bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implicit Bias and the Feedback Paradox: Exploring How Health Professionals Engage With Feedback While Questioning Its Credibility
Authors: Sukhera Javeed , Wodzinski Michael , Milne Alexandra , Teunissen Pim W. , Lingard Lorelei , Watling Chris 
Published: May 2019

Purpose
Learners and practicing health professionals may dismiss emotionally charged feedback related to self, yet little research has examined how to address feedback that threatens an individual’s identity. The implicit association test (IAT) provides feedback to individuals regarding their implicit biases. Anticipating feedback about implicit bias might be emotionally charged for mental health professionals, this study explored their experience of taking the IAT and receiving their results, to better understand the challenges of identity-threatening feedback.

Method
The researchers sampled 32 psychiatry nurses, psychiatrists, and psychiatric residents at Western University in Ontario, Canada, after they completed the mental illness IAT and received their results. Using constructivist grounded theory, semistructured interviews were conducted from April to October 2017 regarding participants’ experience of taking the IAT. Using constant comparative analysis, transcripts were iteratively coded and analyzed for results.

Results
While most participants critiqued the IAT and questioned its credibility, many also described the experience of receiving feedback about their implicit biases as positive or neutral. Most justified their implicit biases while acknowledging the need to better manage them.

Conclusions
These findings highlight a feedback paradox, calling into question assumptions regarding self-related feedback. Participants’ reactions to the IAT suggest that potentially threatening self-related feedback may still be useful to participants who question its credibility. Further exploration of how the feedback conversation influences engagement with self-related feedback is needed.
Reversal of Partial Neuromuscular Block and the Ventilatory Response to Hypoxia
Authors: Broens Suzanne J. L. , Boon Martijn , Martini Chris H. , Niesters Marieke , van Velzen Monique , Aarts Leon P. H. J. , Dahan Albert 
Published: May 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The ventilatory response to hypoxia is a life-saving chemoreflex originating at the carotid bodies that is impaired by nondepolarizing neuromuscular blocking agents. This study evaluated the effect of three strategies for reversal of a partial neuromuscular block on ventilatory control in 34 healthy male volunteers on the chemoreflex. The hypothesis was that the hypoxic ventilatory response is fully restored following the return to a train-of-four ratio of 1.

Methods
In this single-center, experimental, randomized, controlled trial, ventilatory responses to 5-min hypoxia (oxygen saturation, 80 ± 2%) and ventilation at hyperoxic isohypercapnia (end-tidal carbon dioxide concentration, 55 mmHg) were obtained at baseline, during rocuronium-induced partial neuromuscular block (train-of-four ratio of 0.7 measured at the adductor pollicis muscle by electromyography), and following reversal until the train-of-four ratio reached unity with placebo (n = 12), 1 mg neostigmine/0.5 mg atropine (n = 11), or 2 mg/kg sugammadex (n = 11).

Results
This study confirmed that low-dose rocuronium reduced the ventilatory response to hypoxia from 0.55 ± 0.22 (baseline) to 0.31 ± 0.21 l · min−1 · %−1 (train-of-four ratio, 0.7; P < 0.001). Following full reversal as measured at the thumb, there was persistent residual blunting of the hypoxic ventilatory response (0.45 ± 0.16 l · min−1 · %−1; train-of-four ratio, 1.0; P < 0.001). Treatment effect was not significant (analysis of covariance, P = 0.299) with chemoreflex impairment in 5 (45%) subjects following sugammadex reversal, in 7 subjects (64%) following neostigmine reversal, and in 10 subjects (83%) after spontaneous reversal to a train-of-four ratio of 1.

Conclusions
Despite full reversal of partial neuromuscular block at the thumb, impairment of the peripheral chemoreflex may persist at train-of-four ratios greater than 0.9 following reversal with neostigmine and sugammadex or spontaneous recovery of the neuromuscular block.
Artificial intelligence, osteoporosis and fragility fractures
Authors: Ferizi Uran , Honig Stephen , Chang Gregory 
Published: May 2019

Purpose of review
Artificial intelligence tools have found new applications in medical diagnosis. These tools have the potential to capture underlying trends and patterns, otherwise impossible with previous modeling capabilities. Machine learning and deep learning models have found a role in osteoporosis, both to model the risk of fragility fracture, and to help with the identification and segmentation of images.

Recent findings
Here we survey the latest research in the artificial intelligence application to the prediction of osteoporosis that has been published between January 2017 and March 2019. Around half of the articles that are covered here predict (by classification or regression) an indicator of osteoporosis, such as bone mass or fragility fractures; the other half of studies use tools for automatic segmentation of the images of patients with or at risk of osteoporosis. The data for these studies include diverse signal sources: acoustics, MRI, CT, and of course, X-rays.

Summary
New methods for automatic image segmentation, and prediction of fracture risk show promising clinical value. Though these recent developments have had a successful initial application to osteoporosis research, their development is still under improvement, such as accounting for positive/negative class bias. We urge care when reporting accuracy metrics, and when comparing such metrics between different studies.
Development of the Initial Surveys for the All of Us Research Program
Authors: Cronin Robert M. , Jerome Rebecca N. , Mapes Brandy , Andrade Regina , Johnston Rebecca , Ayala Jennifer , Schlundt David , Bonnet Kemberlee , Kripalani Sunil , Goggins Kathryn , Wallston Kenneth A. , Couper Mick P. , Elliott Michael R. , Harris Paul , Begale Mark , Munoz Fatima , Lopez-Class Maria , Cella David , Condon David , AuYoung Mona , Mazor Kathleen M. , Mikita Steve , Manganiello Michael , Borselli Nicholas , Fowler Stephanie , Rutter Joni L. , Denny Joshua C. , Karlson Elizabeth W. , Ahmedani Brian K. , O’Donnell Christopher J. 
Published: May 2019

Background:
The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these information sources. We report the process used to develop and refine the initial three surveys for this program.

Methods:
The All of Us survey development process included: (1) prioritization of domains for scientific needs, (2) examination of existing validated instruments, (3) content creation, (4) evaluation and refinement via cognitive interviews and online testing, (5) content review by key stakeholders, and (6) launch in the All of Us electronic participant portal. All content was translated into Spanish.

Results:
We conducted cognitive interviews in English and Spanish with 169 participants, and 573 individuals completed online testing. Feedback led to over 40 item content changes. Lessons learned included: (1) validated survey instruments performed well in diverse populations reflective of All of Us; (2) parallel evaluation of multiple languages can ensure optimal survey deployment; (3) recruitment challenges in diverse populations required multiple strategies; and (4) key stakeholders improved integration of surveys into larger Program context.

Conclusions:
This efficient, iterative process led to successful testing, refinement, and launch of three All of Us surveys. Reuse of All of Us surveys, available at http://researchallofus.org, may facilitate large consortia targeting diverse populations in English and Spanish to capture participant-provided information to supplement other data, such as genetic, physical measurements, or data from electronic health records.
In utero tobacco smoke exposure, DNA methylation, and asthma in Latino children
Authors: Neophytou Andreas M. , Oh Sam S. , Hu Donglei , Huntsman Scott , Eng Celeste , Rodríguez-Santana José R. , Kumar Rajesh , Balmes John R. , Eisen Ellen A. , Burchard Esteban G. 
Published: May 2019

Background:
Maternal smoking during pregnancy is a risk factor for chronic disease later in life and has been associated with variability of DNA methylation at specific cytosine-phosphate-guanine (CpG) loci. We assessed the role of DNA methylation as a potential mediator of adverse effects of in utero tobacco smoke exposures on asthma outcomes in Latino children from the US mainland and Puerto Rico.

Methods:
Relationships between self-reported exposure and DNA methylation at CpG loci previously reported to be associated with maternal smoking were assessed in a subsample consisting of 572 children aged 8–21 years (310 cases with asthma, 262 healthy controls), sampled from a larger asthma case-control study. Subsequently, we assessed associations between top loci and asthma-related outcomes, followed by mediation analysis for loci for which associations with outcomes were observed.

Results:
Self-reported maternal smoking was associated with a −1.5% (95% confidence interval (CI) = −2.4%, −0.6%) lower methylation at CpG locus cg05575921 on the AHRR gene; a 1% increase in DNA methylation at the same locus resulted in an odds ratio (OR) of 0.90 (95% CI = 0.83, 0.96) for the odds of asthma. The OR for the indirect effect of maternal smoking on asthma mediated through methylation at the cg05575921 locus was 1.18 (95% CI = 1.07, 1.68), compared to the OR for the total effect of exposure in the parent study of 1.48 (95% CI = 1.03, 2.11).

Conclusions:
Our findings suggest potential mediation by DNA methylation in the association between maternal smoking during pregnancy and asthma status.
Prevention and management of bowel injury during gynecologic laparoscopy: an update
Authors: Eisner Isabel S. , Wadhwa Ruchi K. , Downing Keith T. , Singhal Pankaj K. 
Published: May 2019

Purpose of review
The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury.

Recent findings
Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes than delayed diagnosis. Repair can be performed by a gynecologic surgeon, with or without the help of a consultant depending on the extent of the injury and surgeon comfort.

Summary
Bowel injury is a potentially catastrophic complication in gynecologic surgery, but its rarity presents a challenge in research. A high index of suspicion and meticulous surgical technique are the cornerstones of managing a bowel injury.
Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches
Authors: Da Silva Joyce T. , Letzen Janelle E. , Haythornthwaite Jennifer A. , Finan Patrick H. , Campbell Claudia M. , Seminowicz David A. 
Published: May 2019

Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
Factors Associated With Nonadherence to Cardiovascular Medications
Authors: van der Laan Danielle M. , Elders Petra J. M. , Boons Christel C. L. M. , Nijpels Giel , Hugtenburg Jacqueline G. 
Published: May 2019

Background
Cardiovascular medications have well-established benefits in the primary and secondary prevention of cardiovascular diseases. Unfortunately, adherence to these medicines is often suboptimal. To develop interventions intended to enhance adherence to cardiovascular medications, more insight is needed into the complex character of medication nonadherence.

Objective
The aim of the present study was to identify which factors are associated with nonadherence to cardiovascular medications in a sample of patients from Dutch community pharmacies.

Methods
In this cross-sectional study, patients using cardiovascular medications from 23 community pharmacies were included. Patient demographics, medication and disease characteristics, knowledge, quality of life, attitude toward medicines, and satisfaction with information were assessed. Both an adherent sample (n = 146) and a sample of patients nonadherent to prescribed medications (n = 109) during the last 6 months as assessed with pharmacy refill data (proportion of days covered <80%) were selected. Associations with refill nonadherence were assessed using univariate and multivariate logistic regression analyses.

Results
In total, 255 patients participated (53.3% men, 71.6 ± 10.9 years). Factors associated with cardiovascular medication nonadherence in multivariate analyses included experiencing difficulties with medication use due to forgetting, having insufficient knowledge on what to do when a dose is forgotten, and having an ambivalent attitude toward medicines (beliefs of high necessity and high concerns).

Conclusions
Intervention strategies to enhance cardiovascular medication nonadherence should be targeted mainly to the unintentional dimension of nonadherence and include information and tools to prevent forgetting. Conversely, the influence of factors that underlie intentional nonadherence, particularly patients' beliefs about medicines, should also be addressed.
Deep benign fibrous histiocytoma occurring in the kidney
Authors: Du Jiang , Zhang Xue-Ting , Yang Man , Liu Xiao-Fang , Lin Xu-Yong 
Published: May 2019

Abstract

Rationale:
Deep benign fibrous histiocytoma (BFH) is relatively rare in contrast to superficial BFH involving the skin. Moreover, it was extremely rare for deep BFH occurring in the solid organ. To our knowledge, so far, only one case of deep BFH of the kidney was reported in English literature.

Patient concerns:
Herein, we report another case of deep BFH located in the kidney in a 88-year-old female. She was referred to our hospital for a severe pain in the right upper abdomen. Computed tomography revealed a round low-density shadow measuring 6 cm in the kidney.

Diagnosis:
The lesion was diagnosed as a deep BFH of the kidney, as the tumor was histologically predominately composed of bland ovoid cells arranged in a storiform pattern.

Intervention:
The patient underwent the total resection of the right kidney with the tumor in our hospital.

Outcomes:
The postoperative course was uneventful. The patient was alive with no tumor recurrence or metastasis within 6 months of follow-up.

Lessons:
We present another case of deep BFH of the kidney. Because of the rarity, the tumor may be poorly recognized. The typical storiform pattern in histology may be helpful for diagnosis. This report serves to remind that deep BFH is also a differential diagnosis for a tumor with storiform pattern in the kidney.
Comparisons of cancer-associated fibroblasts in the intratumoral stroma and invasive front in colorectal cancer
Authors: Son Gyung Mo , Kwon Myeong-Sook , Shin Dong-Hoon , Shin Nari , Ryu Dongryeol , Kang Chi-Dug 
Published: May 2019

Abstract
The aim of this study was to evaluate the cytomorphologic maturity and molecular activation of cancer-associated fibroblasts (CAFs) in the intratumoral stroma and invasive front in colorectal cancer and understand how they affect cancer invasion and long-term oncological outcomes.
The cytomorphologic maturity of and α-smooth muscle actin (α-SMA), fibroblast activation protein α (FAPα), and fibroblast-specific protein 1 (FSP-1) expression in CAFs in the intratumoral stroma (CAFIT) and the invasive front (CAFIF) of colorectal cancer tissues were compared (n = 147). The correlations between CAF maturation, molecular activity markers, and cancer invasion were evaluated by network analysis. Overall survival and systemic recurrence were analyzed to assess the oncological effects of CAF properties.
The cytomorphologic maturation rate was comparable between CAFIT and CAFIF. The presence of mature CAFs was related to epidermal growth factor receptor overexpression in cancer cells. Expression rates of α-SMA (96.6%–98.0%) and FAPα (18.6%–22.9%) were similar between CAFIT and CAFIF. FSP-1 expression was more frequent in CAFIT than in CAFIF (66.4% vs 58.2%, P = .038). There was a significant decrease in FSP-1 expression in CAFIT and CAFIF in higher stages. The infiltrating growth pattern of the tumor was more frequent in the immature CAFIT. In colorectal cancer with perineural invasion and lymph node metastasis, FSP-1 expression in CAFIF was significantly lower. On multivariate analysis using the Cox proportional hazards model, immature CAFIF was found to be an independent prognostic factor of overall survival. In non-metastatic (stage I-III) colorectal cancer patients, CAF maturity was not a prognostic factor for systemic recurrence.
Cytomorphologic maturity and molecular activation markers were similar between CAFs in the intratumoral stroma and invasive front of colorectal cancer.
Efficacy of cognitive behavior language therapy for aphasia following stroke: Implications for language education research
Authors: Akabogu Josephine , Nnamani Amuche , Otu Mkpoikanke Sunday , Ukoha Evelyn , Uloh-Bethels Annah C. , Obiezu Maureen Nnenna , Ike Chioma Vivian , Iyekekpolor Olayinka M. , Omile Jacinta Chinwe , Dike Anastasia E. 
Published: May 2019

Abstract

Background/Objective:
Evidence from previous research has shown that the incidence of aphasia following a stroke is high in Nigeria and other countries, and there is a call for intervention programs. The objective of the current study was to investigate the efficacy of cognitive behavior language therapy (CBLT) on aphasia following a stroke.

Methods:
The study was designed as a group randomized trial, which involved treatment and no-treatment control procedures. The participants of the study were 86 patients who had experienced aphasia following a stroke. The Porch Index of Communicative Ability (PICA) and Speech-Language Unhelpful Thoughts and Beliefs Scale (SLUTBS) were the measures used in the study. The repeated measures analysis of variance procedure, with Partial eta squared

JOURNAL/medi/04.03/00005792-201905030-00010/inline-graphic1/v/2023-09-14T035738Z/r/image-tiff

, adjusted R
2, mean, standard deviation, and upper/lower limit was followed in analyzing the data collected in the study.

Results:
The CBLT intervention significantly reduced aphasia following a stroke and significantly reduced speech-language and unhelpful thought and beliefs among aphasic stroke patients exposed to the treatment intervention when compared with the no-treatment control group.

Conclusion:
Based on the findings of the study, language educators, speech and language pathologists and therapists in education institutions, hospitals, and rehabilitation centers should adopt the principles of CBLT used in the current study to help them improve communication ability among aphasia stroke patients.
Intrathecal morphine combined with ropivacaine induces spinal myoclonus in cancer patients with an implanted intrathecal drug delivery system
Authors: Guo Xuejiao , Li Yunze , Yang Yixin , Zhao Yimin , Guo Jianguo , Zhang Yanfeng , Peng Zhiyou , Feng Zhiying 
Published: May 2019

Abstract

Rationale:
Although intrathecal opioid infusion has been used for decades for the treatment of severe pain, myoclonus as one of the complications of this therapeutic modality is now beginning to be recognized more.

Patients concerns:
Here, we report three patients who developed myoclonus after dose adjustment in intrathecal drug delivery system for the treatment of refractory cancer pain.

Diagnosis:
Spinal myoclonus is a sudden, brief, shock-like muscle contractions originating from the central nervous system.
[1]
In our cases, it occurred after opioid administration via intrathecal delivery system with no abnormality found in laboratory or imaging examinations.

Interventions:
Spinal myoclonus can be treated effectively by reducing the dose or infusion rate as described in case 1, or changing from an intrathecal to systemic administration in case 2, or correcting infusion and bolus parameters mistakes in case 3.

Outcomes:
All patients recovered quickly after stopping or decreasing the intrathecal drug infusion.

Lessons:
Prevention is more important than treatment as for spinal myoclonus. Pain management teams should be aware of this distressing complication. Dose of intrathecal drugs should not exceed the recommended maximal daily doses by guidelines and patient education is important for successful intrathecal analgesic therapy.