bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender dysphoria in youth: An overview for primary care providers
Authors: Kameg Brayden N. , Nativio Donna G. 
Published: August 2018

ABSTRACT

Background and purpose:
Primary care providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one's true, expressed sexual identity. Because those with untreated gender dysphoria are at risk of a variety of negative outcomes, including mood symptomatology, suicidality, substance use disorders, and other psychosocial risk factors, it is critical that health care providers are adept in the provision of holistic, patient-centered care. The purpose of this report is to provide an updated review of the current evidence from the literature pertaining to the identification, treatment, and coordination of care among children with gender dysphoria within the primary care setting or medical home.

Methods:
Using PubMed and CINAHL, a literature review spanning from 2012 to the present was conducted using the following key words: gender dysphoria, transgender health, LGBT health, and hormone therapy. Reference lists of identified articles were also explored for relevance.

Conclusions:
Treatment may include a social transition, hormone antagonist therapy, or the administration of cross-sex hormone therapy, with a medical home needed to facilitate coordination of care. Best practice guidelines vary across pediatric and developmental groups and include both reversible and nonreversible modalities. Screening for negative psychosocial sequelae must be completed to include mood symptomatology, suicidality, substance use disorders, and risky sexual behavior, so that appropriate screening, identification, and treatment interventions can be implemented.

Implications for practice:
The primary care medical home must act as a foundation for the identification of gender dysphoria and/or associated comorbidities and must treat, when able, or refer, when indicated. In addition, because of structural barriers and stigmatization, public policy often fails the transgender community and can exacerbate the aforementioned psychosocial comorbidities faced by the transgender youth community. Health care providers, particularly nurse practitioners, are in a unique position to expand on the face-to-face care provided to the community and engage in advocacy efforts to dismantle structural barriers impeding transgender individuals and communities while also providing primary health care, anticipatory guidance, and care coordination.
What Do Breast Cancer Survivors Expect From Exercise?
Authors: Hirschey Rachel , Pan Wei , Hockenberry Marilyn , Kimmick Gretchen , Shaw Ryan , Lipkus Isaac 
Published: August 2018

Background
Exercise outcome expectations (OEs) (ie, what one expects to obtain or avoid by exercising) are influential to increase exercise among cancer survivors.

Objective
The aim of this study was to measure the accessibility (ie, frequency one thinks about exercise resulting in an outcome) and importance (ie, one’s value of the outcome) of OEs among breast cancer survivors.

Methods
Stage IA to IIB breast cancer survivors who were 1 to 5 years posttreatment completed OE questionnaires. Descriptive statistics were used to examine OE accessibility and importance.

Results
The sample (n = 73) was 91.8% white, 5.4% African American, 1.4% Asian or Pacific Islander, and 1.4% other. The mean age was 58 (SD, 9.6) years. Outcome expectation importance mean was 6.1 (SD, 0.4), indicating OEs are overall “important.” Accessibility mean was 4.8 (SD, 0.6), demonstrating breast cancer survivors think about exercise OEs “sometimes/50% of the time.” There was a moderate (r
s = 0.48) relationship between OE importance and accessibility, indicating they are related, yet distinct.

Conclusions
Outcome expectations are generally important to breast cancer survivors. Thus, OEs may motivate increased exercise among this population.

Implications for Practice
Oncology providers should encourage patients to think about OEs more often to increase exercise. Compared with traditional approaches of informing patients about exercise benefits, this may be a more comprehensive and powerful approach to motivate exercise among breast cancer survivors.
Using Continuous Vital Sign Monitoring to Detect Early Deterioration in Adult Postoperative Inpatients
Authors: Verrillo Sue Carol , Cvach Maria , Hudson Krysia Warren , Winters Bradford D. 
Published: August 2018

Background:
Episodic vital sign collection (eVSC), as single data points, gives an incomplete picture of adult patients' postoperative physiologic status.

Local Problem:
Late detection of patient deterioration resulted in poor patient outcomes on a postsurgical unit.

Methods:
Baseline demographic and outcome data were collected through retrospective chart review of all patients admitted to the surgical unit for 12 weeks prior to this quality improvement project. Data on the same outcomes were collected during the 12-week project.

Intervention:
This project compared outcomes between the current standard of eVSC and the proposed standard of continuous vital sign monitoring (cVSM).

Results:
Using cVSM demonstrated a statistically significant 27% decrease in the complication rate, and a clinically significant decrease in transfers to an intensive care unit and failure-to-rescue (FTR) events rate.

Conclusions:
cVSM demonstrated detection of early signs of patient deterioration to prevent FTR.
Understanding Anosognosia for Hemiplegia After Stroke
Authors: Byrd Elizabeth M. , Jablonski Rita J. , Vance David E. 
Published: August 2018

Abstract

Background
Anosognosia for hemiplegia (AHP) after stroke is a complex cognitive behavioral disorder that removes awareness of one-sided paralysis (hemiplegia). As a result, stroke survivors afflicted with AHP may be more likely to have unrealistic expectations for stroke rehabilitation, display unsafe behaviors and experience falls, and ultimately suffer the physical and psychological consequences of frequent falling.

Objective
The purpose of this article is to describe AHP by discussing anosognosia within the context of contemporary theoretical understandings, examining current imaging evidence of the disorder, and summarizing emerging interventions designed to reinstate self-awareness in anosognosic patients.

Method
Systematic review with a focus on defining and describing AHP based on human experimental studies was conducted within a 10-year period.

Results
Eleven studies were identified. The content and foci of the 11 studies fell into one of three categories: theory testing, imaging evidence, and interventions for individuals with AHP.
The procoagulant molecule plasminogen activator inhibitor-1 is associated with injury severity and shock in patients with and without traumatic brain injury
Authors: Condron Mary , Rowell Susan , Dewey Elizabeth , Anderson Taylor , Lealiiee Lelani , Farrell David , Hinson Holly 
Published: August 2018

BACKGROUND
Traumatic injury is associated with an increased risk of coagulopathy and venous thrombosis. plasminogen activator inhibitor-1 (PAI-1) is a procoagulant molecule that inhibits tPA/uPA, thrombomodulin, and activated protein C. We hypothesized that elevated PAI-1 levels would be associated with increased Injury Severity Score (ISS) in injured patients with and without traumatic brain injury and that PAI-1 levels would vary with injury type.

METHODS
We retrospectively analyzed demographic, ISS, and hemodynamic data from a prospectively collected database. Patients with traumatic injury requiring intensive care unit admission (n = 268) were classified as multiple injuries, isolated body, or isolated head based on Abbreviated Injury Severity score. Admission PAI-1 levels were quantified using a Luminex analyte platform. Univariate tests for association informed the construction of a multivariate model of the relationship between PAI-1 and ISS.

RESULTS
Plasminogen activator inhibitor-1 positively associated with ISS (p < 0.0001) and was highest in patients with ISS greater than 35 (p < 0.0001). Plasminogen activator inhibitor-1 was significantly different between multiple injuries, isolated body, and isolated head patients (p < 0.0001). On univariate analysis, age (p = 0.0011), hypotension (p = 0.0076), and alcohol intoxication (p = 0.0024) were all positively associated with PAI-1 level. Admission international normalized ratio was not associated with PAI-1 level (p = 0.638). After adjusting for age, sex, hypotension, and alcohol intoxication, higher PAI-1 levels were associated with higher ISS (p < 0.0001).

CONCLUSION
Elevated PAI-1 at admission is associated with higher ISS. This association is more pronounced in patients with hypotension. These findings suggest that PAI-1 levels may reflect the burden of endothelial damage and platelet activation after injury.

LEVEL OF EVIDENCE
Prognostic, level III.
The volume-outcome relationship in severely injured patients: A systematic review and meta-analysis
Authors: Sewalt Charlie A. , Wiegers Eveline J. A. , Venema Esmee , Lecky Fiona E. , Schuit Stephanie C. E. , Hartog Dennis Den , Lingsma Hester F. 
Published: August 2018

BACKGROUND
The volume-outcome relationship in severely injured patients remains under debate and this has consequences for the designation of trauma centers.

OBJECTIVES
The aim of this study was to evaluate the relationship between hospital or surgeon volume and health outcomes in severely injured patients.

METHODS
Six electronic databases were searched from 1980 up to January 30, 2018, to identify studies that describe the relationship between hospital or surgeon volume and health outcomes in severely injured patients (preferably Injury Severity Score above 15). Selection of relevant studies, data extraction, and critical appraisal of the methodological quality were performed by two independent reviewers. Pooled adjusted and unadjusted estimates of the effect of volume on in-hospital mortality, only in study populations with Injury Severity Score greater than 15, were calculated with a random-effects meta-analysis. A mixed effects linear regression model was used to assess hospital volume as continuous parameter.

RESULTS
Eighteen observational cohort studies were included. The majority (13 [72%] of 18) reported an association between higher hospital or surgeon volume and lower mortality rate. Overall, the quality of the included studies was reasonable, with insufficient adjustment as one of the most common limitations. Eight studies were included in the meta-analysis with a total of 222,418 patients. High hospital volume (>240 admitted severely injured patients per year) was associated with a lower risk of mortality (adjusted odds ratio, 0.85; 95% confidence interval, 0.76–0.94). Four studies were included in the regression model, providing a beta of −0.17 per 10 patients (95% CI, −0.27 to −0.07). There was no clear association between surgeon volume and mortality rates based on three available studies.

CONCLUSION
Our systematic overview of the literature reveals a modest association between high-volume centers and lower mortality in severely injured patients, suggesting that designation of high-volume centers might improve outcomes among severely injured patients.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III. Systematic review registration number: PROSPERO registration ID CRD42017056729
Changes in Simultaneous Liver-kidney Transplant Allocation Policy May Impact Postliver Transplant Outcomes
Authors: Cullaro Giuseppe , Hirose Ryutaro , Lai Jennifer C. 
Published: August 2018

Background.
Previous simultaneous liver-kidney (SLK) transplant allocation was based on serum creatinine, a metric that disadvantaged women relative to men. A recent SLK transplant policy change uses estimated glomerular filtration rate (eGFR), which accounts for sex-based differences in creatinine.

Methods.
To understand the impact of this new policy, we analyzed nonstatus 1 adults listed for liver transplantation (LT) from May 2007 to July 2014, excluding those with exceptions. We defined patients who met the new SLK policy as having an eGFR <60 mL/min for 90 days, with a final eGFR <30 mL/min.

Results.
Of 40979 candidates, 1683 would have met only the new criteria (N-SLK), 2452 would have met only the old criteria (O-SLK), and 1878 would have met both criteria (B-SLK). Compared to those in the B-SLK or O-SLK groups, those in the N-SLK group were significantly more likely to be female (52% versus 36% versus 39%, P < 0.001). Cox-regression analysis demonstrated that in adjusted analysis those in the N-SLK group were significantly less likely to die postliver transplant (hazard ratio [HR], 0.0; P < 0.001). Further, in Cox regression subgroup analyses, both in women (HR 0.04; P < 0.001) and in men (HR, 0.02, P < 0.001) those in the N-SLK group who underwent liver transplant were significantly less likely to die postliver transplant, even after adjustment for confounders.

Conclusions.
We anticipate that implementation of the new SLK policy will increase the proportion of women and decrease the proportion of men who are listed for SLK but may not improve posttransplant survival. Our data highlight the need for monitoring of SLK outcomes after implementation of the new policy.
Management of a Groin Wound Using a Concentrated Surfactant-Based Gel Dressing
Authors: Ratliff Catherine R. 
Published: August 2018

BACKGROUND:
A groin wound associated with a vascular graft infection is associated with significant morbidity. Management of groin wounds is often challenging due to their anatomical location that renders them difficult to visualize and keep clean.

CASE:
This case report describes the use of a concentrated surfactant-based gel dressing for an infected groin wound.

CONCLUSIONS:
Because of their location and complex topography, groin wounds are difficult to keep clean and maintain dressing integrity. This case study describes the use of a concentrated surfactant-based gel dressing that remained in place and promoted healing of an infected groin wound.
Metaepigenomic analysis reveals the unexplored diversity of DNA methylation in an environmental prokaryotic community
Authors: Hiraoka Satoshi , Okazaki Yusuke , Anda Mizue , Toyoda Atsushi , Nakano Shin-ichi , Iwasaki Wataru 
Published: August 2018

AbstractDNA methylation plays important roles in prokaryotes, such as in defense mechanisms against phage infection, and the corresponding genomic landscapes—prokaryotic epigenomes—have recently begun to be disclosed. However, our knowledge of prokaryote methylation systems has been severely limited to those of culturable prokaryotes, whereas environmental communities are in fact dominated by uncultured members that must harbor much more diverse DNA methyltransferases. Here, using single-molecule real-time and circular consensus sequencing techniques, we revealed the ‘metaepigenomes’ of an environmental prokaryotic community in the largest lake in Japan, Lake Biwa. A total of 19 draft genomes from phylogenetically diverse groups, most of which are yet to be cultured, were successfully reconstructed. The analysis of DNA chemical modifications identified 29 methylated motifs in those genomes, among which 14 motifs were novel.Furthermore, we searched for the methyltransferase genes responsible for the methylation of the detected novel motifs and confirmed their catalytic specificities via transformation experiments involving artificially synthesized genes. Finally, we found that genomes without DNA methylation tended to exhibit higher phage infection levels than those with methylation. In summary, this study proves that metaepigenomics is a powerful approach for revealing the vast unexplored variety of prokaryotic DNA methylation systems in nature.
Transforming summary statistics from logistic regression to the liability scale: application to genetic and environmental risk scores
Authors: Gillett Alexandra C. , Vassos Evangelos , Lewis Cathryn M. 
Published: August 2018

1.Abstract1.1.ObjectiveStratified medicine requires models of disease risk incorporating genetic and environmental factors. These may combine estimates from different studies and models must be easily updatable when new estimates become available. The logit scale is often used in genetic and environmental association studies however the liability scale is used for polygenic risk scores and measures of heritability, but combining parameters across studies requires a common scale for the estimates.1.2.MethodsWe present equations to approximate the relationship between univariate effect size estimates on the logit scale and the liability scale, allowing model parameters to be translated between scales.1.3.ResultsThese equations are used to build a risk score on the liability scale, using effect size estimates originally estimated on the logit scale. Such a score can then be used in a joint effects model to estimate the risk of disease, and this is demonstrated for schizophrenia using a polygenic risk score and environmental risk factors.1.4.ConclusionThis straightforward method allows conversion of model parameters between the logit and liability scales, and may be a key tool to integrate risk estimates into a comprehensive risk model, particularly for joint models with environmental and genetic risk factors.
Phylogenetic barriers to horizontal transfer of antimicrobial peptide resistance genes in the human gut microbiota
Authors: Kintses Bálint , Méhi Orsolya , Ari Eszter , Számel Mónika , Györkei Ádám , Jangir Pramod K. , Nagy István , Pál Ferenc , Fekete Gergö , Tengölics Roland , Nyerges Ákos , Likó István , Bálint Balázs , Vásárhelyi Bálint Márk , Bustamante Misshelle , Papp Balázs , Pál Csaba 
Published: August 2018

AbstractThe human gut microbiota has adapted to the presence of antimicrobial peptides (AMPs) that are ancient components of immune defence. Despite important medical relevance, it has remained unclear whether AMP resistance genes in the gut microbiome are available for genetic exchange between bacterial species. Here we show that AMP- and antibiotic-resistance genes differ in their mobilization patterns and functional compatibilities with new bacterial hosts. First, whereas AMP resistance genes are widespread in the gut microbiome, their rate of horizontal transfer is lower than that of antibiotic resistance genes. Second, gut microbiota culturing and functional metagenomics revealed that AMP resistance genes originating from phylogenetically distant bacteria only have a limited potential to confer resistance inEscherichia coli, an intrinsically susceptible species. Third, the phenotypic impact of acquired AMP resistance genes heavily depends on the genetic background of the recipient bacteria. Taken together, functional compatibility with the new bacterial host emerges as a key factor limiting the genetic exchange of AMP resistance genes. Finally, our results suggest that AMPs induce highly specific changes in the composition of the human microbiota with implications for disease risks.
Costs and benefits of mating with fertilized females in a species with first male sperm precedence
Authors: Rodrigues Leonor R , Figueiredo Alexandre RT , Van Leeuwen Thomas , Olivieri Isabelle , Magalhães Sara 
Published: August 2018

SummaryDifferent patterns of sperm precedence are expected to result in specific mating costs and benefits for each sex, generating different selection pressures on males and females. However, most studies concern species with mixed paternity or last male sperm precedence, neglecting species with first male sperm precedence, in which only the first mating is effective.Here, we measured costs and benefits of multiple mating for both sexes of the spider mite Tetranychus urticae. First, we assessed the stability of the sperm precedence pattern, by mating females to one, two or several males, immediately after the first mating or 24 hours later. We found complete first male precedence, independently of the mating interval and the number of matings. Females paid a cost of polyandry, as multiply-mated females laid fewer eggs than once-mated females. However, while first males had reduced survival when exposed to an intermediate number of virgin females, second males paid no additional costs by matings with several mated females. Moreover, by mating multiply with mated females, males decreased the total number of offspring sired by first males, which suggests that these matings may entail a relative benefit for second males, despite being ineffective.Our results show that complex costs and benefits may arise in males in species with first male precedence. How these costs and benefits affect the maintenance of selection for polyandry remains an open question.
Unique transcriptomic landscapes identified in idiopathic spontaneous and infection related preterm births compared to normal term births
Authors: Brockway Heather M , Kallapur Suhas G , Buhimschi Irina A , Buhimschi Catalin S , Ackerman William E , Muglia Louis J , Jones Helen N 
Published: August 2018

AbstractPreterm birth (PTB) is leading contributor to infant death in the United States and globally, yet the underlying mechanistic causes are not well understood. Histopathological studies of preterm birth suggest advanced villous maturity may have a role in idiopathic spontaneous preterm birth (isPTB). To better understand pathological and molecular basis of isPTB, we compared placental villous transcriptomes from carefully phenotyped cohorts of PTB due to infection or isPTB between 28-36 weeks gestation and healthy term placentasu. Transcriptomic analyses revealed a unique expression signature for isPTB distinct from the age-matched controls that were delivered prematurely due to infection. This signature included the upregulation of three IGF binding proteins (IGFBP1, IGFBP2, and IGFBP6), supporting a role for aberrant IGF signaling in isPTB. However, within the isPTB expression signature, we detected secondary signature of inflammatory markers including TNC, C3, CFH, and C1R, which have been associated with placental maturity. In contrast, the expression signature of the gestational age-matched infected samples included upregulation of proliferative genes along with cell cycling and mitosis pathways. Together, these data suggest an isPTB molecular signature of placental hypermaturity, likely contributing to the premature activation of inflammatory pathways associated with birth and providing a molecular basis for idiopathic spontaneous birth.
Genome Wide Study of Tardive Dyskinesia in Schizophrenia
Authors: Lam Max , Lim Keane , Tay Jenny , Karlsson Nina , Deshpande Smita N , Thelma BK , Ozaki Norio , Inada Toshiya , Sim Kang , Chong Siow-Ann , Liu Jianjun , Lee Jimmy 
Published: August 2018

AbstractTardive dyskinesia (TD) is a severe condition characterized by repetitive involuntary movement of orofacial regions and extremities. Patients treated with antipsychotics typically present with TD symptomatology. Here, we conducted the largest GWAS of TD to date, by meta-analyzing samples of East-Asian, European, and African-American ancestry, followed by analyses of biological pathways and polygenic risk with related phenotypes. We identified a novel locus and three suggestive loci, implicating immune-related pathways. Through integrating trans-ethnic fine-mapping, we identified putative credible causal variants for three of the loci. Multivariate analyses of polygenic risk for TD supports the genetic susceptibility of TD, with relatively lower allele frequencies variants being associated with TD, beyond that of antipsychotic medication. Together, these findings provide new insights into the genetic architecture and biology of TD.