bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-readmission decisions in the intensive care unit: A qualitative study of physicians’ experience in a multicentre French study
Authors: Jacquier Marine , Meunier-Beillard Nicolas , Ecarnot Fiona , Large Audrey , Aptel François , Labruyère Marie , Dargent Auguste , Andreu Pascal , Roudaut Jean-Baptiste , Rigaud Jean-Philippe , Quenot Jean-Pierre 
Published: January 2021

Purpose
Deciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU.

Materials and methods
Multicenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis.

Results
In total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous.

Conclusions
Non-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.
Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain
Authors: Garralda Fernandez Javier , Molero Vilches Ignacio , Bermejo Rodríguez Alfredo , Cano Torres Isabel , Colino Romay Elda Isabel , García Arata Isabel , Jaqueti Aroca Jerónimo , Lillo Rodríguez Rosa , López Lacomba Daniel , Mazón Cuadrado Luis , Molina Esteban Laura , Morales García Luis Javier , Moratilla Monzo Laura , Nieto-Borrajo Elva , Pacheco Delgado María , Prieto Menchero Santiago , Sánchez Hernández Cristina , Sánchez Testillano Eva , García-Martínez Jesús 
Published: January 2021

Background
The COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk.

Methods and findings
This is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (p<0.01).

Conclusions
The global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms.
The effect of antenatal care on perinatal outcomes in Ethiopia: A systematic review and meta-analysis
Authors: Shiferaw Kasiye , Mengiste Bizatu , Gobena Tesfaye , Dheresa Merga 
Published: January 2021

BackgroundThe estimated annual global perinatal and neonatal death is four million. Stillbirths are almost equivalent to neonatal mortality, yet they have not received the same attention. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but its effectiveness as a means of reducing perinatal mortality has not been evaluated in Ethiopia. Therefore, we will identify the pooled effect of antenatal care on perinatal outcomes in Ethiopia.MethodsMedline, Embase, Cinahl, African journal online and Google Scholar was searched for articles published in English language between January 1990 and May 2020. Two independent assessors selected studies and extracted data from eligible articles. The Risk of Bias Assessment tool for Non-Randomized Studies was used to assess the quality of each included study. Data analysis was performed using RevMan 5.3. Heterogeneity and publication bias were assessed using I2test statistical significance and Egger's test for small-study effects respectively. The random effect model was employed, and forest plot was used to present the risk ratio (RR) with 95% confidence interval (CI).ResultsThirteen out of seventeen included studies revealed antenatal care utilization had a significant association with perinatal outcomes. The pooled risk ratio by the random-effects model for perinatal death was 0.42 (95% CI: 0.34, 0.52); stillbirth 0.34 (95% CI: 0.25, 0.46); early neonatal death 0.85 (95% CI: 0.21. 3.49).ConclusionWomen who attended at least one antenatal care visit were more likely to give birth to an alive neonate that survives compared to their counterpart. Therefore, the Ethiopian Ministry of health and other stakeholders should design tailored interventions to increase antenatal care utilization since it has been shown to reduce perinatal mortality.
Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe
Authors: Mapangisana Tichaona , Machekano Rhoderick , Kouamou Vinie , Maposhere Caroline , McCarty Kathy , Mudzana Marceline , Munyati Shungu , Mutsvangwa Junior , Manasa Justen , Shamu Tinei , Bogoshi Mampedi , Israelski Dennis , Katzenstein David 
Published: January 2021

Introduction
Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.

Methods
From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).

Results
At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).

Conclusion
Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.
The effects of laser displacement on femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery
Authors: Foo Valencia Hui Xian , Liu Yu-Chi , Ong Hon Shing , Ang Marcus , Mehta Jodhbir S. 
Published: January 2021

Aims
To evaluate the effects of no-suction femtosecond laser (FSL) stability on conjunctival autograft (CAG) dissection in pterygium surgery.

Methods
Prospective analysis of 35 eyes from 34 subjects who underwent femtosecond laser-assisted pterygium surgery with the Ziemer Z8 laser (Ophthalmic Systems AG, Switzerland). Intraoperative absolute FSL displacements were measured and correlated with the duration and ease of CAG peel, CAG thickness, measured with intraoperative optical coherence tomography, and deviation from intended graft thickness.

Results
The median absolute FSL displacement was 22 μm (interquartile range [IQR] 14.7 to 60.8), while median vertical FSL displacement was 14.7 μm (IQR 7.3 to 44) and median horizontal FSL displacement was 22.0 μm (IQR 14.7 to 44). 65.7% had a grade 1 peel, 11.4% had grade 2 peel, 14.3% had grade 3 peel and 8.6% had grade 4 peel. The median duration of CAG peel was 5.4 seconds (IQR 3 to 21.4). The median CAG thickness was 69 μm (IQR 60.3 to 78.5), and the median deviation from targeted graft thickness was 9 μm (IQR 1 to 16). Eyes with more difficult peels and longer duration of CAG peels had significantly greater vertical FSL displacements (p = 0.04 and 0.02 respectively), but not horizontal displacement, age, ethnicity, CAG thickness or deviation from original thickness, compared to those with better quality and shorter duration peels. 1 eye (2.9%) had an incomplete CAG peel with a buttonhole and 2 eyes had graft tears (5.7%).

Conclusion
Micro-displacements during the suction-free CAG preparation are common but they did not affect the quality of the CAG peel, duration of peel, or CAG thickness. However, vertical globe displacement during FSL-assisted CAG creation was significantly associated with a more difficult and longer CAG peel duration. This highlights the importance of the cornea traction suture fixation to ensure stability of the eye during FSL application.
Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of U.S. adults
Authors: Grover Madhusudan , Kolla Bhanu Prakash , Pamarthy Rahul , Mansukhani Meghna P. , Breen-Lyles Margaret , He Jian-Ping , Merikangas Kathleen R. 
Published: January 2021

Background/Aims
Patients with irritable bowel syndrome (IBS) in referral practice commonly report mental disorders and functional impairment. Our aim was to determine the prevalence of mental, physical and sleep-related comorbidities in a nationally representative sample of IBS patients and their impact on functional impairment.

Methods
IBS was defined by modified Rome Criteria based on responses to the chronic conditions section of the National Comorbidity Survey-Replication. Associations between IBS and mental, physical and sleep disorders and 30-day functional impairment were examined using logistic regression models.

Results
Of 5,650 eligible responders, 186 met criteria for IBS {weighted prevalence 2.5% (SE = 0.3)}. Age >60 years was associated with decreased odds (OR = 0.3; 95% CI:.1-.6); low family income (OR = 2.4; 95% CI:1.2–4.9) and unemployed status (OR = 2.3; 95% CI:1.2–4.2) were associated with increased odds of IBS. IBS was significantly associated with anxiety, behavior, mood disorders (ORs 1.8–2.4), but not eating or substance use disorders. Among physical conditions, IBS was associated with increased odds of headache, chronic pain, diabetes mellitus and both insomnia and hypersomnolence related symptoms (ORs 1.9–4.0). While the association between IBS and patients’ role impairment persisted after adjusting for mental disorders (OR = 2.4, 95% CI 1.5–3.7), associations with impairment in self-care, cognition, and social interaction in unadjusted models (ORs 2.5–4.2) were no longer significant after adjustment for mental disorders.

Conclusion
IBS is associated with socioeconomic disadvantage, comorbidity with mood, anxiety and sleep disorders, and role impairment. Other aspects of functional impairment appear to be moderated by presence of comorbid mental disorders.
Gender-Specific Factors Influencing Gastroenterologists to Pursue Careers in Advanced Endoscopy: Perceptions vs Reality
Authors: David Yakira N. , Dixon Rebekah E. , Kakked Gaurav , Rabinowitz Loren G. , Grinspan Lauren T. , Anandasabapathy Sharmila , Greenwald David A. , Kim Michelle K. , Sethi Amrita , Kumta Nikhil A. 
Published: January 2021

INTRODUCTION:
In 2020, only 19% of 63 matched advanced endoscopy (AE) fellows were women. This study evaluates the gender-specific factors that influence gastroenterologists to pursue careers in AE.

METHODS:
An anonymous survey was distributed to gastroenterology fellows and attendings through various gastroenterology society online forums. Data were collected on demographics, training, mentorship, current practice, family planning, and career satisfaction.

RESULTS:
Women comprised 71.1% of the 332 respondents. 24.7% of female fellows plan to pursue an AE career compared with 37.5% of male fellows (P = 0.195). The main motivating factor for both genders was interest in the subject area. Interest in another subspecialty was the main deterring factor for both genders. Women were more deterred by absence of same-sex mentors (P < 0.001), perception of gender-based bias in the workplace (P = 0.009), family planning (P = 0.018), fertility/pregnancy risks from radiation (P < 0.001), and lack of ergonomic equipment (P = 0.003). AE gastroenterologists of both genders were satisfied with their career decision and would recommend the field to any fellow. Most respondents (64%) believed that more female role models/mentors would improve representation of women in AE.

DISCUSSION:
There are multiple gender-specific factors that deter women from pursuing AE. Increasing the number of female role models is strongly perceived to improve representation of women in AE. Most AE attendings are satisfied with their career and would recommend it to fellows of any gender. Thus, early targeted mentorship of female trainees has potential to improve recruitment of women to the field.
Gender Disparities in Food Security, Dietary Intake, and Nutritional Health in the United States
Authors: Ma Christopher , Ho Stephanie K.M. , Singh Siddharth , Choi May Y. 
Published: January 2021

INTRODUCTION:
Food insecurity is associated with negative nutritional outcomes and is experienced differently by women vs men. We evaluated the effects of gender on food insecurity and dietary intake in the United States.

METHODS:
Data from the National Health and Nutrition Examination Survey (2007–2016) were analyzed. Survey-weighted linear and logistic regression models were used to evaluate predictors of food security and the effect of food security on dietary consumption and body anthropometrics. Gender was modeled as a covariable and as an effect modifier.

RESULTS:
A total of 30,251 respondents were included. Approximately 15.1% (95% confidence interval [CI]: 14.1%–16.1%) of participants were food insecure. This increased over time from 11.7% in 2007–2008 to 18.2% in 2015–2016. A higher proportion of women experienced food insecurity compared with men (53.3% vs 46.7%, P = 0.02), although this was not significant after adjusting for poverty and other confounders (adjusted odds ratio 1.01; 95% CI: 0.93–1.09; P = 0.81). Among food insecure women, 32.4% (95% CI: 30.0%–34.9%) received emergency food assistance and 75.0% (95% CI: 71.5%–78.2%) received supplemental nutrition assistance benefits. Relative to men, food insecure women were less likely to meet the recommended dietary allowance of most macronutrients and micronutrients. They were also significantly more likely to be obese, have a wider waist circumference, and have higher total body fat percentage (P interaction all <0.001).

DISCUSSION:
Food insecurity represents a substantial public health challenge in the United States that differentially affects women compared with men. Alternative strategies may be required to meet the nutritional requirements for food insecure women.
Estrogen-Driven Growth of Focal Nodular Hyperplasia: Truth or Myth?
Authors: Ashhab Ashraf A. , Abu-Sulb Ahmad , Yang Ju Dong , Noureddin Mazen , Sundaram Vinay , Kuo Alexander , Ayoub Walid S. 
Published: January 2021

ABSTRACT
The etiologic association between focal nodular hyperplasia (FNH) and estrogen has been a subject of doubt and controversy. We present a case of a female patient with FNH that had been monitored for several years with noted size stability and later regression, who developed tumor growth during pregnancy. This case suggests that a subset of FNH is indeed hormone sensitive, as opposed to what has been frequently suggested by many other reports that question the association, a finding that may have clinical implications, in terms of monitoring of patients with high estrogen statuses.
Correlation of Fecal Immunochemical Testing Levels With Pathology Results in a National Colorectal Cancer Screening Program
Authors: O'Reilly Susanne M. , MacNally Sara , O'Donoghue Diarmuid , Mooney Therese , Fitzpatrick Patricia , Mulcahy Hugh E. , Cullen Garret 
Published: January 2021

INTRODUCTION:
Fecal immunochemical testing (FIT) positivity is determined by a threshold decided by individual screening programs. Data are limited on correlation between FIT levels and pathology identified at colonoscopy. Our aim was to examine the correlation between FIT levels and pathology identified in a national colorectal cancer screening program.

METHODS:
FIT levels (n = 9,271) were analyzed and correlated with patient demographics and pathology identified, including adenomas, sessile serrated lesions, number/size of adenomas, and presence of dysplasia. Levels were divided into 2 categories: FIT levels were defined as “high” or “low” based on whether they were above or below the median (479 ngHb/mL). Multivariate analysis was performed.

RESULTS:
A total of 8,084 patients (87%) underwent colonoscopy. Those younger than 65 years (odds ratio [OR] 1.267, 95% confidence interval [CI] 1.107–1.45, P = 0.001), those with an adenoma >10 mm (OR 1.736, 95% CI 01.512–1.991, P < 0.001), and those with left-sided adenomas (OR 1.484, 95% CI 1.266–1.74, P < 0.001) had higher FIT levels. Cancers (OR 2.8, 95% CI 2.09–3.75, P < 0.001) and high-grade dysplasia (OR 1.356, 95% CI 1.08–1.7, P = 0.008) had higher FIT levels, but varied greatly. The number of adenomas was not significant.

DISCUSSION:
In this study, FIT levels were high for left-sided and large adenomas, suggesting that FIT has poor sensitivity for detection of diminutive and right-sided neoplasia. FIT levels had no association with gender and declined with age. Adenoma burden did not correlate with FIT levels; this is a novel finding. FIT levels vary greatly even in those with advanced neoplasia; therefore, FIT is unlikely to be useful as a risk stratification tool.
Analysis of a diffusive host-pathogen model with standard incidence and distinct dispersal rates
Authors: Wang Jinliang , Cui Renhao 
Published: January 2021

Abstract
This paper concerns with detailed analysis of a reaction-diffusion host-pathogen model with space-dependent parameters in a bounded domain. By considering the fact the mobility of host individuals playing a crucial role in disease transmission, we formulate the model by a system of degenerate reaction-diffusion equations, where host individuals disperse at distinct rates and the mobility of pathogen is ignored in the environment.We first establish the well-posedness of the model, including the global existence of solution and the existence of the global compact attractor. The basic reproduction number is identified, and also characterized by some equivalent principal spectral conditions, which establishes the threshold dynamical result for pathogen extinction and persistence. When the positive steady state is confirmed, we investigate the asymptotic profiles of positive steady state as host individuals disperse at small and large rates. Our result suggests that small and large diffusion rate of hosts have a great impacts in formulating the spatial distribution of the pathogen.
Global FT4 immunoassay standardization: an expert opinion review
Authors: Kratzsch Juergen , Baumann Nikola A. , Ceriotti Ferruccio , Lu Zhong X. , Schott Matthias , van Herwaarden Antonius E. , Henriques Vieira José Gilberto , Kasapic Dusanka , Giovanella Luca 
Published: January 2021

Abstract

Objectives
Results can vary between different free thyroxine (FT4) assays; global standardization would improve comparability of results between laboratories, allowing development of common clinical decision limits in evidence-based guidelines.

Content
We summarize the path to standardization of FT4 assays, and challenges associated with FT4 testing in special populations, including the need for collaborative efforts toward establishing population-specific reference intervals. The International Federation of Clinical Chemistry and Laboratory Medicine Committee for Standardization of Thyroid Function Tests has undertaken FT4 immunoassay method comparison and recalibration studies and developed a reference measurement procedure that is currently being validated. Further studies are needed to establish common reference intervals/clinical decision limits. Standardization of FT4 assays will change test results substantially; therefore, a major education program will be required to ensure stakeholders are aware of the benefits of FT4 standardization, planned transition procedure, and potential clinical impact of the changes. Assay recalibration by manufacturers and approval process simplification by regulatory authorities will help minimize the clinical impact of standardization.

Summary
Significant progress has been made toward standardization of FT4 testing, but technical and logistical challenges remain.

Outlook
Collaborative efforts by manufacturers, laboratories, and clinicians are required to achieve successful global standardization of the FT4 assays.