bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evening binge alcohol disrupts cardiovagal tone and baroreflex function during polysomnographic sleep
Authors: Greenlund Ian M , Bigalke Jeremy A , Tikkanen Anne L , Durocher John J , Smoot Carl A , Carter Jason R 
Published: May 2021

AbstractStudy ObjectivesBinge alcohol consumption is associated with increased cardiovascular risk. The effects of evening binge alcohol consumption (i.e. 4–5 beverages within 2 h) on the vagal components of HRV and cardiovagal baroreflex sensitivity (cvBRS) during sleep remain largely equivocal. The present study examined the effects of evening binge alcohol consumption on nocturnal cardiac vagal tone and baroreflex sensitivity during stage N2, slow wave (SWS), and rapid eye movement (REM) sleep. We hypothesized that evening binge drinking would reduce HRV and cvBRS in each sleep stage.MethodsFollowing a familiarization night within the laboratory, twenty-three participants were examined following a night of binge alcohol consumption and a fluid control (randomized, crossover design). A quality nocturnal beat-to-beat blood pressure signal was obtained in both conditions in 16 participants (seven men, nine women; 25 ± 1 years).ResultsBinge drinking reduced both the high frequency (HF) and time-domain components (i.e. pNN50 and RMSSD) of HRV in stage N2 sleep, SWS, and REM. In addition, cvBRS up-up (vagal activation) was reduced following binge alcohol consumption in stage N2 (21 ± 3 vs. 15 ± 3 ms/mmHg, p = 0.035) and REM (15[11–28] vs. 11[9–18] ms/mmHg, p = 0.009). Binge alcohol consumption reduced cvBRS down-down (vagal withdrawal) in stage N2 (23 ± 2 vs. 14 ± 2 ms/mmHg, p &lt; 0.001), SWS (20[14–30] vs. 14[9–17] ms/mmHg, p = 0.022), and REM (14[11–24] vs. 10[7–15] ms/mmHg, p = 0.006).ConclusionsEvening binge alcohol consumption disrupts cardiac vagal tone and baroreflex function during nearly all sleep stages. These findings provide mechanistic insight into the potential role of binge drinking and alcohol abuse on cardiovascular risk.Clinical Trials DetailsAlcohol and Neural Cardiovascular Control in Binge Drinkers, www.clinicaltrials.gov/ct2/show/NCT03567434, NCT03567434.
The social and economic cost of sleep disorders
Authors: Streatfeild Jared , Smith Jackson , Mansfield Darren , Pezzullo Lynne , Hillman David 
Published: May 2021

Abstract

Study Objectives
To estimate economic cost of common sleep disorders in Australia for 2019–2020.

Methods
Costs were estimated for obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) using prevalence, financial, and nonfinancial data from national databases. These included: (1) financial costs associated with health care, informal care, productivity losses, non-medical accident costs, deadweight loss from taxation/welfare inefficiencies; and (2) nonfinancial costs associated with loss of well-being. They were expressed in U.S. dollars ($).

Results
Estimated overall cost of sleep disorders in Australia in 2019–2020 (population: 25.5 million) was $35.4 billion (OSA $13.1 billion; insomnia $13.3 billion, RLS $9.0 billion). Of this, the financial cost component was $10.0 billion, comprised of: health system costs $0.7 billion; productivity losses $7.7 billion; informal care $0.2 billion; other, mainly non-medical accident costs, $0.4 billion; and deadweight losses $1.0 billion. For moderate to severe OSA syndrome, insomnia unrelated to other conditions and RLS, financial costs represented $16,717, $21,982, and $16,624 per adult with the condition for the year, respectively. The nonfinancial cost was $25.4 billion.

Conclusions
The economic costs associated with sleep disorders are substantial. The financial component of $10.0 billion is equivalent to 0.73% of Australian gross domestic product. The nonfinancial cost of $25.4 billion represents 3.2% of total Australian burden of disease for the year. Health system costs of these disorders are low relative to those associated with their consequences, suggesting greater expenditure on detection, treatment and prevention is warranted.
Quantifying nitrogen uptake and translocation for mature trees: an in situ whole-tree paired 15N labeling method
Authors: Zhu Feifei , Dai Luming , Hobbie Erik A , Qu Yuying , Huang Dan , Gurmesa Geshere A , Zhou Xulun , Wang Ang , Li Yinghua , Fang Yunting 
Published: May 2021

AbstractNitrogen (N) is one of the major nutrients limiting plant growth in terrestrial ecosystems. To avoid plant–microbe competition, previous studies on plant N uptake preference often used hydroponic experiments on fine roots of seedlings and demonstrated ammonium preference for conifer species; however, we lack information about N uptake and translocation in the field. In this paper, we described a method of in situ paired 15N labeling and reported the rates and time course of N uptake and translocation by mature trees in situ. We added 15N-enriched ammonium or nitrate, together with the nitrification inhibitor dicyandiamide, to paired Larix kaempferi (Lamb.) Carr (larch) trees from 30-, 40- and 50-year-old plantations. Fine roots, coarse roots, leaves and small branches were collected 2, 4, 7, 14 and 30 days after labeling. Nitrate uptake and translocation averaged 1.59 ± 0.16 μg 15N g−1 day−1, which is slightly higher than ammonium (1.08 ± 0.10 μg 15N g−1 day−1), in all tree organs. Nitrate contributed 50–78% to N uptake and translocation, indicating efficient nitrate use by larch in situ. We observed no age effect. We suggest that sampling leaves after 4 days of 15N labeling is sufficient to detect mature tree N uptake preference in situ. Whole-tree 15N-ammonium recovery equaled that of 15N-nitrate 30 days after 15N addition, implying the importance of both ammonium and nitrate to mature larch N use in the long run. We conclude that our method is promising for studying mature tree N uptake preference in situ and can be applied to other conifer and broadleaf species. We suggest using highly enriched 15N tracer to overcome soil dilution and a nitrification inhibitor to minimize ammonium transformation to nitrate. Our study revealed mature tree N preference in situ and demonstrated the strong contribution of nitrate toward mature larch growth on soils rich in nitrate.
Reduction in Racial Disparities in Severe Maternal Morbidity From Hemorrhage in a Large-scale Quality Improvement Collaborative
Authors: Main E.K. , Chang S.-C. , Dhurjati R. , Cape V. , Profit J. , Gould J.B. 
Published: May 2021

(Am J Obstet Gynecol. 2020;223:123.e1–14)
Racial and ethnic disparities in maternal morbidity and mortality continue to persist in the United States. Maternal death is 3-4 times more likely in black women than in white women, and the risk for severe maternal morbidity (SMM) is 2 times greater among black women than white women. Many of these cases are believed to be preventable by addressing the quality of care. Quality improvement (QI) collaboratives have been put forth as one way to reduce these disparities, but little is known about their effectiveness on racial/ethnic disparities in maternal outcomes. The aim of this study was to investigate whether a QI collaborative could narrow the difference in the rates of SMM from hemorrhage between black and white pregnant women.
Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review
Authors: Huntley B.J.F. , Huntley E.S. , Di Mascio D. , Chen T. , Berghella V. , Chauhan S.P. 
Published: May 2021

(Obstet Gynecol. 2020;136:303–312)
As of May 1, 2020, more than 3.33 million cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been confirmed globally. This novel coronavirus has the potential to increase adverse outcomes in the more than 140 million births that occur around the globe annually. While there have been a number of case reports of SARS-CoV-2 in pregnancy, the sample sizes have been small, limiting our understanding of the virus’ impact on pregnancy. The aim of this study was to assess the occurrence of maternal and neonatal complications in pregnancies affected by SARS-CoV-2.
Public Health Agency of Sweden’s Brief Report: Pregnant and Postpartum Women With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Intensive Care in Sweden
Authors: Collin J. , Byström E. , Carnahan A.S. , Ahrne M. 
Published: May 2021

(Acta Obstet Gynecol Scand. 2020;99:819–822)
In early April 2020, Swedish authorities observed a high number of pregnant and postpartum patients presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who required admission to the intensive care unit (ICU). However, at that time European and American authorities were not reporting similar trends regarding pregnant and postpartum women with SARS-CoV-2 and ICU admission. This rapid assessment compared the rates of pregnant or postpartum women with treated in the ICU compared with non-pregnant women of the same age during the same period.
Associations Between Comorbidities and Severe Maternal Morbidity
Authors: Brown C.C. , Adams C.E. , George K.E. , Moore J.E. 
Published: May 2021

(Obstet Gynecol. 2020;136:892–901)
Severe maternal morbidity (SMM) includes long- or short-term consequences to a woman’s health due to pregnancy and childbirth. Since 1993, the US has seen a two-fold increase in the rate of SMM. The rate of SMM is nearly double for non-Hispanic Black women compared to non-Hispanic white women. Compared to women without chronic conditions, women with multiple chronic conditions are 3.8 times more likely to experience severe maternal morbidity and mortality. This study investigated the differences in risk of SSM associated with having zero, one, two or three or more comorbidities. The hypothesis of the study was that a higher number of comorbidities would be associated with a greater risk of SMM, and that these associations would vary by race.
Novel Suction Tube Uterine Tamponade for Treating Intractable Postpartum Haemorrhage: Description of Technique and Report of Three Cases
Authors: Hofmeyr G.J. , Singata-Madlik M.I. 
Published: May 2021

(BJOG. 2020;127:1280–1283)
Postpartum hemorrhage (PPH), when unresponsive to other treatments, can be treated with uterine balloon tamponade (UBT). There is a clear need for more research on all methods of UBT, and some studies have found worse outcomes with use of an improvised condom UBT in low-resource settings compared to no UBT. The uterine suction tamponade (UST) uses intrauterine negative pressure to induce contraction and retraction of the uterus. Studies on UST with purpose-designed UST cannulas found successful results, but these were limited in affordability and availability. This study described the use of a widely-available wide-bore flexible suction catheter as a suction tube uterine tamponade (STUT) and reported three cases of severe PPH in which STUT was used as a last resort treatment.
Delayed Versus Immediate Pushing in the Second Stage of Labor in Women With Neuraxial Analgesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Di Mascio D. , Saccone G. , Bellussi F. , Al-Kouatly H.B. , Brunelli R. , Panici P.B. , Liberati M. , D’Antonio F. , Berghella V. 
Published: May 2021

(Am J Obstet Gynecol. 2020;223:189–203)
Maternal and perinatal outcomes are influenced by several variables in second-stage labor management, including neuraxial analgesia, oxytocin use, parity, fetal position, maternal characteristics, and neonatal birthweight. Thus, many strategies have been evaluated which assess proper management strategies for second-stage labor. Once a woman achieves complete cervical dilation, she can begin pushing immediately or she can delay pushing. The aim of this meta-analysis and systematic review was to evaluate the effects of immediate compared to delayed pushing during the second stage of labor on mode of delivery for women with neuraxial analgesia.
Killing the Pathogen and Sparing the Placenta
Authors: Mysorekar I.U. 
Published: May 2021

(N Engl J Med. 2020;182:1125.e18–1139.e18)
During pregnancy, the maternal immune system must protect from bacteria, viruses and other pathogens, while not rejecting the fetus. Decidual natural killer (NK) cells, the most abundant immune cells at the maternal-fetal interface in the first trimester of pregnancy invade the maternal side of the placenta and release cytotoxic granules. Recently, Crespo and colleagues have reported on how NK cells are able to kill harmful pathogens without damaging the placenta.
Cystic fibrosis
Authors: Wendekier Camille , Wendekier-Raybuck Katheryn 
Published: May 2021

Abstract:
Cystic fibrosis (CF) is an autosomal recessive genetic disorder that causes a lifetime of debilitating and life-threatening complications affecting the lungs and other organ systems. Over 1,700 gene mutations that cause this rare disorder have been identified. This article describes the current treatment landscape for adults with CF, including the 2019 FDA approval of a breakthrough triple-drug combination therapy that may significantly improve the quality of life for an estimated 90% of patients with CF.
Clinical Nurse Specialist: A Critical Member of the ICU Team
Authors: Gabbard Erika R. , Klein Deborah , Vollman Kathleen , Chamblee Tracy B. , Soltis Lisa M. , Zellinger Mary 
Published: May 2021

OBJECTIVES:
To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist–led quality improvement and research that resulted in improved patient outcomes is provided.

DATA SOURCES:
Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists.

STUDY SELECTION:
Not applicable.

DATA EXTRACTION:
Not applicable.

DATA SYNTHESIS:
Not applicable.

CONCLUSIONS:
The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
Nurse practitioner and physician assistant onboarding in a family medicine practice
Authors: Chaney Amanda , Martin Angela , Cardona Kathy , Presutti Richard J. 
Published: May 2021

ABSTRACT
The nurse practitioner (NP) and physician assistant (PA) professions are rapidly growing. Historically, these professions have filled a health care delivery gap caused by lack of health care access and physician shortages. Many medical practices are more accustomed to adding new physicians as compared with adding new NPs or PAs. This article describes one institution's approach to develop and implement a successful NP/PA onboarding program. Several key components are discussed, including (1) established roles and responsibilities, (2) a clear timeline of the onboarding period including a foundational curriculum, (3) the mentor–mentee relationship, (4) the onboarding checklist, and (5) the onboarding itinerary. The objective was to have our NPs/PAs on a regular patient calendar within the 6-month period. The success rate with this has been 86%. In addition, there has been a 90% retention of NP/PA hires over the past 3 years. The authors believe this approach to NP/PA onboarding serves the patients well, providing excellent patient outcomes and patient experience.
Health IT advances for the 21st century
Authors: Jenkins Melinda L. 
Published: May 2021

ABSTRACT
The United States is working toward a value-based health care system in which reimbursement will be based on quality outcomes rather than on Current Procedural Terminology payment codes. Health data will be more easily shared, and patients will have more control of their records. Health information technology advances in the federal 21st Century Cures Act follow earlier related legislation and regulation that moved clinical care and research forward. Policy analysis of the Cures Act is presented following the three phases of the Longest model (2010): formation, implementation, and modification. With the passage of the Cures Act and promulgation of its final rules, the formation phase is complete. The implementation phase has begun. Modification may occur, based on the evaluation of key deliverables over time. Advanced practice nurses are well-suited to the use of electronic tools to share data with patients and other providers. New competencies, tools, and infrastructure are needed for advanced practice nurses to fully participate in value-based health care. Full implementation of the 21st Century Cures Act with the use of coded concepts in standardized nursing terminologies will provide an ideal foundation for strong patient-centered care, population health, and reimbursement that takes advanced nursing practice into account.
Comparison of empagliflozin and sitagliptin therapy on myocardial perfusion reserve in diabetic patients with coronary artery disease
Authors: Oh Minyoung , Choi Joon Ho , Kim Seon-Ok , Lee Pil Hyung , Ahn Jung-Min , Lee Seung-Whan , Moon Dae Hyuk , Lee Cheol Whan 
Published: May 2021

Background
Sodium-glucose co-transporter 2 inhibitors reduce the risk of cardiovascular events in type 2 diabetic patients with coronary artery disease (CAD); however, the underlying mechanisms remain unclear.

Objectives
We compared the effects of empagliflozin vs. sitagliptin therapy on myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) imaging.

Methods
In total, 100 patients with type 2 diabetes, CAD and an MPR <2.5 were randomized to receive either empagliflozin (10 mg once daily) or sitagliptin (100 mg once daily). Dynamic SPECT examinations were performed at baseline and at 6 months. The primary endpoint was the percent change of global MPR. Evaluable SPECT data were available for 98 patients.

Results
Baseline clinical characteristics and SPECT data were well balanced between the two groups. At a 6-month follow-up, the fasting glucose and glycated hemoglobin levels significantly decreased in both groups. Hematocrit and hemoglobin levels significantly increased in the empagliflozin group but not in the sitagliptin group. The global MPR significantly improved after treatment in both groups (34.5 ± 70.6%; P = 0.005 for empagliflozin vs. 22.4 ± 45.7%; P = 0.024 for sitagliptin). However, there was no significant difference in the global MPR between the two groups (P = 0.934). Similar findings were detected with regard to the regional MPR.

Conclusion
Among patients with type 2 diabetes and CAD, both empagliflozin and sitagliptin significantly improved the global MPR with no significant difference between the groups.
Prospective evaluation of organ-specific dose and lesional doses following therapeutic [177Lu]Lu-EDTMP administration in patients with multiple skeletal metastases and its correlation with clinical hematological toxicity
Authors: Kamaldeep  , Thapa Pradeep , Wanage Gaurav , Tervankar Shriram , Kaisar Sushma , Ranade Rohit , Basu Sandip , Das Tapas , Banerjee Sharmila 
Published: May 2021

Aim
In patients with multiple skeletal metastases, accurate estimation of absorbed doses to radiosensitive bone marrow in bone-directed systemic radionuclide therapies (RNT) is critically important from clinical dose determination standpoint. The primary aim of the present study was to estimate the radiation absorbed doses of therapeutic [177Lu]Lu-EDTMP to bone marrow by two methods viz. Medical Internal Radiation Dose (MIRD) schema and using OLINDA software and correlate with hematological toxicity.

Methods
A total of 15 patients diagnosed to have multiple painful skeletal metastases being treated with [177Lu]Lu-EDTMP for palliation of pain, were enrolled for this prospective study. For all patients, urine was collected immediately after infusion of [177Lu]Lu-EDTMP up to 24 h post-administration and cumulative activity excreted from body via urine was calculated. For dosimetry, patients underwent post-administration whole-body scintigraphy at five-time points: 0.5 (pre-void), 2, 24, 48 and 120 h (post-void). From the time-activity curves generated by drawing regions of interest (ROIs) on the images, number of disintegrations was determined. Absorbed doses for organs and bone lesions were calculated using OLINDA 2.2.0 software. For bone marrow dose estimates, in addition to OLINDA 2.2.0 software, MIRD schema was also adopted. Hematological profile was monitored in all patients during the treatment and post-treatment follow-up (estimating complete blood counts, every 15 d for 3 months after therapy).

Results
The mean ± standard deviation activity of [177Lu]Lu-EDTMP administered per patient per cycle was 2.08 ± 0.45 GBq. The results demonstrated higher uptake of [177Lu]Lu-EDTMP in bone metastases compared to normal bones. Within 2 and 24 h of administration of [177Lu]Lu-EDTMP, [177Lu]Lu activity excreted from the body was 24 ± 9% and 39 ± 14%, respectively. The mean absorbed organ doses (mean ± SD) in Gy/GBq were as follows: osteogenic cells 3.15 ± 1.85, bone marrow 0.57 ± 0.31, kidneys 0.08 ± 0.05, urinary bladder 0.32 ± 0.04, and bone lesions 2.91 ± 1.88. Strong correlation was found between (a) MIRD schema and OLINDA 2.2.0 software method for estimation of bone marrow doses (r = 0.96; P = <0.0001) and (b) Bone marrow absorbed dose and hematological toxicity (r = 0.81, P = 0.0027).

Conclusion
Radiation absorbed doses to the bone marrow and skeletal metastatic lesions, following therapeutic [177Lu]Lu-EDTMP were estimated using a convenient and non-invasive quantitative imaging method. The estimated bone marrow absorbed dose, either by MIRD schema or the OLINDA 2.2.0 software method, demonstrated strong correlation. Strong correlation was also observed between bone marrow absorbed dose and hematological toxicity.