bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angiopoietin-2 as a Marker of Retinopathy in Children and Adolescents With Sickle Cell Disease: Relation to Subclinical Atherosclerosis
Authors: Andrawes Nevine G. , Ismail Eman A. , Roshdy Maged M. , Ebeid Fatma S.E. , Eissa Deena S. , Ibrahim Amna M. 
Published: April 2019

Objectives:
Angiopoietin-2 (Ang-2) is a multifaceted cytokine that functions in both angiogenesis and inflammation. A proangiogenic state has been found in adults with sickle cell disease (SCD), mainly because of elevated Ang-2 levels. We determined Ang-2 level in 40 children and adolescents with SCD compared with 40 healthy controls and assessed its relation to retinopathy as well as carotid intimamedia thickness (CIMT).

Methods:
Hematologic profile, serum ferritin, and serum Ang-2 were measured. CIMT was assessed using high-resolution ultrasound. Fundus examination was performed followed by fundus fluorescein angiography. Optical coherence tomography angiography (OCTA) was used to find small vascular changes not clinically manifested.

Results:
Ang-2 levels and CIMT were significantly higher in SCD patients compared with controls. The incidence of nonproliferative retinopathy was 45%. SCD patients with retinopathy were older in age with a history of sickling crisis of >3 attacks per year and had a higher incidence of sickle cell anemia than sickle β-thalassemia. Ang-2 cutoff value 9000 pg/mL could significantly detect the presence of retinopathy among SCD patients with 100% sensitivity and specificity. Serum Ang-2 levels were positively correlated with HbS and CIMT. Logistic regression analysis revealed that Ang-2 and HbS significantly contribute to retinopathy among patients with SCD.

Conclusions:
Elevated Ang-2 highlights the role of angiogenesis in the pathophysiology of SCD and may be considered a promising marker for screening of patients at risk of sickle retinopathy and vascular dysfunction.
The Cutoff of Ferritin for Evaluation of Hypothyroidism in Patients With Thalassemia
Authors: Baghersalimi Adel , Rad Afagh H. , Koohmanaee Shahin , Darbandi Bahram , Mirzaee Morteza M. , Aminzadeh Vahid , Medghalchi Abdolreza , Dalili Setila 
Published: April 2019

Background:
Thalassemia major is a genetic disease with a recessive autosomal pattern of inheritance that occurs as a result of disorder in hemoglobin synthesis. Researchers aimed to investigate the cutoff of ferritin for the development of hypothyroidism in patients with thalassemia major.

Materials and Methods:
This was a retrospective analytic cross-sectional study that was conducted on the medical records of patients with thalassemia major. Overt hypothyroidism was defined as thyroid stimulating hormone (TSH) level of >6.5 mIU/L and T4 level of < 4.2 ng/dL and subclinical hypothyroidism was defined as TSH level of >6.5 mIU/L and T4 level of >4.2 ng/dL. Data were gathered by a form including age, sex, weight, height, body mass index, thyroid test results, and the mean of last 3 consecutive hemoglobin and ferritin levels.

Results:
In this study, 67 patients were evaluated. The mean age of the participants was 15.37±3.73 years. The frequency of subclinical hypothyroidism was 10.4%, and no cases of clinical hypothyroidism were noted as well as secondary hypothyroidism. Although there was a significant linear correlation between mean ferritin level and TSH (P=0.008), no significant correlation was noted between levels of ferritin and T4 levels. As ferritin was significantly correlated with TSH, the results showed that the mean serum level of ferritin in β-thalassemia major patients with hypothyroidism was higher than that in β-thalassemia major patients with normal thyroid status (P=0.013). The cutoff point for ferritin was 1953 ng/mL (sensitivity=85.7%, specificity=60%).

Conclusion:
It seems that considering the development of hypothyroidism by reaching the ferritin cutoff point, intensification of the iron chelation regimen along with a shorter interval for laboratory endocrine examinations can be recommended.
North Carolina Nurse Leader Project
Authors: Williams Megan P. , Li Yin 
Published: April 2019

OBJECTIVES
The study examined nurse leader roles, barriers, and the need for nurse leader succession planning in North Carolina (NC).

BACKGROUND
This study was conducted to assess leadership capacity in NC and further the efforts of the Future of Nursing report, which calls for nurses to lead change and advance health.

METHODS
This study employed an exploratory research design using the Florida Action Coalition 56-item survey of active RNs and advanced practice RNs in NC.

RESULTS
Key findings include nurse leader demographics, roles, barriers, retirement and succession plans, and development needs of current leaders in NC. NC nurse leaders are predominately female, white, non-Hispanic, and older than 50 years; plan to retire within the next 10 years; and report that their organizations do not have succession plans for nursing leadership.

CONCLUSIONS
Attention toward assessing nurse leadership capacity should be a priority to meet workforce needs.
Nurse Staffing and Healthcare-Associated Infection, Unit-Level Analysis
Authors: Shang Jingjing , Needleman Jack , Liu Jianfang , Larson Elaine , Stone Patricia W. 
Published: April 2019

OBJECTIVE
To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data.

BACKGROUND
Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses.

METHODS
Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks.

RESULTS
Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later.

CONCLUSIONS
Understaffing is associated with increased risk of HAIs.
C-Suite Strategies for Nurse Empowerment and Executive Accountability
Authors: Bogue Richard J. , Joseph M. Lindell 
Published: April 2019

OBJECTIVE
We examined C-suite executives' strategies to empower the nursing workforce and to ensure their own accountability for nursing empowerment.

BACKGROUND
Leadership affects workforce empowerment. The literature provides little formal guidance on optimal strategies C-suite executives can adopt for improving nurse empowerment or ensuring leadership accountability for empowering the workforce.

METHODS
A system's top 47 executives were invited to be panelists in a Delphi study. Two Delphi rounds revealed leadership strategies for embedding empowerment and strategies for assessing leadership performance in workforce empowerment.

RESULTS
C-suite executives rated specific strategies higher for nursing workforce empowerment and for holding themselves accountable. Specific strategies were rated high as easier to implement and more likely to have a major impact.

CONCLUSIONS
C-suite executives implementing strategies with greater impact may accelerate nursing empowerment, especially when executives also adopt their own strategies for holding themselves accountable.
The DNP Degree
Authors: Bowie Bonnie H. , DeSocio Janiece , Swanson Kristen M. 
Published: April 2019

OBJECTIVE
This study addressed how recently graduated doctor of nursing practice (DNP) nurses describe their current practice, how their supervisors describe the DNP's current practice, and whether nurse and supervisor descriptions of the practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials and, if so, how?

BACKGROUND
Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for effective leadership in complex healthcare environments. The value of the DNP degree for nurses in healthcare systems is evolving.

METHODS
We used conventional content analysis to inductively describe how DNP graduates from 7 different schools and their supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to assess whether the AACN DNP Essentials were enacted in practice.

RESULTS
The overarching theme was “becoming more: re-envisioning self as an agent of change.”

CONCLUSIONS
Results support the claim that DNP education prepares advanced practice nurses for leadership across complex healthcare systems. Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other leaders and capable of driving change using evidence and effective collaboration.
Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae Detected With Aptima Assays Performed on Self-Obtained Vaginal Swabs and Urine Collected at Home and in a Clinic
Authors: Chernesky Max , Jang Dan , Martin Irene , Arias Manuel , Shah Anika , Smieja Marek , Ratnam Sam , Getman Damon , Schachter Julius 
Published: April 2019

Abstract
Self-obtained vaginal swabs, first-void urine and pooled specimens were collected at home and in a clinic. Percent prevalence and collection site concordance was 30.3 and 100 for Mycoplasma genitalium (74.4% azithromycin resistant) 15.1 and 96.7 for Chlamydia trachomatis and 6.6 and 100 for Neisseria gonorrhoeae (27% ciprofloxacin-resistant).
Addressing Gaps in the Management of Chlamydia trachomatis and Neisseria gonorrhoeae in Primary Care: Lessons Learned in a Pilot Intervention Study
Authors: Rose Sally B. , Garrett Susan M. , Hutchings Deborah , Lund Kim , Kennedy Jane , Pullon Susan R.H. 
Published: April 2019

Background
We aimed to test the acceptability and utility of strategies designed to facilitate the delivery of clinical best practice for patients diagnosed with chlamydia or gonorrhea in primary care.

Methods
A nonrandomized pilot intervention study with a historic control period was run over 9 months in six primary health care clinics (2 youth services, 3 low-fee clinics, and 1 student health service) in Wellington, New Zealand. “Study nurses” in participating clinics oversaw the implementation of strategies designed to facilitate partner notification and follow-up for patients diagnosed with chlamydia or gonorrhea. Clinics chose which of 2 approaches they wished to trial—either managing all study processes themselves or drawing on the assistance of an external specialist sexual health advisor. Outcome measures included acceptability and utility of study processes ascertained via structured interviews with study nurses and collection of clinical data.

Results
Outcomes for 287 patients seen during the intervention were compared with 240 historic controls. Participant views on study processes were positive overall, and all clinics intended to continue all or most of the study processes implemented. During the intervention, substantial improvements were observed in documented patient management (sexual history, partner notification, and outcomes, P < 0.05). Increases were observed in percentages of patients reached for follow-up (74% vs. 26% at baseline, P < 0.05) and partners reported to have been notified (79% vs. 23%, P < 0.05).

Conclusions
Nurse-led strategies implemented were deemed acceptable and appeared to facilitate delivery of best practice care for patients diagnosed with bacterial sexually transmitted infections in participating primary care practices.
Serological Markers for Syphilis Among Persons Presenting With Syndromes Associated With Sexually Transmitted Infections: Results From the Zimbabwe STI Etiology Study
Authors: Rietmeijer Cornelis A. , Mungati More , Kilmarx Peter H. , Barr Beth Tippett , Gonese Elizabeth , Kularatne Ranmini S. , Lewis David A. , Klausner Jeffrey D. , Rodgers Luanne , Handsfield H. Hunter 
Published: April 2019

Background
Syphilis prevalence in sub-Saharan Africa appears to be stable or declining but is still the highest globally. Ongoing sentinel surveillance in high-risk populations is necessary to inform management and detect changes in syphilis trends. We assessed serological syphilis markers among persons with sexually transmitted infections in Zimbabwe.

Methods
We studied a predominantly urban, regionally diverse group of women and men presenting with genital ulcer disease (GUD), women with vaginal discharge and men with urethral discharge at clinics in Zimbabwe. Syphilis tests included rapid plasma reagin and the Treponema pallidum hemagglutination assay.

Results
Among 436 evaluable study participants, 36 (8.3%) tested positive for both rapid plasma reagin and Treponema pallidum hemagglutination assay: women with GUD: 19.2%, men with GUD: 12.6%, women with vaginal discharge: 5.7% and men with urethral discharge: 1.5% (P < 0.0001).

Conclusions
Syphilis rates in Zimbabwe are high in sentinel populations, especially men and women with GUD.
Trends and Characteristics Associated With Human Papillomavirus Vaccination Uptake Among Men Who Have Sex With Men in the United States, 2014–2017
Authors: Loretan Caitlin , Chamberlain Allison T. , Sanchez Travis , Zlotorzynska Maria , Jones Jeb 
Published: April 2019

Background
Human papillomavirus (HPV) and HPV-associated cancer rates are high among men who have sex with men (MSM). The US Advisory Committee on Immunization Practices recommends HPV vaccination for all MSM through age 26 years. We examined trends in HPV vaccine uptake among young US MSM between 2014 and 2017.

Methods
Cochran-Armitage tests and estimated annual percentage changes were used to examine annual trends (2014–2017) in HPV vaccination initiation among US MSM ≤26 years as of 2011 who participated in a nationwide annual cross-sectional online survey. We identified independent correlates of HPV vaccination in 2017 using Poisson regression modeling.

Results
There were 2,381 participants in 2014; 4,143 in 2015; 3,926 in 2016; and 3,407 in 2017. Mean age was 23.5 years, 39% lived in metropolitan areas, and 37% lived in the South. HPV vaccination significantly increased (P < 0.0001) from 22.5% in 2014 to 37.6% in 2017 (estimated annual percentage change = 17.4%). HPV vaccination was significantly greater for MSM who were younger, had health insurance, saw a healthcare provider in the past 12-months, resided in the Northeast, resided in metropolitan areas, had higher household income, disclosed their sexual identity to health care provider, and had gonorrhea/chlamydia diagnosis in the past 12-months.

Conclusions
Human papillomavirus vaccination among MSM increased from 2014 to 2017, but vaccine uptake varied significantly by MSM subgroup. Despite favorable trends, the HPV vaccination coverage for this population (37.6%) is less than half of the Healthy People 2020 target (80%). Additional efforts are needed to increase coverage.
The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial
Authors: Slopen Natalie , Tang Alva , Nelson Charles A. , Zeanah Charles H. , McDade Thomas W. , McLaughlin Katie A. , Fox Nathan A. 
Published: April 2019

ABSTRACT

Objective
Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.

Methods
The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.

Results
Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (−0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = −0.07, p = .03).

Conclusions
The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

Clinical Trial Registration

NCT00747396
Resting-State Functional Connectivity Between Centromedial Amygdala and Insula as Related to Somatic Symptoms in Depressed Patients: A Preliminary Study
Authors: Zu Meidan , Wang Anzhen , Bai Tongjian , Xie Wen , Guan Jianjun , Tian Yanghua , Wang Kai 
Published: April 2019

ABSTRACT

Objective
Somatic symptoms are prevalent in patients with depression. The centromedial amygdala (CMA) is a key brain region that mediates autonomic and somatic responses. Abnormal function in the CMA may contribute to the development of somatic symptoms in depressed patients.

Methods
We compared the resting-state functional connectivity (RSFC) based on the seed of the left and right CMA between 37 patients with depression and 30 healthy controls. The severity of depressive and somatic symptoms was assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15). Correlation analysis was performed to investigate the relationship between the RSFC and clinical variables (HDRS and PHQ-15) in depressed patients.

Results
Compared with healthy controls, patients with depression exhibited decreased RSFC between the CMA and insula, and superior temporal gyrus. In addition, functional connectivity between the left CMA and left insula was negatively correlated with PHQ-15 (r = −0.348, p = .037) in depressed patients. No significant relation was found between the RSFC and HDRS in depressed patients.

Conclusions
Functional connectivity between the CMA and insula is reduced in depressive patients, which is associated with the severity of somatic symptoms. Our findings may provide a potential neural substrate to interpret the co-occurrence of depression with somatic symptoms.
Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents
Authors: Spicer Julie , Giesbrecht Gerald F. , Aboelela Sally , Lee Seonjoo , Liu Grace , Monk Catherine 
Published: April 2019

ABSTRACT

Objective
An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes.

Methods
Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13–16, 24–27, and 34–37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records.

Results
After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = −0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed.

Conclusions
These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.
Between the Error Bars: How Modern Theory, Design, and Methodology Enrich the Personality-Health Tradition
Authors: Segerstrom Suzanne C. 
Published: April 2019

ABSTRACT
The study of relationships between personality traits and health has a long history in psychosomatic research. However, personality science has evolved from an understanding of personality as fixed traits to one that acknowledges that personality is dynamic. Dynamic approaches to conceptualizing and measuring personality and individual differences can enrich personality-health research. In this Presidential Address (American Psychosomatic Society, 2018), I consider how different formulations of personality—stable traits, stable signals in a noisy or variable measure, within-person changes, and intraindividual variability—can be implemented to better understand how personality is related to health and particularly to immune function. These approaches recognize and, in some cases, capitalize on the fact that personality factors can display variability as well as stability over time. They also require repeated measurement and therefore greater methodological sophistication that considers reliability and generalizability, Simpson's paradox, and the difference between variability and flexibility. Dynamic qualities of personality and individual differences potentially influence health, and designs and methodology that incorporate them can illuminate the important processes that occur inside the error bars.
Human prion diseases
Authors: Wang Han , Rhoads Daniel D. , Appleby Brian S. 
Published: April 2019

Purpose of review
Prion diseases are rapidly progressive neurodegenerative conditions that can be difficult to diagnose and are transmissible under specific circumstances. The authors will provide background regarding prion disease and focus on diagnostic tools.

Recent findings
Prion disease is caused by misfolded prion protein. The three possible causes of prion disease include sporadic (85%), genetic (10–15%), and acquired (<1%). Acquired prion diseases include kuru, iatrogenic, and variant Creutzfeldt–Jakob disease. Prion diseases differ in their clinical manifestation, neuropathology, and diagnostic test results. A variety of recent diagnostic tools have evolved that allow more reliable antemortem diagnosis of prion disease such as brain MRI and cerebrospinal fluid real-time quaking-induced conversion. Special infectivity guidelines must be followed when dealing with central nervous system tissue, but only standard precautions are needed for routine clinical care of patients with prion disease.

Summary
The only way to definitely diagnose prion disease and determine its type is via neuropathologic examination. However, brain MRI and cerebrospinal fluid real-time quaking-induced conversion have drastically increased diagnostic accuracy and are important tests to use when evaluating patients with suspected prion disease.