate logistic regression.

Results:
The prevalence of adequate bowel preparation improved significantly from the preintervention period to the postintervention and validation periods, which had prevalence of 79.0%, 81.3%, and 84.0%, respectively. Using the preintervention period prevalence as a reference, the adjusted odds ratios (aORs) for adequate bowel preparation in the postintervention and validation periods were 2.199 (95% confidence interval [CI]: 1.538-3.142) and 2.035 (1.525-2.716), respectively. Men had a lower probability of adequate cleansing than women (aOR = 0.757; 95% CI = 0.598-0.957), and purgative containing polyethylene glycol had a lower probability of adequate cleansing than purgative containing sodium phosphate (aOR = 0.366; 95% CI: 0.277-0.483).

Conclusions:
Bowel preparation quality for colonoscopy could be improved by enhancing patient education via TRM, and we suggest that effective quality improvement schemes should be proposed for health-screening programs.
FDG PET/CT in 3 Cases of Hypertrophic Pachymeningitis Associated With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Authors: Zhang Jian , Li Yuhan , Dong Aisheng , Zhu Yuzhao 
Published: March 2021

Abstract
Hypertrophic pachymeningitis associated with antineutrophil cytoplasmic antibody–associated vasculitis is a rare dural inflammatory disorder. We describe MRI and FDG PET/CT findings in 3 cases of hypertrophic pachymeningitis associated with antineutrophil cytoplasmic antibody–associated vasculitis. Enhanced brain MRI of the 3 cases showed linear enhancement of the thickened dura matter involving the skull base, tentorium, and/or convexity. On FDG PET/CT, the thickened dura matter showed diffusely increased FDG uptake with SUVmax ranging from 5.8 to 11.3. Familiarity with these MRI and FDG PET/CT findings is helpful for correct diagnosis and treatment.
18F-FDG PET/CT in Infective Endocarditis on Papillary Muscles
Authors: Fang Na , Zeng Lei , Jin Fei , Lin Shuai , Wang Yan-li 
Published: March 2021

Abstract
Infective endocarditis is a serious, potentially life-threatening condition. The valve leaflets and annulus are the most commonly affected sites, but involvement of the papillary muscles is extremely rare. We present the case of a 69-year-old woman who had infective endocarditis only involving the papillary muscle on 18F-FDG PET/CT.
Axillary Lymph Nodes Hypermetabolism After BNT162b2 mRNA COVID-19 Vaccination in Cancer Patients Undergoing 18F-FDG PET/CT
Authors: Bernstine Hanna , Priss Miriam , Anati Tamer , Turko Olga , Gorenberg Miguel , Steinmetz Adam Peter , Groshar David 
Published: March 2021

Purpose
Recognition of the pattern of FDG uptake in hypermetabolic axillary lymph nodes (HALs) and association with recent messenger RNA (mRNA) vaccination are important to prevent patient anxiety and further needless examinations or costly biopsies in cancer patients.

Materials and Methods
This study was a retrospective cohort study in a single tertiary care institution. We investigate the occurrence and pattern of HAL on FDG PET/CT scans from 650 consecutive cancer patients with recent BNT162b2 mRNA COVID-19 vaccination.

Results
Between December 20, 2020, and February 8, 2021, 650 patients (351 female patients [54%]; mean age, 68.9 years) had recent mRNA COVID-19 vaccination and an FDG PET/CT scan. HALs were found in 57 (14.5%) of 394 patients (95% confidence interval [CI], 10.9%–18.7%) 12.3 ± 5.9 (1–22) days after dose 1 and in 111 (43.3%) of 256 patients (95% CI, 35.3%–52.2%; P < 0.0001) after 7.5 ± 5.4 (1–22) days after dose 2. There was no difference between dose 1 and dose 2 concerning SUVmax (3.7 ± 1.8 [1.3–11.3] and 4.5 ± 3.9 [1.4–26.3], P = 0.13, respectively), SUVmean (2.1 ± 1.0 [0.7–6.5] and 2.7 ± 2.4 [0.8–17], P = 0.08, respectively), and reactogenicity volume (2.7 ± 2.3 [0.2–11.6] cm3 and 2.7 ± 2.4 [0.2–15.5] cm3, P = 0.98, respectively). There was no difference in number and in size of positive lymph nodes between dose 1 and dose 2: 3.2 ± 2.2 (1–10) and 3.7 ± 2.4 (1–12) (P = 0.18), and 1.4 ± 0.4 cm (0.7–2.5 cm) and 1.5 ± 0.4 cm (0.6–3.2 cm) (P = 0.75), respectively.

Conclusions
A cluster pattern of hypermetabolic ipsilateral small axillary lymph nodes is common after mRNA COVID-19 vaccination, mainly after the second injection.
The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills—A Mixed-Method Study
Authors: Zetner Diana B. , Konge Lars , Fabrin Anja , Christensen John B. , Thinggaard Ebbe 
Published: March 2021

Introduction
Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually.

Methods
One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale.

Results
Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult.

Conclusions
No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.
Evolution of a Simulation Faculty Development Program in a Low-Resource Setting
Authors: Seethamraju Rajasri R. , Stone Kimberly P. , Shepherd Michael 
Published: March 2021

Summary Statement
The PediSTARS Faculty Development Program is a novel approach for simulation faculty training with an aim to increase the pool of trained simulation faculty in India and neighboring countries that could then facilitate simulation-based training, both at their own workplaces and in the PediSTARS simulation-based workshops that provide training in pediatric and neonatal emergencies. This commentary describes the evolution of the faculty development program, the initial process, the feedback obtained, the changes undertaken, the progress made to date, and the challenges ahead. There is also an emphasis on the key generalizable principles that can be applicable to other low-resource settings.
World Society of Emergency Surgery-American Association for the Surgery of Trauma Guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients: An executive summary
Authors: Sartelli Massimo , Ansaloni Luca , Biffl Walter A. , Coccolini Federico , De Simone Belinda , Leppaniemi Ari , Kluger Yoram , Tolonen Matti , Moore Ernest E. , Catena Fausto 
Published: March 2021

ABSTRACT
In the last three decades, the dramatic worldwide increase in incidence and severity of Clostridioides difficile infection (CDI) (formerly Clostridium difficile infection) has made CDI a global public health challenge. Surgery is a known risk factor for development of CDI yet surgery is also a treatment option in severe cases of CDI. The World Society of Emergency Surgery guidelines for management of CDI in surgical patients were published in 2015. In 2019, the guidelines were revised and updated according to the grading of recommendations assessment, development and evaluation methodology. This executive summary is intended to consolidate knowledge on the management of CDI focusing on aspects that a general and emergency surgeon should know about the prevention and the management of CDI, by providing a practical and concise version of the original guidelines.
Addition of neurological status to pediatric adjusted shock index to predict early mortality in trauma: A pediatric Trauma Quality Improvement Program analysis
Authors: Lammers Daniel T. , Marenco Christopher W. , Morte Kaitlin R. , Conner Jeffrey R. , Horton John D. , Barlow Meade , Martin Matthew J. , Bingham Jason R. , Eckert Matthew J. , Escobar Mauricio A. 
Published: March 2021

INTRODUCTION
Pediatric adjusted shock index (SIPA) has demonstrated the ability to prospectively identify children at the highest risk for early mortality. The addition of neurological status to shock index has shown promise as a reliable triage tool in adult trauma populations. This study sought to assess the utility of combining SIPA with Glasgow Coma Scale (GCS) for predicting early trauma-related outcomes.

METHODS
Retrospective review of the 2017 Trauma Quality Improvement Program Database was performed for all severely injured patients younger than 18 years old. Pediatric adjusted shock index and reverse SIPA × GCS (rSIG) were calculated. Age-specific cutoff values were derived for reverse shock index multiplied by GCS (rSIG) and compared with their SIPA counterparts for early mortality assessment using area under the receiver operating characteristic curve analyses.

RESULTS
A total of 10,389 pediatric patients with an average age of 11.4 years, 67% male, average Injury Severity Score of 24.1, and 4% sustaining a major penetrating injury were included in the analysis. The overall mortality was 9.3%. Furthermore, 32.1% of patients displayed an elevated SIPA score, while only 27.5% displayed a positive rSIG. On area under the receiver operating characteristic curve analysis, rSIG was found to be superior to SIPA as a predictor for in hospital mortality with values of 0.854 versus 0.628, respectively.

CONCLUSION
Reverse shock index multiplied by GCS more readily predicted in hospital mortality for pediatric trauma patients when compared with SIPA. These findings suggest that neurological status should be an important factor during initial patient assessment. Further study to assess the applicability of rSIG for expanded trauma-related outcomes in pediatric trauma is necessary.

LEVEL OF EVIDENCE
Prognostic study, level IV.
An ERK5-KLF2 signalling module regulates early embryonic gene expression dynamics and stem cell rejuvenation
Authors: Brown Helen A. , Williams Charles A.C. , Zhou Houjiang , Rios-Szwed Diana , Fernandez-Alonso Rosalia , Mansoor Saria , McMulkin Liam , Toth Rachel , Gourlay Robert , Peltier Julien , Dieguez-Martinez Nora , Trost Matthias , Lizcano Jose M. , Stavridis Marios P. , Findlay Greg M. 
Published: March 2021

SummaryThe ERK5 MAP kinase signalling pathway drives transcription of naïve pluripotency genes in mouse Embryonic Stem Cells (mESCs). However, how ERK5 impacts on other aspects of mESC biology has not been investigated. Here, we employ quantitative proteomic profiling to identify proteins whose expression is regulated by the ERK5 pathway in mESCs. This reveals a function for ERK5 signalling in regulating dynamically expressed early embryonic 2-cell stage (2C) genes including the mESC rejuvenation factor ZSCAN4. ERK5-dependent ZSCAN4 induction in mESCs increases telomere length, a key rejuvenative process required for prolonged culture. Mechanistically, ERK5 promotes ZSCAN4 and 2C gene expression via transcription of the KLF2 pluripotency transcription factor. Surprisingly, ERK5 also directly phosphorylates KLF2 to drive ubiquitin-dependent degradation, encoding negative-feedback regulation of 2C gene expression. In summary, our data identify a regulatory module whereby ERK5 kinase and transcriptional activities bi-directionally control KLF2 levels to pattern dynamic 2C gene transcription and mESC rejuvenation.