bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemic Benefit and Hemorrhage Risk of Ticagrelor-Aspirin Versus Aspirin in Patients With Acute Ischemic Stroke or Transient Ischemic Attack
Authors: Johnston S. Claiborne , Amarenco Pierre , Aunes Maria , Denison Hans , Evans Scott R. , Himmelmann Anders , Jahreskog Marianne , James Stefan , Knutsson Mikael , Ladenvall Per , Molina Carlos A. , Nylander Sven , Röther Joachim , Wang Yongjun ,   for the THALES Investigators
Published: September 2021

Background and Purpose:
In patients with acute mild-moderate ischemic stroke or high-risk transient ischemic attack, the THALES trial (Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death) demonstrated that when added to aspirin, ticagrelor reduced stroke or death but increased risk of severe hemorrhage compared with placebo. The primary efficacy outcome of THALES included hemorrhagic stroke and death, events also counted in the primary safety outcome. We sought to disentangle risk and benefit, assess their relative impact, and attempt to identify subgroups with disproportionate risk or benefit.

Methods:
In a randomized, placebo-controlled, double-blind trial of patients with mild-to-moderate acute noncardioembolic ischemic stroke or high-risk transient ischemic attack, patients were randomized within 24 hours after symptom onset to a 30-day regimen of either ticagrelor plus aspirin or matching placebo plus aspirin. For the present analyses, we defined the efficacy outcome, major ischemic events, as the composite of ischemic stroke or nonhemorrhagic death, and defined the safety outcome, major hemorrhage, as intracranial hemorrhage or hemorrhagic death. Net clinical impact was defined as the combination of these 2 end points.

Results:
In 11 016 patients (5523 ticagrelor-aspirin and 5493 aspirin), a major ischemic event occurred in 294 patients (5.3%) in the ticagrelor-aspirin group and in 359 patients (6.5%) in the aspirin group (absolute risk reduction 1.19% [95% CI, 0.31%–2.07%]). Major hemorrhage occurred in 22 patients (0.4%) in the ticagrelor-aspirin group and 6 patients (0.1%) in the aspirin group (absolute risk increase 0.29% [95% CI, 0.10%–0.48%]). Net clinical impact favored ticagrelor-aspirin (absolute risk reduction 0.97% [95% CI, 0.08%–1.87%]). Findings were similar when different thresholds for disability were applied and over a range of predefined subgroups.

Conclusions:
In patients with mild-moderate ischemic stroke or high-risk transient ischemic attack, ischemic benefits of 30-day treatment with ticagrelor-aspirin outweigh risks of hemorrhage.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03354429.
“Peace through the Cross”
Authors: Ziegler Philip G. 
Published: September 2021

Abstract
Central to Markus Barth’s work as a New Testament exegete was the pursuit of an ever more responsible interpretation of the letters of the apostle Paul that combined rigorous historical and theological concerns into a form of “biblical theology.” The culmination of this endeavour is unarguably his two-volume commentary on Ephesians. This essay explores the central claims advanced in that commentary with an especial focus on Barth’s claim that Ephesians 2:11–22 represents a high point in Paul’s witness concerning Jews and Gentiles. It goes on to demonstrate how Barth understood justification as the ‘sociohistorical’ outworking of God’s reconciling act in Jesus Christ. It concludes by examining some of the consequences of Barth’s contentions for orienting Christians toward the important task of Jewish-Christian relations in the present.
Protective effect of Boldine against neuroinflammation in spinal cord injury in rats
Authors: Feng Jigao , Liu Junchi , Liu Xu , Qiu Zhaoyou , Zhang Caicai 
Published: September 2021

Abstract
The successful clinical management of spinal cord injury (SCI) is still a unmet medical need. Despite advances in novel therapeutics, the multifactorial etiology of SCI still poses significant challenge to the mankind. Thus, in the present study, we intend to scrutinize the protective effect of Boldine (BOL), an alkaloid obtained from the boldo tree against experimental spinal cord injury. The effect of BOL was investigated on locomotor function of rats with various biomarkers of oxidative stress (MDA, SOD and GSH), inflammation (TNF-α, IL-1β and IL-6), and apoptosis. Results suggest that BOL showed improvement in locomotor function (on BBB scale) of rats with does-dependent reduction in oxidative stress and inflammation. It also reduces neuronal apoptosis in flow cytometry experiment. The study successfully demonstrated the possible clinical utility of BOL against SCI.
Tackling the ‘digital pandemic’: The effectiveness of psychological intervention strategies in problematic Internet and smartphone use—A meta-analysis
Authors: Augner Christoph , Vlasak Thomas , Aichhorn Wolfgang , Barth Alfred 
Published: September 2021

Objective: Problematic Internet and smartphone use is associated with serious mental health problems. We thus investigated the effectiveness of psychological interventions on problematic Internet and smartphone use. Methods: We conducted a systematic review and meta-analysis and searched in PubMed, PsyArticles, PsycInfo, Medline and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2008 and 2021. Results: A total of 10 studies accompanied by 14 effect sizes were included in the meta-analyses for problematic Internet use and 3 studies accompanied by 4 effect sizes for problematic smartphone use. The total sample size was n = 1439 with a mean age of 20.34 (SD = 6.63) years. Psychological interventions were effective for both problematic Internet use ( g = −1.41, 95% confidence interval = [−1.90, −0.91], p < 0.001) and problematic smartphone use ( g = −0.40, 95% confidence interval = [−0.79, −0.01], p < 0.001). Conclusion: Current evidence indicates that psychological interventions can be effective in reducing problematic Internet use/problematic smartphone use. However, the results must be considered preliminary due to the limited number of studies available in the respective fields.
Quantifying Occupational Stress in Intensive Care Unit Nurses: An Applied Naturalistic Study of Correlations Among Stress, Heart Rate, Electrodermal Activity, and Skin Temperature
Authors: Ahmadi Nima , Sasangohar Farzan , Nisar Tariq , Danesh Valerie , Larsen Ethan , Sultana Ineen , Bosetti Rita 
Published: September 2021

Objective To identify physiological correlates to stress in intensive care unit nurses. Background Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap. Method Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4). Results Positive correlations included stress and heart rate (ρ = .35, p < .001), stress and skin temperature (ρ = .49, p < .05), and heart rate and skin temperatures (ρ = .54, p = .0008). Discussion The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses. Application Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures.
The Effect of Louisiana Medicaid Expansion on Affordability of Health Care
Authors: Shao Yixue , Stoecker Charles 
Published: September 2021

Objectives Louisiana extended Medicaid coverage on July 1, 2016, to previously ineligible populations. We aimed to estimate the effect of Louisiana’s Medicaid expansion on self-reported affordability of health care. Methods We used 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS measured affordability of health care by asking respondents 2 questions: (1) whether they could not see a doctor due to cost in the previous 12 months and (2) whether they could not get a prescribed medication due to cost in the previous 12 months. We estimated difference-in-differences and difference-in-difference-in-differences analytical models using multivariable linear regression that compared trends in Louisiana with trends in states that did not expand Medicaid during the study period. Results Compared with adults aged <65 with annual household income >138% of the federal poverty level (FPL) in nonexpansion states, Medicaid expansion in Louisiana decreased the percentage of adults aged <65 with annual household income ≤138% FPL who reported being unable to see a doctor due to cost by 5.1 percentage points (95% CI, −6.5 to −3.6; P < .001) and unable to afford prescribed medication by 7.9 percentage points (95% CI, −9.2 to −6.6; P < .001). We found similar estimates when we limited the comparison group to Southern nonexpansion states. Conclusions Louisiana’s Medicaid expansion lowered cost barriers to health care. Further research may find improvements in health care affordability in states that have not yet expanded Medicaid.
The effect of trunk training on trunk control, upper extremity, and pulmonary function in children with Duchenne muscular dystrophy: A randomized clinical trial
Authors: Güneş Gencer Gökçe Yağmur , Yilmaz Öznur 
Published: September 2021

Objectives: To investigate the effect of trunk training on trunk control, arm, and pulmonary function in children with Duchenne muscular dystrophy. Design: A randomised controlled trial. Settings: Neuromuscular diseases clinic of university hospital. Subjects: Twenty-six children with Duchenne muscular dystrophy aged 5–16 were included in the study. Intervention: Participants were randomly allocated into two groups. The study group ( N = 13) exercised with the trunk-oriented exercise program and the conventional exercise program, whereas the control group ( N = 13) underwent the conventional exercise program for eight weeks. Main measures: The primary outcomes were trunk control was assessed using the Trunk Control Measurement Scale, the arm function was assessed using Performance of Upper Limb, and respiratory function using the pulmonary function test. Data collection was conducted at baseline, and eighth week. The differences in trunk control scores, arm function scores, and respiratory function values before and after the training were calculated for the intergroup comparison. Results: The mean age of the participants was 11.6 (2.6) in the study group and 10.6 (3.4) in the control group. The changes between trunk control score, arm function score (total and distal level score), and respiratory function value (Forced Vital Capacity, Forced Expiratory Volume in one second, and Peak Expiratory Flow Volume percentage values) were compared and significant differences were found after eight week periods in the study and control groups. Conclusions: Trunk-oriented exercise program in Duchenne muscular dystrophy might be effective for trunk control, arm, and respiratory function.
Categorizing Online Climate Change Interpretation Across the National Park System
Authors: Roberts Ryan , Holly Matt , Perez Larry 
Published: September 2021

Climate change effects are evident across the National Park System, and units are encouraged to provide proactive, meaningful interpretation on the issue to cultivate informed partners and encourage collaborative stewardship. But climate change is not currently interpreted across all units of the National Park System. Anecdotal observations suggest some units highly prioritize the topic, while others do not. Thus, we conducted an assessment of current online climate change interpretation across the National Park System as one means of quantifying park engagement. Results suggest that—of the 391 units included in the analysis—37% interpreted climate change in some manner online as of February, 2019. Though our method of analysis does not fully describe park interpretive efforts, our findings provide a baseline measure of online interpretation and help to prioritize future training and support. Furthermore, our work provides a minimally intensive approach for future assessment of online climate change interpretation.
Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists
Authors: Alkadhimi Aslam , Cunningham Susan J , Parekh Susan , Noar Joe H , Travess Helen C 
Published: September 2021

Objectives: To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus. Design: A prospective cross-sectional study. Setting: Part 1: Eastman Dental Institute and part 2: online questionnaire. Methods: Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians’ opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios. Results: The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21). Conclusion: The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.
Awareness of, attitudes towards, and practices of health information management professionals in South Korea relating to privacy of personal health information
Authors: Kim Yeaeun 
Published: September 2021

Background: While information and communication technology has continued to advance, privacy of personal health information (PHI) has remained a challenge for health information management (HIM) professionals. Objective: This study aims to examine the awareness, attitude and practice relating to PHI privacy among HIM professionals in South Korea. Method: A survey questionnaire was developed for the study based on critical appraisal of relevant literature and expert consensus. It was completed by a sample of 312 respondents who were members of the Korean Health Information Management Association, over the age of 21, and worked in a healthcare organisation. Demographic data and questionnaire items (assessed on a 5-point Likert-type scale) were analysed using descriptive statistics, t-tests and ANOVA. Results: Mean scores and SDs for awareness, attitude and practice related to PHI privacy were calculated: 4.21 (0.60) for awareness, 4.17 (0.60) for attitude and 4.31 (0.63) for practice. Significant positive correlations were found between awareness and attitude scores (r = 0.765, p < 0.01); awareness and practice scores (r = 0.585; p < 0.01); and attitude and action scores (r = 0.672; p < 0.01). HIM professionals’ awareness, attitude, and practice towards PHI privacy differed significantly according to age, level of education, years of HIM experience, type of employment, main task, number of completed privacy education activities within the previous 3 years and whether or not they had signed a pledge of confidentiality on PHI. More highly-educated, full-time employed respondents, those who had completed a greater number of privacy education activities and had more experience as HIM professionals, achieved higher scores on awareness, attitude and practice than did other respondents. These differences were all statistically significant ( p < 0.01). Conclusion: Although causality cannot be inferred from results of this study, findings suggest that there is a relationship between PHI being a core responsibility of HIM professionals and their subsequent awareness, attitude and practice to ensure its privacy and confidentiality. To improve privacy practice, educational efforts should be prioritised and supported at all levels, including national, organisational, individual, and by professional HIM associations.
Outcomes after endovascular embolization for the treatment of nasal and oropharyngeal hemorrhage: safety, efficacy, and rebleeding
Authors: Hoffman Haydn , Jalal Muhammad S , Masoud Hesham E , Gould Grahame C 
Published: September 2021

Background Intractable nasal and oropharyngeal hemorrhage may be treated with endovascular embolization, but limited data are available. We sought to evaluate the efficacy, safety, and factors associated with rebleeding. Methods A retrospective analysis of consecutive embolizations for nasal and oropharyngeal hemorrhage over a 10-year period at a single institution was performed. Outcomes included procedural success (defined as cessation of hemorrhage in the immediate postoperative period), rebleeding requiring an additional intervention, and procedural complications. Results A total of 47 embolizations on 39 patients were included. The mean age was 60 years (standard deviation 16.1), 23.1% of patients were women, and 21 (53.8%) patients had a previously diagnosed head/neck malignancy. Bleeding sites were the nose in 20 patients and oropharynx in 21 (two patients presented with both nasal and oral bleeding). Immediate procedural success was achieved in 45 (95.7%) embolizations. Rebleeding requiring an additional intervention occurred after 11 (23.4%) embolizations at a median of one day after the procedure. In the multivariate analysis, preoperative hypotension (odds ratio 4.78, 95% confidence interval 1.04–24.61) and the use of coils (odds ratio 6.09, 95% confidence interval 1.24–46.69) were associated with rebleeding requiring repeat intervention. Complications included two watershed strokes that were anticipated due to occlusion of the internal carotid artery. Conclusions In our experience endovascular embolization was a safe and effective treatment option for stopping oral and nasal hemorrhage. However, rebleeding was present after 23.4% of treatments and was associated with preoperative hypotension and the use of coils. Further study in a large multi-institutional cohort is warranted.
Impact of pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease and its effect on healthcare utilization
Authors: Munshi Rezwan F. , Pellegrini James R. , Patel Pranavi , Kashin Maxim , Kang James , Sexton Robert , Russe Jose R. , Makaryus Amgad N. , Patel Palakkumar , Thakkar Samarthkumar , Pelletier Brandon , Abraham Tinu , Tiwana Muhammad , Anjum Fatima 
Published: September 2021

We aim to study the impact of pulmonary hypertension on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and pulmonary hypertension as a secondary diagnosis using ICD 10‐CM codes. Exclusion criteria were age under 18 years, non‐elective admission, and discharge in December. The primary outcome was in‐hospital mortality during the index admission. Secondary outcomes were 30‐day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96 h (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90%) patients had a diagnosis of pulmonary hypertension. Pulmonary hypertension was more common among females (61.14%) with a mean age of 71 ± 11.66, Medicare recipients (79.5%), higher Charlson comorbidity index, and treatment in an urban teaching hospital. Pulmonary hypertension was associated with greater mortality (adjusted odds ratio (aOR) 1.89, p < 0.001), higher 30‐day readmission (aOR 1.24, p < 0.001), higher cost (adjusted mean difference (aMD) $2785, p < 0.01), length of stay (aMD 1.09, p < 0.001), and higher instrument utilization including intubation (aOR 199, p < 0.001), PIMV (aOR 2.12, p < 0.001), tracheostomy (aOR 2.1, p < 0.001), bronchoscopy (aOR 1.46, p = 0.007), and chest tube placement (aOR 1.39 p < 0.004). We found that pulmonary hypertension is related to higher in‐hospital mortality, length of stay, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of pulmonary hypertension on AECOPD in hopes to improve future management.
High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19
Authors: Chavarria Adrian Palacios , Lezama Erika Salinas , Navarro Mauricio Gonzalez , Vazquez Rafael Ricardo Valdez , Bello Héctor Herrera , Gascon Julieta Lomelín , Juárez Linda Morales , Avendaño Mónica Arboleya , Gonzalez Luis Esteban Ramirez , Ville Benavides Rodrigo , Wyssmann Renate Victoria Álvarez , Ortiz Brenda Sandoval , de la Cerda Mariana Lizbeth Rodríguez , Castañeda Lidia Moreno , Martinez-Juarez Luis Alberto , Gallardo-Rincón Héctor , Tapia-Conyer Roberto 
Published: September 2021

Introduction: High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6–75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09–1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7–0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19–0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11–20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20–36) days, respectively]. Conclusion: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.