bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Low-Density Lipoprotein Levels Are Associated With, But Do Not Causally Contribute to, Increased Mortality in Sepsis*
Authors: Walley Keith R. , Boyd John H. , Kong HyeJin Julia , Russell James A. 
Published: November 2018

Objectives:
Low low-density lipoprotein levels are associated with increased mortality in sepsis. Whether low low-density lipoprotein levels contribute causally to adverse sepsis outcome is unknown.

Design:
Retrospective analysis of two sepsis patient cohorts using a Mendelian Randomization strategy.

Setting:
Sepsis patients enrolled into clinical research cohorts at tertiary care teaching hospitals.

Patients:
The first cohort included 200 sepsis patients enrolled in an observational study in a hospital Emergency Department. The second cohort included genotyped patients enrolled in the Vasopressin and Septic Shock Trial.

Interventions:
Retrospective analysis of these patient datasets. In 632 patients enrolled in Vasopressin and Septic Shock Trial, Proprotein Convertase Subtilisin/Kexin type 9, and 3-Hydroxy-3-Methylglutaryl-CoA Reductase single nucleotide polymorphisms known to be associated with low-density lipoprotein levels were genotyped, and a genetic score related to low-density lipoprotein levels was calculated.

Measurements and Main Results:
In the first cohort, we replicated the finding that low low-density lipoprotein levels are associated with increased 28-day mortality. In genotyped patients in the Vasopressin and Septic Shock Trial trial, we found that the 3-Hydroxy-3-Methylglutaryl-CoA Reductase genetic score, known to be directly related to low low-density lipoprotein levels, was not associated with increased mortality. Surprisingly the Proprotein Convertase Subtilisin/Kexin type 9 genetic score, known to be directly related to low low-density lipoprotein levels, was associated with decreased (not increased) mortality.

Conclusions:
Both 3-Hydroxy-3-Methylglutaryl-CoA Reductase and Proprotein Convertase Subtilisin/Kexin type 9 genetic scores should have been associated with increased mortality if low low-density lipoprotein levels contributed causally to sepsis mortality. But this was not the case, and the opposite was observed for the Proprotein Convertase Subtilisin/Kexin type 9 genetic score. This suggests that low-density lipoprotein levels, per se, do not contribute causally to adverse sepsis outcomes. The Proprotein Convertase Subtilisin/Kexin type 9 genetic score finding raises the possibility that increased low-density lipoprotein clearance (the effect of these Proprotein Convertase Subtilisin/Kexin type 9 genotypes) may contribute to improved sepsis outcomes.
Efficacy and Safety of Loading Doses With P2Y12-Receptor Antagonists in Patients Without Dual Antiplatelet Therapy Undergoing Elective Coronary Intervention
Authors: Piqueras-Flores Jesús , Jurado-Román Alfonso , López-Lluva María Thiscal , Sánchez-Pérez Ignacio , Abellán-Huerta José , Lozano-Ruiz Poveda Fernando 
Published: November 2018

Background:
European Guidelines on Myocardial Revascularization recommend clopidogrel loading dose added to acetylsalicylic acid in elective percutaneous coronary interventions (PCIs). However, there is few evidence supporting this recommendation and other P2Y12 inhibitors have not been tested in these patients.

Purpose:
To evaluate the effectiveness and safety of different loading doses of clopidogrel and ticagrelor in patients without double antiplatelet therapy and stable coronary artery disease (SCAD) undergoing elective PCI.

Methods:
Retrospective study of 147 consecutive patients with SCAD undergoing elective PCI. Loading P2Y12 inhibitor doses evaluated were: clopidogrel 600 mg, clopidogrel 300 mg, clopidogrel 150 mg, and ticagrelor 180 mg. We analyzed the occurrence of major adverse cardiovascular events and periprocedural myocardial infarction.

Results:
One hundred twenty-five patients were treated with clopidogrel (16 with clopidogrel 150 mg, 7 with clopidogrel 300 mg, and 93 with clopidogrel 600 mg) and 21 with ticagrelor 180 mg at the catheterization laboratory. The ticagrelor group had a significantly lower postprocedural peak of troponin-I (0.7 ± 3.4 vs. 0.3 ± 0.7 ng/mL; P = 0.02). There were no differences between groups in terms of major bleeding and hemoglobin drop after PCI (0.6 ± 0.8 vs. 4 ± 0.6; P = 0.8). The median of follow-up was 17 months (interquartile range 9–32.7). At the end of follow-up, major adverse cardiovascular event rate was not different between groups.

Conclusions:
In patients without dual antiplatelet therapy undergoing elective PCI, the use of ticagrelor showed lower postprocedural myocardial injury without more bleeding complications.
QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES FOR OBJECTIVE CLASSIFICATION AND STAGING OF DIABETIC RETINOPATHY
Authors: Alam Minhaj , Zhang Yue , Lim Jennifer I. , Chan Robison V.P. , Yang Min , Yao Xincheng 
Published: November 2018

Purpose:
This study aims to characterize quantitative optical coherence tomography angiography (OCTA) features of nonproliferative diabetic retinopathy (NPDR) and to validate them for computer-aided NPDR staging.

Methods:
One hundred and twenty OCTA images from 60 NPDR (mild, moderate, and severe stages) patients and 40 images from 20 control subjects were used for this study conducted in a tertiary, subspecialty, academic practice. Both eyes were photographed and all the OCTAs were 6 mm × 6 mm macular scans. Six quantitative features, that is, blood vessel tortuosity, blood vascular caliber, vessel perimeter index, blood vessel density, foveal avascular zone area, and foveal avascular zone contour irregularity (FAZ-CI) were derived from each OCTA image. A support vector machine classification model was trained and tested for computer-aided classification of NPDR stages. Sensitivity, specificity, and accuracy were used as performance metrics of computer-aided classification, and receiver operation characteristics curve was plotted to measure the sensitivity–specificity tradeoff of the classification algorithm.

Results:
Among 6 individual OCTA features, blood vessel density shows the best classification accuracies, 93.89% and 90.89% for control versus disease and control versus mild NPDR, respectively. Combined feature classification achieved improved accuracies, 94.41% and 92.96%, respectively. Moreover, the temporal-perifoveal region was the most sensitive region for early detection of DR. For multiclass classification, support vector machine algorithm achieved 84% accuracy.

Conclusion:
Blood vessel density was observed as the most sensitive feature, and temporal-perifoveal region was the most sensitive region for early detection of DR. Quantitative OCTA analysis enabled computer-aided identification and staging of NPDR.
Ocular Toxicity of Mirvetuximab
Authors: Corbelli Eleonora , Miserocchi Elisabetta , Marchese Alessandro , Giuffrè Chiara , Berchicci Luigi , Sacconi Riccardo , Bandello Francesco , Modorati Giulio Maria 
Published: November 2018

Purpose:
To report the clinical features and outcomes of corneal toxicity following mirvetuximab soravtansine therapy.

Methods:
Five patients who were treated with mirvetuximab soravtansine were evaluated in our hospital for ocular symptoms during a period of 5 months between December 2017 and April 2018. A complete ophthalmologic examination, including anterior segment infrared reflectance (AS-IR) and anterior segment optical coherence tomography (AS-OCT), was performed.

Results:
All 5 patients were female (average age, 62.4 ± 5.5 years) and being treated for advanced epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. Both eyes were involved in each case. Patients complained of blurred vision (n = 5), ocular pain (n = 2), tearing (n = 5), foreign-body sensation (n = 4), and photophobia (n = 4). Slit-lamp examination demonstrated fine corneal subepithelial opacities, mainly involving the corneal periphery migrating toward the center. AS-IR revealed the presence of hyporeflective dots on the cornea, suggesting that they were cystic. AS-OCT confirmed the subepithelial location of lesions. In all patients, the cornea cleared, and visual acuity recovered fully with a short course of topical steroids and lubricants.

Conclusions:
Mirvetuximab soravtansine therapy can cause transient corneal toxicity. A short course of topical steroids can reduce the patient symptoms.
Preventing Hepatitis B in US Adults Through Vaccination
Authors: Schaffner William , Nichol Kristin L. , Reingold Arthur L. 
Published: November 2018

AbstractChronic hepatitis B virus (HBV) infection causes substantial morbidity, with up to 40% of infected individuals developing cirrhosis, hepatocellular carcinoma, or liver failure. Approximately 25% of individuals with chronic hepatitis B will die prematurely from these complications. Hepatitis B vaccines are safe and more than 90% effective in preventing infection in at-risk adults, yet only approximately 25% of US adults for whom vaccination is recommended by the Centers for Disease Control and Prevention are vaccinated. The rate of new HBV infections dropped substantially in the United States after the introduction and high uptake of hepatitis B vaccines in infants and children, and the burden of disease has shifted primarily to adults. There has been a resurgence of hepatitis B cases in US adults in recent years, with sharp increases in new cases noted in states highly impacted by the opioid epidemic. Improved hepatitis B vaccination coverage rates in US adults can help slow the rate of acute infections and reduce the reservoir of infection in US adults.
Investigation of the Experiences of Mothers Living Through Prenatal Loss Incidents: A Qualitative Study
Authors: AYDIN Ruveyde , KÖRÜKCÜ Öznur , KABUKCUOĞLU Kamile 
Published: November 2018

ABSTRACT

Background:
Fetal death causes women to experience negative feelings after the loss. These lived experiences influence the future pregnancies and maternal health of women negatively.

Purpose:
The aim of this study was to investigate the experiences of women whose pregnancies were terminated because of medical indications.

Methods:
A “design for definitive status study” type of qualitative research design was used. Ten women who were hospitalized between April and July 2017 at the Akdeniz University Clinic of Obstetrics and Gynecology and had subsequently experienced pregnancy loss during their hospitalization were enrolled as participants. Thematic analysis was used to analyze the data.

Results:
The pregnancy loss experiences of participants were investigated under the five main themes of (a) lived experiences before the termination of pregnancy, (b) lived experiences after pregnancy termination, (c) willingness to see the baby after termination, (d) posttermination care requirements, and (e) physical condition of hospital rooms during hospitalization. The participants expressed feelings of hope, fear, and worry over being unsuccessful before fetal death and feelings of loneliness, disappointment, blame, and avoidance after fetal death.

Conclusions/Implications for Practice:
In the aftermath of fetal death, health professionals should use insightful and empathic communication skills to help mothers cope with their loss. In addition, some of the participants wanted to see their babies, and some did not. Thus, individualized care is very important for women who experience pregnancy loss.
Mediating Effects of Social Support on Depression and Suicidal Ideation in Older Korean Adults With Hypertension Who Live Alone
Authors: NAM Eun Jeong , LEE Jong-Eun 
Published: November 2018

ABSTRACT

Background:
Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone.

Purpose:
This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship.

Methods:
The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support.

Results:
The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support (r = −.27) and positively correlated with suicidal ideation (r = .21), whereas social support was negatively correlated with suicidal ideation (r = −.35). Social support mediated the relationship between depression and suicidal ideation (Z = 2.69).

Conclusions:
Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.
A scoping review of nurse practitioner workforce data: Part two of a four-part series on critical topics identified by the 2015 Research Agenda Roundtable
Authors: Barnes Hilary , Novosel Lorraine M. 
Published: November 2018

ABSTRACT

Background and purpose:
There is no single comprehensive data source for conducting nurse practitioner (NP)-focused workforce and outcomes research. The 2015 Research Agenda Roundtable of the Fellows of the American Association of Nurse Practitioners supports the development of a national NP data source. A scoping review was conducted to provide an overview of data being used in NP-focused research and to identify key issues relevant to making progress toward a national NP database.

Methods:
PubMed, CINAHL, and EMBASE were searched for English-language articles published within the past 10 years (2007–2017). Twenty-one articles were included for review and categorized into three themes: 1) NP Workforce Data Collection and Availability; 2) Using Data to Identify NPs; and 3) Minimum Data Sets and Key Variables.

Conclusions:
General consensus among workforce experts suggests that rich sources of NP data exist. However, challenges include a lack of a national data source for studying the NP workforce and outcomes; the inability to identify individual NP providers within existing data; and variations in how different sources of data are collected.

Implications for practice:
Improved NP workforce data collection is vital for workforce planning and forecasting and has implications for outcomes research and NP workforce distribution and employment.
Evaluating the Impact of Housing Status on Gonorrhea and Chlamydia Screening in an HIV Primary Care Setting
Authors: Clemenzi-Allen Angelo Asa , Hartogensis Wendy , Cohen Stephanie E. , Gandhi Monica , Geng Elvin , Christopoulos Katerina 
Published: November 2018

Introduction
Gonorrhea and chlamydia (GC/CT) testing falls below recommended rates for people living with HIV (PLWH) in routine care. Despite evidence that homelessness and unstable housing (HUH) negatively impacts clinical outcomes for PLWH, little is known about GC/CT screening for HUH-PLWH in routine care.

Methods
Using an observational cohort of PLWH establishing care at a large publicly funded HIV clinic in San Francisco between February 2013 and December 2014 and with at least 1 primary care visit (PCV) before February 2016, we assessed GC/CT testing for HUH (staying outdoors, in shelters, in vehicles, or in places not made for habitation in the last year) compared with stably housed patients. We calculated (1) the odds of having GC/CT screening at a PCV using logistic regression with random effects to handle intrasubject correlations and (2) the percent of time enrolled in clinical care in which patients had any GC/CT testing (“time in coverage”) based on 180-day periods and using linear regression modeling.

Results
Of 323 patients, mean age was 43 years, 92% were male, 52% were non-Latino white, and 46% were HUH. Homeless and unstably housed PLWH had 0.66 odds of GC/CT screening at a PCV than did stably housed patients (95% confidence interval, 0.44–0.99; P = 0.043). Time in coverage showed no difference by housing status (regression coefficient, −0.93; 95% confidence interval, −8.02 to 6.16; P = 0.80).

Conclusions
Homeless and unstably housed PLWH had 34% lower odds of GC/CT screening at a PCV, demonstrating a disparity in routine care provision, but similar time in coverage. More research is needed to effectively increase GC/CT screening among HUH-PLWH.
Altered Functional Connectivity of Amygdala with the Fronto-Limbic-Striatal Circuit in Temporal Lobe Lesion as a Proposed Mechanism for Poststroke Depression
Authors: Zhang Xue-fei , He Xia , Wu Lei , Liu Chu-juan , Wu Wen 
Published: November 2018

Objective
Poststroke depression (PSD) is an important complication that affects stroke rehabilitation. Abnormal cortical-subcortical connectivity may be associated with the development of PSD. However, few studies have focused on the emotional network of PSD in the temporal lobe lesions. The aim of is study was to investigate amygdala-cortical functional connectivity (FC) in the temporal lobe in individuals with and without PSD.

Design
Twenty-three patients with PSD and 21 stroke patients without depression were recruited to undergo functional magnetic imaging scanning.

Results
In stroke patients with depression, the left amygdala had increased FC with the bilateral precuneus and right orbital frontal lobe but decreased FC with the right putamen. The right amygdala had increased FC with the right temporal pole, right rectus gyrus, and left orbital frontal lobe but decreased FC with the right primary sensory area (S1). Correlative analyses revealed that the amygdala's FCs with the right orbital frontal lobe, right insular cortex, and right cingulate cortex were correlated with the Hamilton Depression Rating Scale score.

Conclusion
The current study identified mood affected through the fronto-limbic-striatal circuit in PSD. Hyperconnectivity between the amygdala, default mode network, and salience network might be related to depressive symptoms, which may provide novel insight into the underlying neuropathologic mechanisms of PSD in temporal lobe lesions.
Association Between Endothelial Function and Cognitive Performance in Patients With Coronary Artery Disease During Cardiac Rehabilitation
Authors: Saleem Mahwesh , Herrmann Nathan , Dinoff Adam , Mazereeuw Graham , Oh Paul I. , Goldstein Benjamin I. , Kiss Alex , Shammi Prathiba , Lanctôt Krista L. 
Published: November 2018

ABSTRACTObjectiveSubtle cognitive deficits indicating early neural risk are common in the clinical presentation of coronary artery disease (CAD). Although deterioration may be mitigated by exercise, cognitive response to exercise is heterogeneous. Vasculopathy including endothelial dysfunction is a hallmark of CAD and may play an important role in impairing neural adaptation to exercise. This study aimed to assess peripheral measurements of endothelial function as predictors of cognitive performance in CAD participants undertaking cardiac rehabilitation (CR).MethodsCAD patients (N= 64) undergoing CR were recruited for this prospective observational study. Neuropsychological and endothelial function assessments were performed at baseline and after 3 months of CR. Z-scores for overall cognitive performance and specific cognitive domains (verbal and visuospatial memory, processing speed, and executive function) were calculated. Endothelial function was measured by the reactive hyperemia index (RHI) using peripheral arterial tonometry. Cross-sectional and longitudinal associations between RHI and overall cognition were assessed using linear regressions and mixed models, respectively. Domain-specific associations were also explored.ResultsAlthough lower RHI was not associated with overall cognition at baseline (b= 0.26,p= .10), an increased RHI was significantly associated with an improvement in overall cognition (b= 0.55,p= .030) over 3 months. Lower RHI was associated with poorer verbal memory (β = 0.28,p= .027) at baseline and an increased RHI over 3 months was associated with an improvement in processing speed (b= 0.42,p= .033).ConclusionsRHI may be a clinically useful predictor of cognitive change and might provide insight into the etiology of cognitive dysfunction in patients with CAD.
Adaptation and Resilience in Families of Children With Spina Bifida in South Korea
Authors: Choi Eun Kyoung , Van Riper Marcia , Jang Mina , Han Sang Won 
Published: November 2018

Abstract

Purpose
The purpose of this study, which was guided by the Family Resilience Model, was twofold: (1) to assess the risk and protective factors related to adaptation and resilience in families of children with spina bifida (SB) in South Korea and (2) to examine predictors of family adaptation and resilience.

Design
This is a descriptive study using survey methodology.

Methods
Data were collected from 203 parents of children with SB between June 2013 and February 2014 at the SB clinic in South Korea and analyzed using stepwise linear regression.

Findings
The best predictors of family adaptation and resilience in children with SB included one risk factor (parental depression) and four protective factors (parental health, family cohesion, family communication skills, and supportive friends/relatives). These five factors explained 39.7% of the total variance in family functioning (an indicator of family adaptation and resilience; F = 26.43, p < .001).

Conclusion and Clinical Relevance
Findings suggest that nursing interventions designed to strengthen protective factors and reduce risk factors are likely to promote adaptation and resilience in families of children with SB.