bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social Determinants of Health and Delirium Occurrence and Duration in Critically Ill Adults
Authors: Wu Ting-Ting , Zegers Marieke , Kooken Rens , Griffith John L. , Molnar Beth E. , Devlin John W. , van den Boogaard Mark 
Published: September 2021

OBJECTIVES:
Social determinants of health may affect ICU outcome, but the association between social determinants of health and delirium remains unclear. We evaluated the association between three social determinants of health and delirium occurrence and duration in critically ill adults.

DESIGN:
Secondary, subgroup analysis of a cohort study.

SETTING:
Single, 36-bed mixed medical-surgical ICU in the Netherlands.

PATIENTS:
Nine hundred fifty-six adults consecutively admitted from July 2016 to February 2020. Patients admitted after elective surgery, residing in a nursing home, or not expected to survive greater than or equal to 48 hours were excluded.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
Four factors related to three Center for Disease Control social determinants of health domains (social/community context [ethnicity], education access/quality [educational level], and economic stability [employment status and monthly income]) were collected at ICU admission from patients (or families). Well-trained ICU nurses evaluated patients without coma (Richmond Agitation Sedation Scale, –4, –5) and with the Confusion Assessment Method-ICU and/or a delirium day was defined by greater than or equal to 1 + Confusion Assessment Method-ICU and/or scheduled antipsychotic use. Multivariable logistic regression models controlling for ICU days and 10 delirium risk variables (before-ICU: age, Charlson, cognitive impairment, any antidepressant, antipsychotic, or benzodiazepine use; ICU baseline: Acute Physiology and Chronic Health Evaluation IV and admission type; daily ICU: Sequential Organ Failure Assessment, restraint use, coma, benzodiazepine, or opioid use) evaluated associations between each social determinant of health factor and both ICU delirium occurrence and duration. Delirium occurred in 393/956 patients (45.4%) for 2 days (1–5 d). Patients with low (vs high) income had more ICU delirium (p = 0.05). Multivariate analyses revealed no social determinants of health to be significantly associated with increased delirium occurrence or duration. Low (vs high) income was weakly associated with increased delirium occurrence (adjusted odds ratio, 1.83; 95% CI, 0.91–3.89). Low (vs high) education (adjusted relative risk, 1.21; 95% CI, 0.97–1.53) was weakly associated with a longer delirium duration.

CONCLUSIONS:
Social determinants of health did not affect ICU delirium in one Dutch region. Additional research across different countries/regions and where additional social determinants of health are considered is needed to define the association between social determinants of health and ICU delirium.
Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veteran VA Users Nationwide With Traumatic Brain Injury, 2012-2020
Authors: Holmer Haley K. , Gilbert Tess A. , Ashraf Alexandria J. , O'Neil Maya E. , Carlson Kathleen F. 
Published: September 2021

Objective:
Many post-9/11 Veterans have received Department of Veterans Affairs (VA) healthcare for traumatic brain injury (TBI). Pain conditions are prevalent among these patients and are often managed with opioid analgesics. Opioids may impose unique risks to Veterans with a history of TBI, especially when combined with other psychotropic medications. We examined receipt of opioid and sedative-hypnotic prescriptions among post-9/11 Veterans with TBI who received VA care nationally between 2012 and 2020.

Setting:
Nationwide VA outpatient care.

Participants:
Veterans with, versus without, clinician-confirmed TBI based on the VA's Comprehensive TBI Evaluation (CTBIE) were followed up for subsequent years in which they received VA care.

Design:
A historical cohort study.

Main Measures:
Proportions of Veterans who received opioid, benzodiazepine, and nonbenzodiazepine sedative-hypnotic prescriptions were compared by CTBIE outcome (TBI yes/no) and by year; overlaps between medication classes, long-term opioid therapy, and high-dose opioid therapy were also examined. Among those with confirmed TBI, logistic regression was used to examine associations between veteran characteristics and likelihood of these potentially high-risk opioid use outcomes.

Results:
Among 69 752 Veterans with clinician-confirmed TBI, 26.9% subsequently received opioids. The prevalence receiving opioids each year increased from 2012 (16.7%) to 2014 (17.7%), and then decreased each of the following years through 2020 (5.8%). Among Veterans with TBI who received opioids, large proportions also received benzodiazepine (30.1%) and nonbenzodiazepine (36.0%) sedative-hypnotic prescriptions; these proportions also decreased in recent years. In both bivariable and multivariable regression models, Veterans' demographic, TBI, and clinical characteristics were associated with likelihood of potentially high-risk opioid use.

Conclusions:
VA opioid prescribing to Veterans with TBI has decreased in recent years but remains an important source of risk, particularly when considering coprescriptions of sedative-hypnotic medication. Understanding patterns of psychotropic prescription use among Veterans with TBI can highlight important healthcare and rehabilitation needs in this large patient cohort.
Admission for Isolated Low-Grade Solid Organ Injury May Not Be Necessary in Pediatric Patients
Authors: Butt Erin , Kotagal Meera , Shebesta Kaaren , Bailey Allison , Moody Suzanne , Falcone Richard 
Published: September 2021

Background:
Recent publications indicate that blunt solid organ injuries can be safely managed with reduced length of stay using pathways focused on hemodynamics. We hypothesized that pediatric patients with isolated blunt Grade I or II solid organ injuries may be safely discharged after brief observation with appropriate outpatient follow-up.

Objective:
The purpose of this study is to evaluate the need for admission of pediatric trauma patients with isolated low-grade solid organ injury resulting from blunt trauma.

Methods:
We performed a retrospective cohort study of trauma registry data from 2011 to 2018 to identify isolated blunt Grade I or II solid organ injuries among children younger than 19 years. “Complication or intervention” was defined as transfusions, transfer to the intensive care unit, repeat imaging, decrease in Hgb greater than 2 g/dl, fluid bolus after initial resuscitation, operation or interventional radiology procedure, or readmission within 1 week.

Results:
A total of 51 patients were admitted to the trauma service with isolated Grade I or II blunt solid organ injuries during the 8-year study period. The average age was 11 years. Among isolated Grade I or II injuries, seven (14%) had “complication or intervention” including greater than 2 g/dl drop in Hgb in four patients (8%), follow-up ultrasonography for pain in one patient (2%), readmission for pain in one patient (2%), or a fluid bolus in two patients (4%). None required transfusion or surgery. The most common mechanism of injury was sports related (45%), and the average length of stay was 1 day.

Conclusion:
Among a cohort of 51 patients with isolated blunt Grade I or II solid organ injuries, none required a significant intervention justifying need for admission. All “complication or intervention” patients observed were of limited clinical significance. We recommend that hemodynamically stable patients with isolated low-grade solid organ injuries may be discharged from the emergency department after a brief observation along with appropriate instructions and pain management.
The Pediatric Trauma Society Annual Meeting: An Analysis of Scholarly Output From the First 5 Years
Authors: Knaus Maria E. , Berg Gina M. , Vogel Adam M. , Prince Jose M. , Burd Randall S. , Gosain Ankush 
Published: September 2021

Background:
The Pediatric Trauma Society (PTS) is a multidisciplinary organization, with scientific presentations at its annual meeting addressing trauma care from prehospital through rehabilitation.

Objective:
The purpose of this study was to identify and describe the scholarly areas of focus of presentations at the annual meeting over the society's first 5 years and evaluate research dissemination.

Methods:
Data were collected on abstracts presented between 2014 and 2018, including titles, authors, and abstract classification. PubMed and Google Scholar searches identified abstracts that resulted in publications. Journal impact factors were identified.

Results:
Over 5 years, 491 of 635 (77.3%) abstracts were accepted. The number of submitted and accepted abstracts increased, but the acceptance rate was stable (range = 72.1%–81.2%, p = NS [nonsignificant]). The most frequently accepted categories included “Epidemiology,” “Abdominal or Thoracic Trauma,” and “Neurosurgery or Traumatic Brain Injury (TBI),” whereas “Trauma Nursing” and “Quality Improvement” were less common. Among the 2014–2016 abstracts, 55.4% of podium and 24.3% of poster presentations were published. Abstracts categorized as “Epidemiology,” “Education & Injury Prevention,” and “Neurosurgery or TBI” were commonly presented but uncommonly published. The median journal impact factor of publications was 2.1 and 2.0 for podium and poster presentations, respectively (ranging from 0.11 to 10.25).

Conclusion:
Most of the scholarly effort presented at the PTS remains unpublished. Published work is mainly in low-impact factor journals. Mentorship in the publication process and encouragement of multidisciplinary collaboration within the society are needed to address limitations in the number and potential impact of the scientific content of the annual meeting. This type of analysis is relevant not only to the PTS but also to any professional society seeking to improve its impact.
Cytomegalovirus-Associated Mild Encephalopathy/Encephalitis With Reversible Splenial Lesion
Authors: Fu Mao-Lin , Han Ning , Wang Wei 
Published: September 2021

Introduction:
Mild encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiologic syndrome presenting with a reversible lesion in the splenium of the corpus callosum. MERS is associated with many potential etiologies, including cytomegalovirus (CMV) infection in children. We report an adult patient with CMV-associated MERS.

Case Report:
A previously healthy 25-year-old man was admitted with a 4-day history of fever, headache, and vomiting. Brain magnetic resonance imaging demonstrated an isolated lesion of the splenium of the corpus callosum with hyperintensity on T2 and diffusion-weighted sequences and reduced values on apparent diffusion coefficient maps. High throughput gene detection for pathogens in cerebrospinal fluid revealed infection with CMV. The splenial lesion resolved 4 weeks after onset.

Conclusion:
This is the first report an adult patient with CMV-associated MERS. Recognition of this clinical-radiologic syndrome can guide diagnosis and management.
Pain sensitivity does not differ between obese and healthy weight individuals
Authors: Emerson Nichole M. , Nahman-Averbuch Hadas , Peugh James L. , Coghill Robert C. 
Published: September 2021

Abstract

Introduction:
There is emerging evidence suggesting a relationship between obesity and chronic pain.

Objectives:
The aim of this study was to determine whether pain-free obese individuals display altered pain responses to acute noxious stimuli, thus raising the possibility of greater pain sensitivity and potential susceptibility for chronic pain development.

Methods:
Psychophysical and anthropometric data were collected from 38 individuals with an obese body mass index (BMI) classification (BMI ≥ 30) and 41 age/sex-matched individuals of a healthy BMI (BMI < 24.9). Because BMI may be an inaccurate index of obesity, additional anthropometric parameters of central adiposity and percent body fat were examined. Pain responses to suprathreshold noxious heat and cold stimuli were examined. Subjects provided pain intensity and unpleasantness ratings to noxious heat (49°C) applied at varying durations and locations (ventral forearm/lower leg). Cold pain ratings, thresholds, and tolerances were obtained after immersion of the hand in a cold-water bath (0–2°C). Between-group differences in pain responses, as well as relationships between pain responses and obesity parameters, were examined. Importantly, confounds that may influence pain such as anxiety, depression, impulsivity, sleepiness, and quality of life were assessed.

Results:
No between-group differences in pain sensitivity to noxious heat and cold stimuli were found. No relationships were found between central adiposity or body fat (percentage or distribution) and pain responses to noxious heat or cold stimuli.

Conclusions:
Obesity has minimal influence on pain sensitivity. Accordingly, it is unlikely that obesity alone increases susceptibility for chronic pain development through amplification of nociceptive processes.
Brain gamma-aminobutyric acid, but not glutamine and glutamate levels are lower in older adults with chronic musculoskeletal pain: considerations by sex and brain location
Authors: Cruz-Almeida Yenisel , Forbes Megan , Cohen Ronald C. , Woods Adam J. , Fillingim Roger B. , Riley Joseph L. , Porges Eric S. 
Published: September 2021

Abstract

Introduction and Objectives:
GABAergic and glutamatergic neurotransmitter systems are central to the pathophysiology of chronic pain and are equally affected by aging processes. We measured levels of frontal gamma-aminobutyric acid (GABA) and the combined resonance of glutamate and glutamine (Glx) in vivo using proton magnetic resonance spectroscopy (1H-MRS) to elucidate age-specific and pain-specific associations with clinical and experimental pain in older adults.

Methods:
Younger (18–24, n = 24) and older (60–94, n = 41) individuals part of a larger study (Neuromodulatory Examination of Pain and Mobility Across the Lifespan [NEPAL]) underwent questionnaires, quantitative sensory testing, and 1H-MRS Mescher-Garwood point-resolved spectroscopy to measure GABA and Glx levels in prefrontal and sensorimotor brain regions.

Results:
Older participants had significantly lower sensorimotor, but not prefrontal, GABA and Glx levels, compared with younger controls (P's < 0.05). Younger controls had significantly higher prefrontal and sensorimotor GABA, but not Glx, levels compared with older controls and older adults with chronic pain (P's < 0.05). Older males with chronic pain had significantly lower prefrontal GABA compared with older and younger male controls (P's < 0.05). Prefrontal GABA, but not Glx, was significantly associated with self-reported and experimental pain measures (P's < 0.05). Our results are the first to focus exclusively on age and pain differences in GABA and Glx including younger and older controls to elucidate aging and pain contributions to brain GABAergic and glutamatergic processes.

Conclusion:
Evaluation of both the neuroinhibitory and neuroexcitatory mechanisms provide promising potential for improving both our understanding of the mechanisms of chronic pain in aging and opportunities for effective, individualized treatments.
Dyella telluris sp. nov. and Dyella acidiphila sp. nov., isolated from forest soil of Dinghushan Biosphere Reserve, China
Authors: Huang Tao , Fu Jia-cheng , Dong Shuo-han , Zhang Qiu-mei , Wu Ting-ting , Qiu Li-hong 
Published: September 2021

Cells of bacterial strains G9T and 7MK23T, isolated from forest soil samples collected from the Dinghushan Biosphere Reserve, Guangdong Province, PR China, were Gram-stain-negative, aerobic and rod-shaped. Strain G9T was motile with single polar flagellum and grew at 12–37 °C (optimum, 28 °C), pH 4.5–8.0 (optimum, pH 6.0–7.5) and in the presence of 0–3.5 % NaCl (optimum, 1.5%, w/v); while strain 7MK23T was non-motile and grew at 12–42 °C (optimum, 28–33 °C), pH 2.5–8.5 (optimum, pH 4.5–6.5) and NaCl levels of 0–1.0 % (optimum, 0–0.5 %, w/v). Phylogenetic analysis based on 16S rRNA gene sequences revealed that both isolates fell within the cluster of the genus

Dyella

. The closely related species (with a 16S rRNA gene sequence similarity >98.65%) of strain G9T were

Dyella terrae

JS14-6T (99.0 %),

D

.

kyungheensis

THG-B117T (98.8 %) and

D

.

amyloliquefaciens

DHC06T (98.7 %) while that of strain 7MK23T were

D

.

mobilis

DHON07T (99.2 %) and

D

.

flava

DHOC52T (99.1 %), but the average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between strains G9T, 7MK23T and the closely related

Dyella

species listed above were in the ranges of 77.5–83.8 % and 22.0–27.0 %, much lower than the species demarcation lines of 95.5 and 70 %, respectively. Phylogenomic analyses using UBCG and Phylophlan also supported that these two strains represent two novel species of

Dyella

. The major fatty acids of strain G9T were iso-C15 : 0, iso-C17 : 1
ω9c and iso-C17 : 0 while that of strain 7MK23T were iso-C15 : 0 and anteiso-C15 : 0. Ubiquinone-8 was the only respiratory quinone detected in both strains. The polar lipids of strain G9T consisted of phosphatidylglycerol, diphosphatidylglycerol, phosphatidylethanolamine, and several unknown phospholipids, aminophospholipids, aminolipids and lipid while strain 7MK23T contained phosphatidylglycerol, diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylmethylethanolamine and several unknown phospholipids and aminophospholipids. The DNA G+C contents of strains G9T and 7MK23T were 64.7 and 63.4 mol%, respectively. On the basis of 16S rRNA gene sequence phylogenetic and phylogenomic analyses as well as phenotypic data obtained, we propose that strains G9T and 7MK23T represent two novel species of the genus

Dyella

, for which the names Dyella telluris sp. nov. (type strain G9T=KACC 21725T=GDMCC 1.2132T) and Dyella acidiphila sp. nov. (type strain 7MK23T=KCTC 62739T=GDMCC 1.1446T) are proposed.
Effectiveness of COVID-19 Vaccines Against SARS-CoV-2 Infection During a Delta Variant Epidemic Surge in Multnomah County, Oregon, July 2021
Authors: Barlow Russell S. , Jian Kevin , Larson Lindsey 
Published: September 2021

AbstractBackgroundCoronavirus disease 2019 (COVID-19) vaccines have been shown to be highly effective in preventing SARS-CoV-2 infection within controlled trials and real-world vaccine effectiveness (VE) studies. Recent reports have estimated reduced VE with the emergence and dissemination of the B.1.617.2 variant (“Delta variant”). We assess VE in Multnomah County, Oregon during a delta variant related epidemic expansion.MethodsA test-negative design (TND) matched case-control analysis was performed to estimate the effectiveness of vaccination against SARS-CoV-2 infection during July 2021. Cases included a random sample of individuals that tested positive for SARS-CoV-2 and were reported by electronic laboratory report, were >15 years of age, and had no prior known SARS-CoV-2 infections. Controls were age and postal code matched individuals that tested negative for SARS-CoV-2 during July 2021. Immunization status was assessed using the Oregon ALERT Immunization Information system.Results500 case-control pairs were matched (n=1000). 40.4% of cases were up-to-date on COVID-19 immunizations compared to 64.6% of controls. Effectiveness of any completed COVID-19 immunization was 73% (95% Confidence Interval [CI] 49-86%), 74% (95% CI 65-85%) for mRNA immunizations (BNT162b2, mRNA-1273), and 72% (95% CI 47-85%) for individuals partially immunized with mRNA immunizations.ConclusionsOur findings estimate high, yet reduced, VE during Delta variant dissemination. These results highlight the importance of COVID-19 immunizations for reducing SARS-CoV-2 infection while juxtaposing the need for additional non-pharmaceutical interventions. Importantly, the reduced VE identified here may predict future reductions in vaccine performance in the context of ongoing viral genetic drift.
Sars-Cov-2 antibody titer 3 months post-vaccination is affected by age, gender, smoking and vitamin D
Authors: Parthymou Anastasia , Habeos Evagelia E , Habeos George I , Deligakis Apostolos , Livieratos Ektoras , Marangos Markos , Chartoumpekis Dionysios V 
Published: September 2021

AbstractContextVaccination against Sars-Cov-2 is in full swing during COVID-19 pandemic. One of the efficient methods to evaluate response to vaccination is the assessment of humoral immunity by measuring Sars-Cov-2 antibody titer. Identification of factors that affect the humoral response is important so as to ameliorate the responses to vaccination or identify vulnerable groups that may need vaccination boosters.ObjectiveWe investigated the effect of anthropometric parameters (age, BMI), smoking, diabetes, statin use hypertension and levels of 25(OH)D and DHEAS to the Sars-Cov-2 antibody titer.MethodsIn this longitudinal observational cohort study 712 subjects were tested for Sars-Cov-2 antibodies 3 months after the second dose of BNT162b2 vaccine. Multiple linear regression analysis was performed to identify which factors are associated with the antibody titer.ResultsWe identified age to be negatively associated with antibody titer (p=0.0073) and male sex (p=0.0008). However, interaction of age and gender was significant (p<0.0001) highlighting the finding that only after the age of 40 years men had lower antibody levels than women. DHEAS, an aging marker, was not associated with the antibody titer. Smoking was also associated with low antibody titer (p=0.0008) while overweight or obese subjects did not have different antibody response compared to normal weight individuals. Although diabetic and hypertensive subjects trended towards lower antibody titer, this association was not statistically significant. Replete vitamin D levels were associated with higher antibody titers (p=0.00422).ConclusionsAge, male sex and smoking negatively affects antibody titer while 25(OH)D is associated with increased Sars-Cov-2 antibody titers.
The locus coeruleus shows a spatial pattern of structural disintegration in Parkinson’s disease
Authors: Madelung Christopher F. , Meder David , Fuglsang Søren A. , Marques Marta M. , Boer Vincent O. , Madsen Kristoffer H. , Petersen Esben T. , Hejl Anne-Mette , Løkkegaard Annemette , Siebner Hartwig R. 
Published: September 2021

AbstractBackgroundParkinson’s disease (PD) leads to a loss of neuromelanin positive, noradrenergic neurons in the locus coeruleus (LC) which has been implicated in non-motor dysfunction. “Neuromelanin sensitive” magnetic resonance imaging (MRI) has emerged as a promising tool for mapping the structural integrity of LC in vivo.ObjectivesTo identify spatial patterns of structural LC disintegration in PD and regions in the LC where structural disintegration is associated with specific non-motor dysfunctions.Methods42 patients with PD and 24 age-matched healthy volunteers underwent ultra-high field MRI of the LC using a “neuromelanin sensitive” magnetization transfer weighted (MTw) sequence. The contrast-to-noise ratio of the MTw signal (CNRMTw) served as an estimate of structural integrity, slice- and voxel-wise analyses of CNRMTw were performed to map the spatial pattern of structural disintegration, complemented by Principal Component Analysis (PCA). We also tested for correlations between CNRMTw and the severity of non-motor symptoms.ResultsMean CNRMTw of LC was reduced in patients relative to controls. The attenuation of CNRMTw was not uniformly expressed in LC, but confined to the middle and caudal LC. CNRMTw attenuation in caudal LC scaled with the orthostatic drop in systolic blood pressure and apathy ratings. PCA identified a bilaterally expressed component that was more weakly expressed in patients. This component was characterized by a gradual change in CNRMTw along the rostro-caudal and dorso-ventral axes of the nucleus. The individual expression score of this component reflected the overall severity of non-motor symptoms.ConclusionPD related structural disintegration of LC mainly affects its caudal part and may determine the individual expression of specific non-motor symptoms such as orthostatic dysregulation or apathy.