bluuebunny/crossref_metadata_2025_split huggingface dataset:
A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines
Authors: McKee Gabrielle , Hayes Maria , Caples Norma , Lowry Avril , Shine Maria , Hannon Bernadette , Cronin Edel , Lodge Emer , Hill Loreena , Tuohy Margaret , Gillen Nessa , Teehan Sinead 
Published: April 2021

Background
The implementation of international guidelines within everyday practice remains problematic, which can have a detrimental impact on quality of care delivered. This study aimed to ascertain the factors associated with clinical nurses' perceived knowledge of international guidelines.

Methods
In this cross-sectional survey, nurses from 45 hospitals across Ireland were recruited. A previously validated anonymous questionnaire that assessed guideline knowledge, use, and barriers to implementation was used. Data were analyzed using SPSS 23 and logistic regression.

Results
Of the 542 responses, 54% had used international guidelines relevant to their practice and 50% had consulted within the last year. Most nurses perceived that poor patient follow-up, lack of time and resources, poor clinical leadership, workload, long guidelines, and not understanding guideline detail were barriers to guideline use and implementation. Forty-five percent rated their perceived knowledge of guidelines as “low.” Logistic regression identified that “high” knowledge levels were significantly associated with having read guidelines in the last year and their use with practice. In contrast, low knowledge of the guidelines was associated with perceptions that they were lengthy and not easy to use, lack of confidence to challenge colleagues when guidelines are not implemented, or not being able to influence current practice.

Conclusions
This study identified the specific knowledge needs in this cohort of mainly basic grade registered nurses, with low perceived guideline knowledge. A whole unit or team approach led by nurse champions is needed to develop and establish practice and educational strategies that would increase the availability, application, and knowledge of guidelines within everyday practice.
Low Frequency of Acute Pancreatitis in Hospitalized COVID-19 Patients
Authors: Troncone Edoardo , Salvatori Silvia , Sena Giorgia , De Cristofaro Elena , Alfieri Norma , Marafini Irene , Paganelli Carla , Argirò Renato , Giannarelli Diana , Monteleone Giovanni , Del Vecchio Blanco Giovanna 
Published: April 2021

Objective
The clinical significance of increased serum pancreatic enzymes (PEs) in coronavirus disease 2019 (COVID-19) patients has not yet been fully understood. We aimed to investigate the frequency and the impact on clinical outcome of PE elevation and acute pancreatitis in such patients.

Methods
Clinical data, laboratory tests, and cross-sectional images were analyzed from COVID-19 patients admitted to the Tor Vergata Hospital in Rome. Variables associated with PE abnormalities, intensive care unit (ICU) admission, or death were investigated through univariate and multivariate analyses and Cox proportional hazard model.

Results
Pancreatic enzymes were available in 254 of 282 COVID-19 patients. Among these, 66 patients (26%) showed mild elevation of PE, and 11 patients (4.3%) had severe elevation (>3 times of the upper limit of normal). Overall, 2 patients met the diagnostic criteria for acute pancreatitis. Hepatic and renal involvements were associated with PE elevation. Multivariate analysis showed that mild and severe PE elevations were significantly associated with ICU admission (odds ratios, 5.51 [95% confidence interval, 2.36–12.89; P < 0.0001] and 26.2 [95% confidence interval, 4.82–142.39; P < 0.0001]).

Conclusions
Increase in serum PE, but not acute pancreatitis, is frequent in hospitalized COVID-19 patients and associates with ICU admission.
Pancreatic Cancer Stem-Like Cells With High Calreticulin Expression Associated With Immune Surveillance
Authors: Fujiwara Yasuhiro , Tsunedomi Ryouichi , Yoshimura Kiyoshi , Matsukuma Satoshi , Fujiwara Nobuyuki , Nishiyama Mitsuo , Kanekiyo Shinsuke , Matsui Hiroto , Shindo Yoshitaro , Tokumitsu Yukio , Yoshida Shin , Iida Michihisa , Suzuki Nobuaki , Takeda Shigeru , Ioka Tatsuya , Hazama Shoichi , Nagano Hiroaki 
Published: April 2021

Objective
Pancreatic cancer stem-like cells (P-CSLCs) are thought to be associated with poor prognosis. Previously, we used proteomic analysis to identify a chaperone pro-phagocytic protein calreticulin (CALR) as a P-CSLC–specific protein. This study aimed to investigate the association between CALR and P-CSLC.

Methods
PANC-1-Lm cells were obtained as P-CSLCs from a human pancreatic cancer cell line, PANC-1, using a sphere induction medium followed by long-term cultivation on laminin. To examine the cancer stem cell properties, subcutaneous injection of the cells into immune-deficient mice and sphere formation assay were performed. Cell surface expression analysis was performed using flow cytometry.

Results
PANC-1-Lm showed an increased proportion of cell surface CALR-positive and side-population fractions compared with parental cells. PANC-1-Lm cells also had higher frequency of xenograft tumor growth and sphere formation than PANC-1 cells. Moreover, sorted CALRhigh cells from PANC-1-Lm had the highest sphere formation frequency among tested cells. Interestingly, the number of programmed death-ligand 1–positive cells among CALRhigh cells was increased as well, whereas that of human leukocyte antigen class I–positive cells decreased.

Conclusion
In addition to the cancer stem cell properties, the P-CSLC, which showed elevated CALR expression on the cell surface, might be associated with evasion of immune surveillance.
Cultural Identity Conflict and Psychological Well-Being in Bicultural Young Adults
Authors: Rahim Haza F. , Mooren Trudy T.M. , van den Brink Femke , Knipscheer Jeroen W. , Boelen Paul A. 
Published: April 2021

Abstract
The present study examined the relationship between cultural identity conflict and psychological well-being, as well as the role of self-concept clarity and self-esteem in mediating this linkage. Elevated cultural identity conflict was hypothesized to be associated with lower psychological well-being via both (lower) self-concept clarity and (lower) self-esteem, with self-concept clarity preceding self-esteem. In a cross-sectional design, 473 bicultural young adults (age range, 18–35) completed an online questionnaire assessing cultural identity conflict, self-concept clarity, self-esteem, emotional distress, psychopathological symptoms, and satisfaction with life. Correlation analyses revealed that elevated cultural identity conflict was positively associated with emotional distress and psychopathological symptoms, and negatively associated with satisfaction with life. Mediation analyses indicated that these associations were mediated by lower self-concept clarity and lower self-esteem. The results support the importance of interventions that foster the development of skills in bicultural young adults to obtain more self-concept clarity and promote self-esteem and psychological well-being.
Initial Failure of Pristinamycin Treatment in a Case of Multidrug-Resistant Mycoplasma genitalium Urethritis Eventually Treated by Sequential Therapy
Authors: Palich Romain , Gardette Marie , Bébéar Cécile , Caumes Éric , Pereyre Sabine , Monsel Gentiane 
Published: April 2021

Abstract
We present a case of persistent Mycoplasma genitalium urethritis with documented macrolide and fluoroquinolone resistance, and we describe the A2062T mutation in the 23S rRNA gene, possibly associated with pristinamycin resistance. After several treatment failures and loss of the A2062T mutation, M. genitalium urethritis was finally cured by a sequential antibiotic treatment including minocycline.
Predictors of Human Papillomavirus Seropositivity in Appalachian Women Aged 18 to 26 Years
Authors: Ruffin Mack T. , Hade Erinn M. , Fahey Patrick , Christian Lisa M. , Paskett Electra D. , Harper Diane M. 
Published: April 2021

Background
Key informants of the Appalachian community questioned whether their unique environmental stressors would alter their immune response to human papillomavirus (HPV) infections. The primary aim of this study is to determine predictors of HPV seroprevalence to at least 1 of the 4 vaccine-related HPV types before vaccination using a psychoneuroimmunologic model in Appalachian women.

Method
Women aged 18 to 26 years (n = 185) who had not received HPV vaccination provided cervical HPV DNA and blood samples. Human papillomavirus DNA was identified through Hybrid Capture 2 assay and then genotyped for HPV types 6, 11, 16, and 18 by Roche Linear Array. Competitive Luminex Immunoassay measured the type-specific antibodies to HPV types 6, 11, 16, and 18 in milli-Merck units per milliliter. Nine psychoneuroimmunology scales measuring attributes of stress were self-completed.

Results
Human papillomavirus DNA was detected in 50% (92/183) of participants, with only 14% (26/183) positive for HPV-6/11/16/18 DNA. Seropositivity for at least one anti–HPV-6/11/16 or 18, on the other hand, was present in 35% (64/183) of women, with only 10% (19/183) concomitantly infected and seropositive for the vaccine-related types. The Perceived Stress Scale was not a strong predictor of HPV seropositivity.

Conclusions
Both HPV infection and vaccine-related HPV type seropositivity is common among Appalachian women aged 18 to 26 years. The anticipated effect of environmental stressors on HPV seropositivity was not seen when multiple predictors were considered.
Chlamydial Pgp3 Seropositivity and Population-Attributable Fraction Among Women With Tubal Factor Infertility
Authors: Anyalechi Gloria E. , Hong Jaeyoung , Kirkcaldy Robert D. , Wiesenfeld Harold C. , Horner Paddy , Wills Gillian S. , McClure Myra O. , Hammond Karen R. , Haggerty Catherine L. , Kissin Dmitry M. , Hook Edward W. , Steinkampf Michael P. , Bernstein Kyle , Geisler William M. 
Published: April 2021

Background
Chlamydial infection is associated with tubal factor infertility (TFI); however, assessment of prior chlamydial infection and TFI is imperfect. We previously evaluated a combination of serological assays for association with TFI. We now describe the chlamydial contribution to TFI using a newer Chlamydia trachomatis Pgp3-enhanced serological (Pgp3) assay.

Methods
In our case-control study of women 19 to 42 years old with hysterosalpingogram-diagnosed TFI (cases) and non-TFI (controls) in 2 US infertility clinics, we assessed possible associations and effect modifiers between Pgp3 seropositivity and TFI using adjusted odds ratios with 95% confidence intervals (CIs) stratified by race. We then estimated the adjusted chlamydia population-attributable fraction with 95% CI of TFI.

Results
All Black (n = 107) and 618 of 620 non-Black women had Pgp3 results. Pgp3 seropositivity was 25.9% (95% CI, 19.3%–33.8%) for non-Black cases, 15.2% (95% CI, 12.3%–18.7%) for non-Black controls, 66.0% (95% CI, 51.7%–77.8%) for Black cases, and 71.7% (95% CI, 59.2%–81.5%) for Black controls. Among 476 non-Black women without endometriosis (n = 476), Pgp3 was associated with TFI (adjusted odds ratio, 2.6 [95% CI, 1.5–4.4]), adjusting for clinic, age, and income; chlamydia TFI-adjusted population-attributable fraction was 19.8% (95% CI, 7.7%–32.2%) in these women. Pgp3 positivity was not associated with TFI among non-Black women with endometriosis or among Black women (regardless of endometriosis).

Conclusions
Among non-Black infertile women without endometriosis in these clinics, 20% of TFI was attributed to chlamydia. Better biomarkers are needed to estimate chlamydia TFI PAF, especially in Black women.
Expedited Partner Therapy in Female Adolescents: A Study of Acceptance and the Impact on Reinfection Rates
Authors: Gannon-Loew Kathryn E. , Holland-Hall Cynthia , Ebersole Ashley M. , Alexy Emily , Jackson Kenneth , Bonny Andrea E. 
Published: April 2021

Background
Given the high risk of sexually transmitted infections (STIs) in adolescents and young adults (AYAs), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in female AYA before and after availability of EPT.

Methods
The pre-EPT cohort was a 3-year (November 2012 to November 2015) retrospective chart review of female AYA positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) before introduction of EPT. An EPT protocol for CT and TV infections was implemented after legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016–5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1–6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance.

Results
Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre-EPT versus post-EPT cohorts (CT: 24% (57/240) vs 20% (38/192), P = 0.42; TV: 23% (22/97) versus 14% (12/87), P = 0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT, 13% (6/48) vs 21% (23/110), P = 0.50 and TV, 6% (1/18) vs 18% (9/49), P = 0.69).

Conclusions
Despite the implementation of an EPT protocol, STI reinfection rates among female AYA remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.
Wall Falls
Authors: Jackson Nicole R. , Lathrop Sarah , Dvorscak Lauren 
Published: April 2021

Abstract
The border wall between the United States and Mexico consists of stretches of metal fencing of varying heights alternating and overlapping with areas of electronic surveillance. Despite national conversations centered around the social, environmental, economic, and political implications of this wall, there is a paucity of studies on deaths occurring in this region. Herein are described 2 cases of fatal injuries sustained from scaling the fence and accidentally falling onto the United States’ side in New Mexico. These injuries are compared with those typically incurred in falls from lower and higher heights, and implications of both lateral and vertical expansion of the wall are discussed.
Fatal Sea Snake Envenomation
Authors: Tiemensma Marianne , Byard Roger W. 
Published: April 2021

Abstract
A 23-year-old man working on a prawn trawler off the Northern Australian coast was bitten on the right hand by a black-banded sea snake (Laticauda colubrina), resulting in the rapid onset of ptosis, blurred vision, and respiratory difficulties with convulsions, loss of consciousness, and death. Resuscitation was unsuccessful. No antivenom was available because of the remote location. At autopsy, a small puncture wound was identified on the middle interphalangeal joint of the right little finger. No other significant abnormalities were detected. Elevations in creatine kinase (1558 μ/L) and myoglobin (24,800 μg/L) levels were found. Death was caused by respiratory failure after sea snake envenomation. This case demonstrates potential difficulties in establishing the diagnosis of lethal sea snake envenomation, including the inconspicuous nature of the bite marks with no local reaction and the underlying neurotoxic nature of the lethal mechanisms, which leaves very nonspecific pathological findings. Myonecrosis may occur but is variable. Unless reliably witnessed, sea snake envenomation may not be suspected. Failing vision or unexplained paresis in fishermen or individuals who have been in the sea may point to the diagnosis.
Utility of CDC Screening Guidelines and Autopsy Findings in Identifying Decedents Who Die of SARS-CoV-2 Infection
Authors: Konopka Kristine E. , Nguyen Teresa , Hlavaty Leigh , Rayes Omar , Schmidt Carl J. , Dahl Julia , Myers Jeffrey L. 
Published: April 2021

Abstract
We assess the utility of a Centers for Disease Control and Prevention (CDC) guidelines-based coronavirus disease 2019 (COVID-19) screening checklist for postmortem severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surveillance, detailing the relationship between the histologic findings at autopsy and attribution of death to COVID-19.
SARS-CoV-2 nasopharyngeal swabs were collected at the time of autopsy in all “checklist-positive” decedents. Additional “checklist-negative” decedents were randomly tested daily. Lung slides were blindly reviewed by 3 pathologists, assessing for the presence of diffuse alveolar damage (DAD) and other findings. Sixteen decedents had positive postmortem SARS-CoV-2 nasopharyngeal swabs and underwent complete autopsies. Seven decedents had positive screening checklists. Of these, 4 had DAD and 1 had COVID-19–associated thromboembolic disease. Of the 9 decedents with negative screening checklists, 2 had DAD, but only 1 was attributed to COVID-19; the other was likely drug related. Acute bronchopneumonia was the second most common finding, and aspiration was the likely etiology in cases without concomitant DAD. COVID-19–related DAD was identified more commonly in decedents who screened positive by CDC checklist, but false-negatives did occur. Medical examiner offices should maintain a low threshold for random testing of decedents even when COVID-19 is not suspected.
Diagnostic Errors in Pediatric Critical Care: A Systematic Review*
Authors: Cifra Christina L. , Custer Jason W. , Singh Hardeep , Fackler James C. 
Published: April 2021

OBJECTIVES:
To summarize the literature on prevalence, impact, and contributing factors related to diagnostic error in the PICU.

DATA SOURCES:
Search of PubMed, EMBASE, and the Cochrane Library up to December 2019.

STUDY SELECTION:
Studies on diagnostic error and the diagnostic process in pediatric critical care were included. Non-English studies with no translation, case reports/series, studies providing no information on diagnostic error, studies focused on non-PICU populations, and studies focused on a single condition/disease or a single diagnostic test/tool were excluded.

DATA EXTRACTION:
Data on research design, objectives, study sample, and results pertaining to the prevalence, impact, and factors associated with diagnostic error were abstracted from each study.

DATA SYNTHESIS:
Using independent tiered review, 396 abstracts were screened, and 17 studies (14 full-text, 3 abstracts) were ultimately included. Fifteen of 17 studies (88%) had an observational research design. Autopsy studies (autopsy rates were 20–47%) showed a 10–23% rate of missed major diagnoses; 5–16% of autopsy-discovered diagnostic errors had a potential adverse impact on survival and would have changed management. Retrospective record reviews reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions and 21–25% of patients discussed at PICU morbidity and mortality conferences. Cardiovascular, infectious, congenital, and neurologic conditions were most commonly misdiagnosed. Systems factors (40–67%), cognitive factors (20–3%), and both systems and cognitive factors (40%) were associated with diagnostic error. Limited information was available on the impact of misdiagnosis.

CONCLUSIONS:
Knowledge of diagnostic errors in the PICU is limited. Future work to understand diagnostic errors should involve a balanced focus between studying the diagnosis of individual diseases and uncovering common system- and process-related determinants of diagnostic error.
Trends of Medicare Reimbursement Rates for Common Plastic Surgery Procedures
Authors: Siotos Charalampos , Cheah Michael A. , Damoulakis George , Kelly Jonathan , Siotou Kalliopi , Schechter Loren S. , Shenaq Deana S. , Derman Gordon H. , Dorafshar Amir H. 
Published: April 2021

Background:
Knowledge of Medicare reimbursement is essential for plastic surgeons providing care to Medicare beneficiaries. The authors sought to evaluate changes in Medicare reimbursement for common plastic surgery procedures from 2010 to 2020.

Methods:
The authors assessed the Physician Fee Schedule of the Centers for Medicare and Medicaid Services website. Rates of work-, facility-, or malpractice-related relative value units and total monetary units for 26 common plastic surgery procedures between 2010 and 2020 were evaluated. Descriptive statistics were used to calculate relative differences and to compare observed changes over time with the rate of inflation.

Results:
For the selected procedures, the authors found an average relative difference in terms of monetary units of an increase by 2.02 percent. However, after adjusting for inflation, the average relative difference was a decrease by 14.31 percent. The authors’ analysis indicates that, on average, there was a 1.55 percent decrease in physician relative value units between 2010 and 2020.

Conclusions:
Medicare reimbursement rates have changed significantly over the past decade. However, these changes did not keep pace with the rate of inflation. Plastic surgeons should be aware of these trends and advocate for more fair reimbursement rates.
Revision Rates in Prepectoral Versus Subpectoral Delayed-Immediate Autologous Breast Reconstruction
Authors: Patel Ashraf A. , Cemaj Sophie L. , Martin Shanique A. , Cheesborough Jennifer E. , Lee Gordon K. , Nazerali Rahim S. 
Published: April 2021

Introduction
Breast reconstruction in the prepectoral plane has recently fallen into favor. Minimizing the number of revisionary procedures after reconstruction is an important factor in improving patient care, but long-term studies on the effects of prepectoral reconstruction are limited. In this study, we compare the revision rates after delayed-immediate, autologous reconstruction between prepectoral and subpectoral reconstructions.

Methods
Postoperative charts for all patients undergoing subpectoral or prepectoral delayed-immediate autologous breast reconstruction were retrospectively reviewed at our single tertiary-care institution between 2009 and 2018. Patient demographics, comorbidities, and oncologic history were recorded. Charts after second stage reconstruction were reviewed for up to eighteen months to determine if revisions were necessary. Data collected included the total number of surgeries performed, the average number of procedures performed during each surgery, and the type of revision that was performed. Statistical tests included the chi squared test, unpaired t-test, and logistic regressions.

Results
Data from 89 patients with 125 breast reconstructions were collected. There was a 41.6% of these that were prepectoral reconstructions (P), and 58.4% were subpectoral reconstructions (S). For both groups, nipple sparing, followed by skin sparing mastectomies were most common. Mastectomy rates were not statistically different. Fewer breasts in the prepectoral cohort required any revisions (P, 21.2% vs S, 47.9%; P = 0.002). The subpectoral cohort had higher rates of soft tissue rearrangement (P, 7.7% vs S, 21.9%, P = 0.032), fat grafting (P, 9.6% vs S, 27.4%; P = 0.014), and nipple reconstruction (P: 5.8% vs 20.5%, P = 0.020). Mean follow-up time was not significantly different between patient groups (P, 290.5 days vs S, 375.0 days, P = 0.142). Subpectoral expander placement was found to be the only variable independently predictive of requiring 1 or more revision (P = 0.034).

Conclusions
Breast reconstruction performed in the prepectoral plane is associated with lower overall rates of revisionary surgery. Rates of soft tissue rearrangement, fat grafting, and nipple reconstruction after autologous reconstruction trended higher in subpectoral reconstructions.