bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quadrant-Specific Changes in Corneal and Tear Fluid Reservoir Thickness for After 2 Hours of Wear
Authors: Nau Cherie B. , Dodda Samantha , Hodge David O. , Schornack Muriel M. 
Published: October 2021

Objective:
To measure corneal swelling and thickness of the tear fluid reservoir (TFR) after wearing scleral lenses (SLs).

Methods:
Thirty-five participants had 1 eye fitted with each of three SLs (15.0-mm Jupiter, 18.2-mm Jupiter, and 18.0-mm Digiform). Scheimpflug images were obtained before wear, after application, after 2 hr of wear, and after removal. Initial and final TFR thickness and corneal thickness were measured in the central cornea and 3 mm from the center in the superior, inferior, temporal, and nasal quadrants.

Results:
Corneal thickness increased with wear, but no between-lens differences were observed in the superior (P=0.09), inferior (P=0.38), or temporal (P=0.53) quadrants. The greatest change in central and nasal cornea thickness was with the 15.0-mm SL (P<0.001). All areas showed settling, with no between-lens differences. Greater final TFR thickness was noted for the superior and nasal quadrants with the 18.0-mm SL (P<0.001), and less final TFR thickness was noted in the inferior (P<0.001) and temporal (P<0.001) quadrants with the 15.0-mm SL. Corneal thickness was not associated with the final TFR thickness.

Conclusions:
The greatest corneal swelling was observed in the inferior quadrant with the 15.0-mm SL, although this lens had the least TFR thickness inferiorly. TFR thickness alone did not account for observed corneal swelling.
Integration of Athletic Training Services on a Smokejumper Base
Authors: Callis Isabella , Moody Valerie J. 
Published: October 2021

Objective:
To examine utilization of an athletic trainer (AT) at a Smokejumper base throughout fire season and document Smokejumper satisfaction with services provided.

Methods:
The AT documented patient encounters with Smokejumpers who were invited to complete a five-part injury prevention movement and mobility assessment (MMS) during fire season with follow up consultations to incorporate injury prevention strategies. Smokejumpers were asked to complete an AT satisfaction survey (ATSS) at the end of season.

Results:
One hundred ninety-two documented patient encounters revealed four primary reasons for AT consultation: exercise prescription (31%, n = 59/192); MMS (30%, n = 58/192); injury consultation (27%, n = 51/192); and patient education (12%, n = 24/192). Likert scores on the ATSS ranged from 4.67 to 4.92 out of a possible 5.

Conclusions:
Although continued research into Smokejumper injuries is critical, it is evident that Smokejumpers are interested in having direct access to AT services.
Pulmonary rehabilitation in a postcoronavirus disease 2019 world: feasibility, challenges, and solutions
Authors: Wen Jing , Milne Stephen , Sin Don D. 
Published: October 2021

Purpose of review
Pulmonary rehabilitation improves clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). Traditional centre-based (in-person) pulmonary rehabilitation was largely shut down in response to the COVID-19 pandemic, forcing many centres to rapidly shift to remote home-based programs in the form of telerehabilitation (tele-pulmonary rehabilitation). This review summarizes the recent evidence for the feasibility and effectiveness of remote pulmonary rehabilitation programs, and their implications for the delivery of pulmonary rehabilitation in a postpandemic world.

Recent findings
A number of innovative adaptations to pulmonary rehabilitation in response to COVID-19 have been reported, and the evidence supports tele-pulmonary rehabilitation as a viable alternative to traditional centre-based pulmonary rehabilitation. However, these studies also highlight the challenges that must be surmounted in order to see its widespread adoption.

Summary
There are outstanding questions regarding the optimal model for tele-pulmonary rehabilitation. In the post-COVID-19 world, a ‘hybrid’ model may be more desirable, with some components held in person and others via telehealth technology. This would be determined by the infrastructure and expertise of individual centres, and the needs of their patients. In order to achieve a truly patient-centred pulmonary rehabilitation program, high-quality studies addressing these outstanding questions, as well as multidisciplinary collaboration, are required.
Concordance Among 10 Different Anticholinergic Burden Scales in At-Risk Older Populations
Authors: Tristancho-Pérez Ángela , Villalba-Moreno Ángela , Santos-Rubio María Dolores , Belda-Rustarazo Susana , Santos-Ramos Bernardo , Sánchez-Fidalgo Susana 
Published: October 2021

Objective
The aim of the study was to evaluate the concordance among 10 anticholinergic scales for the measurement of anticholinergic drug exposure in at-risk elderly complex chronic patients in primary care.

Methods
An 8-month cross-sectional, multicenter study was carried out in a cohort of complex chronic patients older than 65 years in treatment with at least 1 drug with anticholinergic activity. Demographic, pharmacological, and clinical data were collected. Anticholinergic burden and risk were detected using the 10 scales included on the anticholinergic burden calculator (http://www.anticholinergicscales.es/). We used κ statistics to evaluated the concordance 2 to 2 (according to risk: high, medium, low or without risk) among the included scales.

Results
Four hundred seventy-three patients were recruited (60.3% female, median age of 84 years [interquartile range = 10]). Eighty was the total number of anticholinergic drugs with any scale (1197 prescriptions), with a median of 2 drugs with anticholinergic activity per patient (interquartile range = 2). The κ statistics comparing all the 10 scales ranged from −0.175 (Drug Burden Index versus Chew Scale) to 0.708 (Anticholinergic Activity Scale [AAS] versus Chew Scale). The best concordance was obtained between AAS and Chew Scale (κ = 0.708), followed by Clinician-Rated Anticholinergic Scale and Duran Scale (κ = 0.632) and AAS and Anticholinergic Cognitive Burden Scale (κ = 0.618), being considered substantial strengths of concordance.

Conclusions
The agreement among the 10 scales in elderly patients with complex chronic conditions was highly variable. Great care should be taken when assessing anticholinergic drug exposure using existing scales because of the wide variability among them. The only scales that showed agreement were the AAS-Chew, Clinician-Rated Anticholinergic Scale–Duran, and AAS–Anticholinergic Cognitive Burden Scale pairs. In the rest of the cases, the scales are not interchangeable.
Decade of Patient Experience Improvement at a Tertiary Care Urban Hospital
Authors: Eamranond Alyssa , Rodis John F. , Richard Kimberlee E. , Safer Amanda , Kunupakaphun Schawan , Grey Michael R. , Eamranond Pracha Peter 
Published: October 2021

Background and Objective:
The purpose of this quality management study was to demonstrate how one hospital made a journey from average patient experience to become a regional leader in the experience of patient care for nationally recognized quality and safety metrics.

Methods:
Saint Francis Hospital & Medical Center (SFHMC) located in Hartford, Connecticut, serves a diverse sociodemographic community as part of Trinity Health. “Recommend the Hospital” (RTH) has been the main marker of patient experience at SFHMC and Trinity Health across the United States as part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). From 2010 to 2019, SFHMC implemented unit-based rounding hospital-wide, adopting charge nurse and executive leadership rounding as standard work. The intense support from senior leadership spurred the implementation of these changes across middle management and all frontline workers. The t test was used to determine differences between the mean RTH scores between SFHMC, Connecticut, and the United States.

Results:
Patient experience at SFHMC was regularly assessed by Press Ganey surveys and HCAHPS, which demonstrated higher scores than averages for the state of Connecticut and the United States between 2010 and 2019 (both Ps < .001). SFHMC was the top performer with an RTH score of 83%, with the state average being 71% and the national average being 72%. In the years following the implementation of a multipronged low-cost strategy, hospital RTH scores rose linearly from the state and national average. SFHMC observed gains in patient safety and quality scores as measured by national benchmarks, including Leapfrog patient safety scores of 7 A's and 1 B over a 4-year period. SFHMC was the only hospital in Connecticut to receive an A grade 4 years in a row.

Conclusion:
A combination of nurse-led, unit-based rounding and executive team rounding with a consistent focus on patient experience resulted in significant improvement in RTH scores for a busy teaching urban hospital, with only a modest investment of resources. There was also improvement in quality and safety outcomes, which together with patient experience of care drove fiscal stability in an increasingly value-based health care environment.
Metrics of HIV Pre-exposure Prophylaxis (PrEP) Implementation Before and After a Multidisciplinary Task Force at an Academic Institution
Authors: Liu Peter , Stewart Leslie , Short William R. , Koenig Helen 
Published: October 2021

Background and Objectives:
There is a paucity of guidance on HIV pre-exposure prophylaxis (PrEP) implementation in an academic medical center. The objectives of this study were to describe interventions by a multidisciplinary PrEP task force at an academic medical center and compare metrics of PrEP implementation pre- and post-creation of this entity.

Methods:
The interventions of the task force are described within the rubric of the PrEP care continuum. Participants were adults prescribed PrEP for greater than or equal to 30 days at 9 clinical sites across a university health system. Metrics of PrEP implementation were compared over 12-month intervals before and after the creation of the task force.

Results:
An increased proportion of participants had HIV testing within 7 days of new PrEP prescriptions (92% vs 63%, P < .001) and were prescribed PrEP in increments of 90 days or shorter (74% vs 56%, P < .001) after the creation of the task force. There were higher rates of testing for bacterial sexually transmitted infections in men who had sex with men and transgender women in the post-intervention compared with pre-intervention period.

Conclusions:
A multidisciplinary team that focuses on optimizing PrEP delivery along each step of the care continuum may facilitate PrEP scale-up and best practices in an academic setting.
Unusual Increased Blood Pool Activity on 68Ga-DOTATATE PET/CT in a Patient With Metastatic Neuroendocrine Disease
Authors: Sharma Akash , Navaz Anem J. , Pandey Mukesh K. , Parent Ephraim E. 
Published: October 2021

Abstract

68Ga-DOTATATE is a well-established, positron-emitting, somatostatin receptor–binding radiopharmaceutical. We present an unusual case of transiently increased blood pool uptake of 68Ga-DOTATATE in a patient with well-differentiated stage IV neuroendocrine tumor, with Ki-67 <2% (WHO grade 1) maintained on lanreotide. During serial 68Ga-DOTATATE PET/CT examinations, increased blood pool accumulation of presumably unbound 68Ga was demonstrated, which could impact the Kenning score and lead to a false treatment response assessment.
Increased 68Ga-FAPI Uptake in Sacral Chordoma
Authors: Yang Xiao , Mou Chunru , Wang Yong , Liu Huipan , Chen Yue 
Published: October 2021

Abstract
A 47-year-old woman presented with low back pain for 2 months. Her CT scan showed a soft tissue mass in S3 to S4 vertebral bodies. The patient was subsequently enrolled in our 68Ga-FAPI clinical trial on tumors (ChiCTR2100044131). Increased tracer uptake was noted in the sacrum. Postoperative pathology confirmed the diagnosis of sacral chordoma accordingly.
Closed-Incision Negative Pressure Therapy Decreases Wound Morbidity in Open Abdominal Wall Reconstruction With Concomitant Panniculectomy
Authors: Ayuso Sullivan A. , Elhage Sharbel A. , Okorji Leslie M. , Kercher Kent W. , Colavita Paul D. , Heniford B. Todd , Augenstein Vedra A. 
Published: October 2021

Introduction
Patients undergoing abdominal wall reconstruction (AWR) with concomitant panniculectomy (CP) may be at higher risk for wound complications due to the need for large incisions and tissue undermining. The aim of this study was to evaluate whether the use of closed-incision negative pressure therapy (ciNPT) decreases wound complications in AWR patients undergoing CP.

Methods
Beginning in February 2018, all patients at this institution who underwent AWR with CP received ciNPT. These patients were identified from a prospectively maintained institutional database. A standard dressing (non-NPT) group was then created in a 1:1 fashion by identifying patients who had AWR with CP immediately before the beginning of ciNPT use (2016–2018). A univariate comparison was made between the ciNPT and non-NPT groups. The primary outcome was wound complication rate; however, other perioperative outcomes, such as requirement for reoperation, were also tracked. Standard statistical methods and logistic regression were used.

Results
In total, 134 patients met criteria, with 67 patients each in the ciNPT and non-NPT groups. When comparing patients in the ciNPT and non-NPT groups, they were demographically similar, including body mass index, smoking, and diabetes (P < 0.05). Hernias was large on average (289.5 ± 158.2 vs 315.3 ± 197.3 cm2, P = 0.92) and predominantly recurrent (58.5% vs 72.6%, P = 0.14). Wound complications were much lower in the ciNPT group (15.6% vs 35.5%, P = 0.01), which was mainly driven by a decrease in superficial wound breakdown (3.1% vs 19.7%, P < 0.01). Patients in the ciNPT group were less likely to require a return trip to the operating room for wound complications (0.0% vs 13.3%, P < 0.01). In logistic regression, the use of ciNPT continued to correlate with reduced wound complication rates (P = 0.02).

Conclusions
In AWR with CP, the use of ciNPT significantly decreased the risk of postoperative wound complications, particularly superficial wound breakdown, and lessened the need for wound-related reoperation.
Emergency general surgery transfer to lower acuity facility: The role of right-sizing care in emergency general surgery regionalization
Authors: Baimas-George Maria , Schiffern Lynnette , Yang Hongmei , Paton Lauren , Barbat Selwan , Matthews Brent , Reinke Caroline E. 
Published: October 2021

BACKGROUND
Regionalization of emergency general surgery (EGS) has primarily focused on expediting care of high acuity patients through interfacility transfers. In contrast, triaging low-risk patients to a nondesignated trauma facility has not been evaluated. This study evaluates a 16-month experience of a five-surgeon team triaging EGS patients at a tertiary care, Level I trauma center (TC) to an affiliated community hospital 1.3 miles away.

METHODS
All EGS patients who presented to the Level I TC emergency department from January 2020 to April 2021 were analyzed. Patients were screened by EGS surgeons covering both facilities for transfer appropriateness including hemodynamics, resource need, and comorbidities. Patients were retrospectively evaluated for disposition, diagnosis, comorbidities, length of stay, surgical intervention, and 30-day mortality and readmission.

RESULTS
Of 987 patients reviewed, 31.5% were transferred to the affiliated community hospital, 16.1% were discharged home from the emergency department, and 52.4% were admitted to the Level I TC. Common diagnoses were biliary disease (16.8%), bowel obstruction (15.7%), and appendicitis (14.3%). Compared with Level I TC admissions, Charlson Comorbidity Index was lower (1.89 vs. 4.45, p < 0.001) and length of stay was shorter (2.23 days vs. 5.49 days, p < 0.001) for transfers. Transfers had a higher rate of surgery (67.5% vs. 50.1%, p < 0.001) and lower readmission and mortality (8.4% vs. 15.3%, p = 0.004; 0.6% vs. 5.0%, p < 0.001). Reasons not to transfer were emergency evaluation, comorbidity burden, operating room availability, and established care. No transfers required transfer back to higher care (under-triage). Bed days saved at the Level I TC were 693 (591 inpatients). Total operating room minutes saved were 24,008 (16,919, between 7:00 am and 5:00 pm).

CONCLUSION
Transfer of appropriate patients maintains high quality care and outcomes, while improving operating room and bed capacity and resource utilization at a tertiary care, Level I TC. Emergency general surgery regionalization should consider triage of both high-risk and low-risk patients.

LEVEL OF EVIDENCE
Prospective comparative cohort study, Level II.
Description of antibiotic-producing novel bacteria Paraburkholderia antibiotica sp. nov. and Paraburkholderia polaris sp. nov.
Authors: Dahal Ram Hari , Kim Jungmin , Chaudhary Dhiraj Kumar , Kim Dong-Uk , Kim Jaisoo 
Published: October 2021

Two white colony-forming, Gram-stain-negative, non-sporulating and motile bacteria, designated G-4-1-8T and RP-4-7T, were isolated from forest soil and Arctic soil, respectively. Both strains showed antimicrobial activity against Gram-negative pathogens (

Pseudomonas aeruginosa

and

Escherichia coli

) and could grow at a pH range of pH 4.0–11.0 (optimum, pH 7.0–9.0). Phylogenetic analyses based on their 16S rRNA gene sequences indicated that strains G-4-1-8T and RP-4-7T formed a lineage within the family

Burkholderiaceae

and were clustered as members of the genus

Paraburkholderia

. Strain G-4-1-8T showed the highest 16S rRNA sequence similarity to

Paraburkholderia monticola

JC2948T (98.1 %), while strain RP-4-7T showed the highest similarity to

Paraburkholderia metrosideri

DNBP6-1T (98.8 %). The only respiratory quinone in both strains was ubiquinone Q-8. Their principal cellular fatty acids were C16 : 0, cyclo-C17 : 0, summed feature 3 (iso-C15 :0 2-OH and/or C16 :1
ω7c) and summed feature 8 (C18 : 1
ω7c and/or C18 : 1
ω6c). Their major polar lipids were phosphatidylethanolamine, diphosphatidylglycerol, phosphatidylglycerol and an unidentified aminophospholipid. The DNA G+C content of strains G-4-1-8T and RP-4-7T were 63.7 and 61.3 mol%, respectively, while their genome lengths were 7.44 and 9.67 Mb, respectively. The genomes of both strains showed at least 12 putative biosynthetic gene clusters. The average nucleotide identity and in silico DNA–DNA hybridization relatedness values between both strains and most closely related

Paraburkholderia

species were below the species threshold values. Based on a polyphasic study, these isolated strains represent novel species belonging to the genus

Paraburkholderia

, for which the names Paraburkholderia antibiotica sp. nov. (G-4-1-8T= KACC 21617T=NBRC 114603T) and Paraburkholderia polaris sp. nov. (RP-4-7T=KACC 21621T=NBRC 114605T) are proposed.
Long-range regulatory effects of Neandertal DNA in modern humans
Authors: Yermakovich Danat , Pankratov Vasili , Võsa Urmo , Yunusbayev Bayazit ,   Estonian Biobank Research Team, Dannemann Michael 
Published: October 2021

AbstractThe admixture between modern humans and Neandertals has resulted in ∼2% of the genomes of present-day non-Africans being composed of Neandertal DNA. Association studies have shown that introgressed DNA significantly influences phenotypic variation in people today and that several of the phenotype-associated archaic variants had links to expression regulation as well. In general, introgressed DNA has been demonstrated to significantly affect the transcriptomic landscape in people today. However, little is known about how much of that impact is mediated through long-range regulatory effects that have been shown to explain ∼20% of expression variation.Here we identified 60 transcription factors (TFs) with their top cis-eQTL SNP being of Neandertal ancestry in GTEx and predicted long-range Neandertal DNA-induced regulatory effects by screening for the predicted target genes of those TFs. We show that genes in regions devoid of Neandertal DNA are enriched among the target genes of some of these TFs. Furthermore, archaic cis-eQTLs for these TFs included multiple candidates for local adaptation and have associations with various immune traits, schizophrenia, blood cell type composition and anthropometric measures. Finally, we show that our results can be replicated in empirical trans-eQTLs with Neandertal variants.Our results suggest that the regulatory reach of Neandertal DNA goes beyond the 40% of genomic sequence that it still covers in present-day non-Africans and that via this mechanism Neandertal DNA additionally influences the phenotypic variation in people today.
How development affects evolution
Authors: González-Forero Mauricio 
Published: October 2021

AbstractNatural selection acts on developmentally constructed phenotypes, but how does development affect evolution? This question calls for simultaneous consideration of development and evolution. However, there has been a lack of general mathematical frameworks mechanistically integrating the two, which may have inhibited progress on the question. Here we use a new mathematical framework that mechanistically integrates development into evolution to analyse how development affects evolution. We show that, whilst selection pushes genotypic and phenotypic evolution up the fitness landscape, development determines the admissible evolutionary pathway, such that evolutionary outcomes occur at path peaks rather than landscape peaks. Changes in development can generate path peaks, triggering genotypic or phenotypic diversification, even on constant, single-peak landscapes. Phenotypic plasticity, niche construction, extra-genetic inheritance, and developmental bias alter the evolutionary path and hence the outcome. Thus, extra-genetic inheritance can have permanent evolutionary effects by changing the developmental constraints, even if extra-genetically acquired elements are not transmitted to future generations. Selective development, whereby phenotype construction points in the adaptive direction, may induce adaptive or maladaptive evolution depending on the developmental constraints. Moreover, developmental propagation of phenotypic effects over age enables the evolution of negative senescence. Overall, we find that development plays a major evolutionary role.