bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Malnutrition and Clinical Outcomes Among Mechanically Ventilated Patients in Intensive Care Units
Authors: Al Tamimi Dua'a , Ahmad Muayyad 
Published: November 2021

Background
Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes.

Aim
The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan.

Methods
A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool.

Results
Of the total 129 mechanically ventilated patients, the mean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4% of mechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009).

Relevance to Clinical Practice
Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU.
Estimating Associations Between Annual Concentrations of Particulate Matter and Mortality in the United States, Using Data Linkage and Bayesian Maximum Entropy
Authors: Rudolph Jacqueline E. , Cole Stephen R. , Edwards Jessie K. , Whitsel Eric A. , Serre Marc L. , Richardson David B. 
Published: November 2021

Background:
Exposure to fine particulate matter (PM2.5) is an established risk factor for human mortality. However, previous US studies have been limited to select cities or regions or to population subsets (e.g., older adults).

Methods:
Here, we demonstrate how to use the novel geostatistical method Bayesian maximum entropy to obtain estimates of PM2.5 concentrations in all contiguous US counties, 2000–2016. We then demonstrate how one could use these estimates in a traditional epidemiologic analysis examining the association between PM2.5 and rates of all-cause, cardiovascular, respiratory, and (as a negative control outcome) accidental mortality.

Results:
We estimated that, for a 1 log(μg/m3) increase in PM2.5 concentration, the conditional all-cause mortality incidence rate ratio (IRR) was 1.029 (95% confidence interval [CI]: 1.006, 1.053). This implies that the rate of all-cause mortality at 10 µg/m3 would be 1.020 times the rate at 5 µg/m3. IRRs were larger for cardiovascular mortality than for all-cause mortality in all gender and race–ethnicity groups. We observed larger IRRs for all-cause, nonaccidental, and respiratory mortality in Black non-Hispanic Americans than White non-Hispanic Americans. However, our negative control analysis indicated the possibility for unmeasured confounding.

Conclusion:
We used a novel method that allowed us to estimate PM2.5 concentrations in all contiguous US counties and obtained estimates of the association between PM2.5 and mortality comparable to previous studies. Our analysis provides one example of how Bayesian maximum entropy could be used in epidemiologic analyses; future work could explore other ways to use this approach to inform important public health questions.
Association between benzodiazepine premedication and 30-day mortality rate
Authors: Kowark Ana , Berger Moritz , Rossaint Rolf , Schmid Matthias , Coburn Mark 
Published: November 2021

BACKGROUND
Recent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients, though with limited supporting evidence.

OBJECTIVE
We conducted a secondary analysis of the POSE data to explore the association of premedication in patients aged 80 years or older with 30-day mortality.

DESIGN
We used propensity score methods to perform a confounder-adjusted time-to-event analysis of the association between benzodiazepine premedication and 30-day mortality of the POSE study.

SETTING
POSE was conducted as a European multicentre prospective cohort study.

PATIENTS
Adults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.

RESULTS
A total of 9497 patients were analysed. One thousand five hundred and twenty-one patients received benzodiazepine premedication, 7936 patients received no benzodiazepine premedication, 30 received clonidine and 10 had missing premedication data. Inverse propensity-score-weighted log-rank analysis did not provide unambiguous evidence for an association between benzodiazepine premedication and 30-day mortality; median [range] P = 0.048 [0.044 to 0.078], estimated 30-day mortality rates 3.21% and 4.45% in benzodiazepine-premedicated and nonbenzodiazepine-premedicated patients, respectively. Inverse propensity-score-weighted Cox regression resulted in a hazard ratio of 0.71 (95% CI 0.49 to 1.04), pointing at a possible reduction of 30-day mortality in the benzodiazepine premedication group. Sensitivity analyses, which constituted subgroup, matched-pairs, and subclassification analyses, resulted in similar findings.

CONCLUSION
This secondary analysis of the POSE data did not find evidence for an unambiguous association between benzodiazepine premedication and 30-day mortality. Point estimates indicated a reduction of 30-day mortality in benzodiazepine-premedicated patients. The results presented here might be affected by unmeasured confounding factors, which could be addressed in a randomised trial.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03152734.
Disparities in Outcomes During Lower Respiratory Tract Infection in American Indian Children
Authors: Palmer Geralyn M. , Kooima Travis R. , Van Hove Christopher M. , Withrow Landon L. , Gurumoorthy Aarabhi , Lopez Santiago M.C. 
Published: November 2021

Background:
American Indian (AI) children are at increased risk for severe disease during lower respiratory tract infection (LRTI). The reasons for this increased severity are poorly understood. The objective of this study was to define the clinical presentations of LRTI and highlight the differences between AI and non-AI previously healthy patients under the age of 24 months.

Methods:
We performed a retrospective chart review between October 2010 and December 2019. We reviewed 1245 patient charts and 691 children met inclusion criteria for this study. Data records included demographics, clinical, laboratory data, and illness outcomes.

Results:
Of 691 patients, 120 were AI and 571 were non-AI. There was a significant difference in breast-feeding history (10% of AI vs. 28% of non-AI, P < 0.0001) and in secondhand smoke exposure (37% of AI vs. 21% of non-AI, P < 0.0001). AI children had increased length of hospitalization compared with non-AI children (median of 3 vs. 2 days, P < 0.001). In addition, AI children had higher rates of pediatric intensive unit admission (30%, n = 37) compared with non-AI children (11%; n = 67, P < 0.01). AI children also had higher rates (62.5%, n = 75) and duration of oxygen supplementation (median 3 days) than non-AI children (48%, n = 274, P = 0.004; median 2 days, P = 0.0002). On a multivariate analysis, AI race was an independent predictor of severe disease during LRTI.

Conclusions:
AI children have increased disease severity during LRTI with longer duration of hospitalization and oxygen supplementation, a higher rate of oxygen requirement and Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation pediatric intensive care unit admissions, and a greater need for mechanical ventilation. These results emphasize the need for improvement in health policies and access to health care in this vulnerable population.
Common bacterial metabolite indole directly activates nociceptive neuron through transient receptor potential ankyrin 1 channel
Authors: Chung Sena , Kim Hayun , Kim Doyun , Lee Jung Moo , Lee C. Justin , Oh Seog Bae 
Published: November 2021

Abstract
Nociceptors are known to directly recognize bacterial cell wall components or secreted toxins, thereby leading to pain induced by bacterial infection. However, direct activation of nociceptors by bacterial metabolites remains unclear although bacteria produce numerous metabolites related to health and disease. In this study, we investigated whether and how a common bacterial metabolite, indole, which is produced by normal microflora of the gastrointestinal tract and oral cavity, can directly activate nociceptive sensory neurons. We found that indole elicits calcium response and evokes inward currents in subsets of dorsal root ganglia (DRG) neurons. Intraplantar (i.pl.) injection of indole produced nocifensive behaviors in adult mice, which were enhanced in complete Freund’s adjuvant–induced chronic inflammatory condition. Indole increased calcitonin gene-related peptide release in DRG neurons, and i.pl. injection of indole increased hind paw thickness, suggesting its role in generation of neurogenic inflammation. These in vitro and in vivo indole-induced responses were pharmacologically blocked by transient receptor potential ankyrin 1 (TRPA1) antagonist, HC-030031, and significantly abolished in TRPA1 knockout (KO) mice, indicating that indole targets TRPA1 for its action in DRG neurons. Nocifensive licking behavior induced by the injection of live Escherichia coli was significantly decreased in tryptophanase mutant (TnaA KO) E. coli-injected mice that lack indole production, further supporting the idea that bacteria-derived indole can induce pain during infection. Identifying the mechanism of action of indole through TRPA1 provides insights into bacteria–neuron interactions and the role of bacterial metabolites in pain signaling, especially in inflammation-accompanied bacterial infection.
The Prospective Association Between Physical Activity, Insomnia Symptoms, and Productivity in an Australian Population-Based Cohort
Authors: Oftedal Stina , Fenwick Matthew J. , Duncan Mitch J. 
Published: November 2021

Objectives:
To investigate the joint, prospective associations of physical inactivity and insomnia symptoms and productivity using the 2013 and 2014 household income and labor dynamics in Australia Survey panel data.

Methods:
The association between (i) presenteeism (yes/no, n = 5864) and (ii) absenteeism (sick leave days, n = 4324) and the mutually exclusive groups “active without insomnia,” “active with insomnia,” “inactive without insomnia,” and “inactive with insomnia” was assessed.

Results:
Participants “active with insomnia” or “inactive with insomnia” had greater odds of presenteeism than those “active without insomnia” (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.07 to 1.85 and OR = 1.44, 95% CI: 1.14 to 1.83, respectively). Participants “inactive with insomnia” had a greater incidence of absenteeism than participants “active without insomnia” (incidence rate ratio [IRR] = 1.28, 95% CI: 1.07 to 1.54).

Conclusions:
Findings suggest improving physical activity levels and insomnia symptoms concurrently may improve productivity by reducing presenteeism and sick leave.
Finding Success in Scholarship: How Physician Assistant Educators Can Overcome Barriers to Publication
Authors: Reed Harrison , Artino Anthony R. 
Published: November 2021

Abstract
Publishing scholarly work offers several benefits for physician assistants (PAs) in faculty roles. It allows them to establish expertise, disseminate knowledge, and advance their careers. However, due to a variety of barriers, PAs are often unable to build a portfolio of scholarly articles. They frequently lack the time, training, experience, and resources to complete large academic projects and navigate the complex publication process. This article offers 6 key strategies to help PAs in academic settings pursue scholarly work and achieve publication.
The Utility of the Modified Dionne's Egress Test as a Predictor of Falls in Adult Medical and Surgical Patients
Authors: Barbay Kathryn , Williams Karen B. , Berning Paul 
Published: November 2021

OBJECTIVE
The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting.

BACKGROUND
Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling.

METHODS
A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data.

RESULTS
The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall.

CONCLUSION
Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.
Controversies in Systemic Lupus Erythematosus
Authors: Porta Sabrina Valeria , Ugarte-Gil Manuel F. , García-de la Torre Ignacio , Bonfá Eloísa , Gómez-Puerta José A. , Arnaud Laurent , Cardiel Mario H. , Alarcón Graciela S. , Pons-Estel Bernardo A. , Pons-Estel Guillermo 
Published: November 2021

Abstract
Systemic lupus erythematosus (SLE) is characterized by great clinical heterogeneity. The objectives of its management are to make a timely diagnosis and to initiate treatment as promptly as possible so organ damage can be avoided while at the same time exposure to potentially toxic drugs is minimized so that its overall course and outcome improve. In reviewing the current literature, it became quite clear that there are specific topics in which controversies do exist. These include how to treat patients with incomplete lupus erythematosus, the real possibility of abandoning altogether the use of oral glucocorticoids, and the pros and cons of the use of cyclophosphamide and mycophenolate mofetil for the induction treatment of lupus nephritis. Herein we discuss different points of view regarding these still unresolved issues; these comments represent a debate that took place during the PANLAR Virtual Congress (Pan American League of Associations for Rheumatology) and that was organized by the PANLAR Lupus study group, GLADEL (Grupo Latino Americano De Estudio del Lupus) on September 19, 2020.
Transabdominal Ultrasound Evaluation of Pancreaticobiliary Maljunction in Children
Authors: Ma Ya , Wang Zhengrong , Ye Mao , Yang Yang , Liu Luyu 
Published: November 2021

Abstract
The development of high-frequency ultrasound made the diagnosis of pancreaticobiliary maljunction (PBM) possible. However, no study has been performed to clarify the sensitivity and specificity of transabdominal ultrasound (TAUS) in the diagnosis of PBM. The purpose of this study was to evaluate the accuracy of TAUS in the diagnosis of pediatric PBM and to assess factors that may influence the accuracy of ultrasound. This was a prospective study and 43 patients with suspected PBM were enrolled. All of these patients underwent TAUS examination to detect the pancreaticobiliary ductal union. Final diagnoses were determined by endoscopic retrograde cholangiopancreatography or intraoperative cholangiography. Sensitivity and specificity were calculated. Fisher exact test was used to analyze the difference of sonographic features between false-negative group and true-positive group. Transabdominal ultrasound demonstrated 77.4% (95% confidence interval, 58.5%–89.7%) sensitivity and 100% (95% confidence interval, 69.9%–100%) specificity for PMB diagnosis. In the false-negative group, infant patients (71.4% vs 16.7%, P = 0.012), cystic dilatation of the common bile duct (CBD) (71.4% vs 16.7%, P = 0.012), and stenosis of the distal CBD (71.4% vs 16.7%, P = 0.012) were more frequently observed than in the true-positive group. On the other hand, the true-positive group showed a higher incidence of protein plugs than the false-negative group (62.5% vs 0%, P = 0.007). Transabdominal ultrasound may serve as a potential alternative detection modality for pediatric patients with suspected PBM. Nondetection of the anomaly may be attributed to factors, such as younger age, cystic dilatation of the CBD, and stenosis of the distal CBD.
Proboscis Lateralis: A Novel Surgical Technique Using Tape Elongation and One-Stage Tunneling
Authors: Engström Olof , Svee Andreas , Hakelius Malin 
Published: November 2021

Abstract
Proboscis lateralis is a rare craniofacial anomaly characterized by a tubular, trunk-like appendage, often arising from the medial canthal region. It can occur in isolation or in association with a variety of other anomalies. Several treatment options have been described depending on the characteristics of the defect, but due to its infrequency, the body of knowledge is limited. Here, the authors present a case of proboscis lateralis in an 18-month-old girl, being successfully treated with a novel technique including tape elongation and a 1 stage tunneling procedure.
Probing Gut-Brain Links in Alzheimer’s Disease with Rifaximin
Authors: Suhocki Paul V. , Ronald James S. , Diehl Anna Mae E. , Murdoch David M. , Doraiswamy P. Murali 
Published: November 2021

AbstractGut-microbiome-inflammation interactions have been linked to neurodegeneration in Alzheimer’s disease (AD) and other disorders. We hypothesized that treatment with rifaximin, a minimally absorbed gut-specific antibiotic, may modify the neurodegenerative process by changing gut flora and reducing neurotoxic microbial drivers of inflammation. In a pilot, open-label trial, we treated 10 subjects with mild to moderate probable AD dementia (MMSE = 17 ± 3) with rifaximin for 3 months. Treatment was associated with a significant reduction in serum neurofilament-light levels (p <0.004) and a significant increase in fecal phylum Firmicutes microbiota. Serum pTau181 and GFAP levels were reduced (effect sizes of -0.41 and -0.48 respectively) but did not reach significance. There was also a non-significant downward trend in serum cytokine IL-6 and IL-13 levels. Increases in stool Erysipelatoclostridium were correlated significantly with reductions in serum pTau 181 and serum GFAP. Insights from this pilot trial are being used to design a larger placebo-controlled clinical trial to determine if specific microbial flora/products underlie neurodegeneration, and whether rifaximin is clinically efficacious as a therapeutic.Research in ContextSystematic ReviewPubMed reviews showed emerging evidence for gut-microbiome-inflammation links in Alzheimer’s disease (AD).InterpretationOur pilot study revealed that rifaximin, a minimally absorbed, gut-specific antibiotic, reduced surrogate markers of neurodegeneration while increasing, potentially beneficial, microbiota in phylum Firmicutes. These data provide initial support to the hypothesis that microbiome related products may play a role in neurodegenerative disorders.Future DirectionsWe plan to conduct additional human and pre-clinical studies to confirm these findings and determine the potential of rifaximin as a therapeutic for AD.
Hospital admissions for respiratory tract infections in children aged 0-5 years for 2017/2023
Authors: Methi Fredrik , Størdal Ketil , Telle Kjetil , Larsen Vilde Bergstad , Magnusson Karin 
Published: November 2021

AimTo compare hospital admissions across common respiratory tract infections (RTI) in 2017-21, and project possible hospital admissions for the RTIs among children aged 0-12 months and 1-5 years in 2022 and 2023.MethodsIn 644 885 children aged 0-12 months and 1-5 years, we plotted the observed monthly number of RTI admissions (upper- and lower RTI, influenza, respiratory syncytial virus (RSV), and COVID-19) from January 1st, 2017 until October 31st, 2021. We also plotted the number of RTI admissions with a need for respiratory support. We used the observed data to project four different scenarios of RTI admissions for the rest of 2021 until 2023, with different impacts on hospital wards: 1) “Business as usual”, 2) “Continuous lockdown”, 3) “Children’s immunity debt”, and 4) “Maternal and child immunity debt”.ResultsBy October 31st, 2021, the number of simultaneous RTI admissions had exceeded the numbers usually observed at the typical season peak in January, i.e. ∼900. Based on our observed data and assuming that children and their mothers (who transfer antibodies to the very youngest) have not been exposed to RTI over the last one and a half years, our scenarios suggest that hospitals should be prepared to handle two to three times as many RTI admissions, and two to three times as many RTI admissions requiring respiratory support among 0-5-year-olds as normal, from November 2021 to April 2022.ConclusionScenarios with immunity debt suggest that pediatric hospital wards and policy makers should plan for extended capacity.
The Failures of an Ideal COVID-19 Vaccine: A Simulation Study
Authors: Kosinski Robert J. 
Published: November 2021

AbstractThis paper simulates an ideal COVID-19 vaccine that confers immediate sterilizing immunity against all SARS-CoV-2 variants. The purpose was to explore how well this ideal vaccine could protect a population against common conditions (such as vaccine hesitancy) that might impair vaccine effectiveness. Simulations were done with an SEIRS spreadsheet model that ran two parallel subpopulations: one that accepted vaccination, and another that refused it. The two subpopulations could transmit infections to one another. Success was judged by the rate of new cases in the period from 1-5 years after the introduction of the vaccine.Under good conditions, including a small subpopulation that refused vaccination, rapid distribution of the vaccine, duration of vaccinal immunity longer than 12 months, good retention of interest in getting vaccinated after the first year, strict maintenance of nonpharmaceutical interventions (NPIs) such as masking, and new variants with R0s less than 4.0, the vaccine was able to end the epidemic. With violation of these conditions, the post-vaccine era futures ranged from endemic COVID at a low or medium level to rates of COVID cases worse than anything seen in the US up to late 2021. The most important conditions for keeping case rates low were a fast speed of vaccine distribution, a low percentage of the population that refuses vaccination, a long duration of vaccinal immunity, and continuing maintenance of NPIs after vaccination began. On the other hand, a short duration of vaccinal immunity, abandonment of NPIs, and new variants with a high R0 were powerful barriers to disease control. New variants with high R0s were particularly damaging, producing high case rates except when vaccination speed was unrealistically rapid. A recurring finding was that most disease afflicting the vaccinated population in these simulations originated in the unvaccinated population, and cutting off interaction with the unvaccinated population caused a sharp drop in the case rate of the vaccinated population.In conclusion, multiple common conditions can compromise the effectiveness of even an “ideal” vaccine.