bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Use and Outcomes in Hospitalized Older Patients With Heart Failure Receiving and Not Receiving Hospice Referrals
Authors: Sheriff Helen M. , Arundel Cherinne , Gill Gauravpal S. , Tummala Lakshmi S. , Zeng Qing , Theisen-Toupal Jesse C. , Morgan Charity J. , Faselis Charles , Allman Richard M. , Singh Steven , Ahmed Ali 
Published: May 2019

Background:
The use of opioids is associated with poor outcomes. Less is known about this association in patients with heart failure (HF) and whether it varies by the receipt of hospice care.

Methods:
Of the 7467 patients hospitalized for HF without previous opioid use, 124 received discharge opioids. We matched 123 of these patients with 123 not receiving opioids based on their propensity scores for opioid use, thus assembling a matched cohort of 246 patients balanced on 30 baseline characteristics (mean age, 76 years, 60% women, and 11% African American). We repeated the process in hospice (n = 155; 20 received opioids) and nonhospice (n = 7298; 104 received opioids) subgroups, thus assembling 2 matched cohorts of 22 and 208 patients, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) associated with opioid use were estimated from matched cohorts.

Results:
During 8.6 (median, 1.4) years of follow-up, all-cause mortality occurred in 80% and 68% of matched patients in the opioid and nonopioid groups, respectively (HR, 1.49; 95% CI, 1.11–1.99; P = 0.008). There was evidence of heterogeneity in this association between hospice and nonhospice patients (P for interaction, 0.027). Among matched hospice and nonhospice patients, HRs (95% CIs) for mortality were 6.37 (2.06–19.69; P = 0.001) and 1.42 (1.03–1.96; P = 0.035), respectively. HRs (95% CIs) for 30-day and 1-year mortality were 1.98 (1.06–3.70; P = 0.033) and 1.72 (1.18–2.49; P = 0.004), respectively. HRs (95% CIs) for all-cause, HF, and non-HF readmissions were 1.31 (0.97–1.76; P = 0.079), 1.03 (0.71–1.49; P = 0.866), and 1.75 (1.05–2.91; P = 0.031), respectively. Readmission associations were similar among matched nonhospice patients. There was no readmission among matched hospice patients receiving opioids.

Conclusions:
In older patients with HF, opioid use is associated with a higher risk of mortality, which is greater in the hospice subgroup, and a higher risk of non-HF readmission in the nonhospice subgroup.
Antimicrobial stewardship in transplant patients
Authors: Hand Jonathan , Patel Gopi 
Published: May 2019

Purpose of review
To provide an update on the current landscape of antimicrobial stewardship in solid organ transplant (SOT) recipients.

Recent findings
Constructing personalized antimicrobial prescribing approaches to avoid untoward consequences of antimicrobials while improving outcomes is an emerging and critical aspect of transplant medicine. Stewardship activities encompassing the specialized interests of transplant patients and programs are evolving. New literature evaluating strategies to optimize antimicrobial agent selection, dosing, and duration have been published. Additionally, consensus guidance for certain infectious clinical syndromes is available and should inform institutional clinical practice guidelines. Novel metrics for stewardship-related outcomes in transplantation are desperately needed. Though exciting new molecular diagnostic technologies will likely be pivotal in the care of immunocompromised patients, optimal clinical adaptation and appropriate integration remains unclear. Important studies understanding the behaviors influencing antimicrobial prescribing in organizational transplant cultures are needed to optimize interventions.

Summary
Consequences of antimicrobial use, such as Clostridiodes difficile and infections with multidrug-resistant organisms disproportionately affect SOT recipients and are associated with poor allograft and patient outcomes. Application of ASP interventions tailored to SOT recipients is recommended though further studies are needed to provide guidance for best practice.
Community-acquired respiratory viruses in solid organ transplant
Authors: Nam Hannah H. , Ison Michael G. 
Published: May 2019

Purpose of review
Respiratory viruses are common in solid organ transplant (SOT) recipients and recognized as a significant cause of mortality and morbidity. This review examines the literature on influenza and noninfluenza viruses in the SOT recipient.

Recent findings
Advances in immunosuppression and antimicrobial prophylaxis have led to improved patient and graft survival, yet respiratory viruses continue to be a common cause of disease in this population. Influenza viruses have received top priority regarding prevention and treatment, whereas advances in molecular diagnostic tests detecting an array of other respiratory viruses have expanded our knowledge about the epidemiology and impact of these viruses in both the general population and SOT patients. Effective treatment and prevention for noninfluenza respiratory viruses are only emerging.

Summary
Respiratory viruses can contribute to a wide array of symptoms in SOT, particularly in lung transplant recipients. The clinical manifestations, diagnosis, and treatment options for influenza and noninfluenza viruses in SOT patients are reviewed. PCR and related molecular techniques represent the most sensitive diagnostic modalities for detection of respiratory viruses. Early therapy is associated with improved outcomes. Newer classes of antivirals and antibodies are under continuous development for many of these community acquired respiratory viruses.
Prevalence of Trichomonas vaginalis Among Civilian, Noninstitutionalized Male and Female Population Aged 14 to 59 Years: United States, 2013 to 2016
Authors: Flagg Elaine W. , Meites Elissa , Phillips Christi , Papp John , Torrone Elizabeth A. 
Published: May 2019

Abstract
Among the US civilian noninstitutionalized population aged 14 to 59 years in 2013 to 2016, prevalence of Trichomonas vaginalis infection in urine was 1.3% overall. Prevalence was 2.1% among females, 0.5% among males, and highest at 9.6% among non-Hispanic black females. Estimate instability limited analysis of factors beyond sex, age, and race/Hispanic ethnicity.
The Rehabilitation Research Experience for Medical Students
Authors: Mohan Manoj , Schnappinger Amy , Dicianno Brad E. 
Published: May 2019

Abstract
The aim of this project was to evaluate the 10-yr outcomes from the Rehabilitation Research Experience for Medical Students. A target benchmark was one high-quality output per student. Students were required to devise a research project and work full time with a mentor at an approved sponsor site for 8 wks. Longitudinal surveys were used to collect data about research outputs, match results, and decisions about whether to pursue academic careers. From 2008 to 2017, 73 (48%) of 153 applicants were awarded summer externships. Residency match results included the following: physical medicine and rehabilitation (45%), internal medicine (17%), emergency medicine (8%), orthopedic surgery (6%), neurology (6%), psychiatry (6%), OBGYN (6%), pediatrics (4%), and anesthesia (2%). The Rehabilitation Research Experience for Medical Students was successful in exceeding the target benchmark for quality scholarly output, which included 73 oral presentations at the Association of Academic Physiatrists meeting, 63 published and 20 in-review articles directly related to summer research, 5 book chapters, and 51 published and 20 in-review articles that were indirectly related to summer research. A total of 77% reported that the Rehabilitation Research Experience for Medical Students positively influenced their decision to pursue research in their future career, and 70% endorsed interest in becoming a clinician scientist.
A New Threshold for Appendicular Lean Mass Discriminates Muscle Weakness in Women With Hip Fracture
Authors: Di Monaco Marco , Castiglioni Carlotta , Bardesono Francesca , Milano Edoardo , Massazza Giuseppe 
Published: May 2019

Objective
The aim of the study was to investigate the relationship between measures of muscle mass and grip strength in women with subacute hip fracture. Firstly, we aimed to assess the capability of the current thresholds for appendicular lean mass, appendicular lean mass/body mass index ratio and appendicular lean mass/height2 to separate weak and nonweak women. Secondly, we aimed to explore alternative thresholds for the three measures of muscle mass to discriminate weakness.

Design
This is cross-sectional study of 160 women with hip fracture admitted to a rehabilitation hospital. We assessed appendicular lean mass by dual-energy x-ray absorptiometry and grip strength by a Jamar hand dynamometer. Weakness was defined as grip strength of less than 16 kg.

Results
Weakness was not significantly associated with appendicular lean mass of less than 15.02 kg, appendicular lean mass/body mass index ratio of less than 0.512 or appendicular lean mass/height2 of less than 5.67 kg/m2. For appendicular lean mass (but not for the other 2 measures of muscle mass), an alternative threshold (11.87 kg instead of 15.02 kg) significantly discriminated weakness: χ2 (1, n = 160) = 10.77 (P = 0.001). The association between appendicular lean mass of less than 11.87 kg and grip strength of less than 16 kg persisted after adjustment for age and body mass index (odds ratio = 2.50, 95% confidence interval = 1.17–5.34, P = 0.018).

Conclusions
Data suggest that the current thresholds for measures of muscle mass do not discriminate weakness in women with subacute hip fracture. For appendicular lean mass, an alternative cutoff point actually separated weak and nonweak women.
The Association Between Perceived Discrimination and Allostatic Load in the Boston Puerto Rican Health Study
Authors: Cuevas Adolfo G. , Wang Kaipeng , Williams David R. , Mattei Josiemer , Tucker Katherine L. , Falcon Luis M. 
Published: May 2019

ABSTRACT

Objective
Perceived discrimination is a risk factor for poor health among ethnic and racial minority groups. However, few studies have examined the association between major lifetime and everyday perceived discrimination and allostatic load (AL), a preclinical indicator of disease. We examine the association between two measures of discrimination and AL among Puerto Rican adults.

Methods
Using primarily wave 3 data from the longitudinal Boston Puerto Rican Health Study, we examined the association between major lifetime and everyday perceived discrimination and AL (multisystem dysregulation of 11 physiological components) among Puerto Rican adults residing in the Boston metro area (N = 882). Five models were tested using multivariable regression. The final model adjusted for demographic factors, migration factors, socioeconomic status and work history, health behaviors/risk factors, and depressive symptom.

Results
Respondents had a M (SD) AL score of 5.11 (1.76; range = 0–11). They had an average score of 0.21 (0.42) for major lifetime perceived discrimination (0–3) and 0.29 (0.49) for everyday perceived discrimination (0–3). In a fully adjusted model, major lifetime perceived discrimination was associated with greater AL (b = 0.56; 95% CI = 0.19 to 0.92), whereas greater everyday perceived discrimination was marginally, but not significantly, associated with lower AL (b = −0.42; 95% CI = −0.87 to 0.04).

Conclusions
Perceived discrimination remains a common stressor and may be a determinant of AL for Puerto Ricans, although the type of perceived discrimination may have differing effects. Further research is needed to better understand the ways in which major lifetime and everyday perceived discrimination operate to effect physiological systems among Puerto Ricans.
A Safety Evaluation of the Impact of Maternity-Orientated Human Factors Training on Safety Culture in a Tertiary Maternity Unit
Authors: Ansari Sophia P. , Rayfield Malissa E. , Wallis Victoria A. , Jardine Jennifer E. , Morris Edward P. , Prosser-Snelling Edward 
Published: May 2019

Background
Human factors have risen to attention in maternity as key contributors to patient harm. Despite national recommendation for multidisciplinary human factors training, there is a lack of guidance and healthcare-orientated training.

Objectives
The aim of the study was to evaluate the impact of maternity-orientated human factors training program on safety culture in a tertiary maternity unit.

Methods
This prospective observational cohort study was conducted for 6 months in a tertiary maternity unit. Participants involved in high-risk intrapartum care completed the Hospital Survey of Patient Safety Culture before and after intervention. Statistical analysis was performed using the χ2 test with statistical significance at 5% (P = 0.05).

Intervention
The human factors curriculum included situational awareness, communication, decision-making, conflict resolution, teamwork, and leadership. A train-the-trainer approach generated a faculty to disseminate multidisciplinary training. Traditional classroom teaching, social media content, and cognitive activities provided theoretical foundations. Forum theater and behavioral simulation taught complex communication issues. Regular labor ward simulations helped embed training into clinical practice.

Results
The results demonstrated statistically significant improvement in safety culture domains of communication openness, handover, nonpunitive response to error, and overall safety perception. Participants felt more able to challenge decisions or actions of those in authority, 33% responded “most of the time or always” in August increasing to 42% in January with a reduction of 50% in those responding “never” (P = 0.02). No change was found relating to team working, staffing or manager expectations promoting patient safety.

Conclusions
This study is proof-of-concept that maternity-orientated human factors training can improve safety culture.
Effect of a Dynamic Exercise Program in Combination With Mediterranean Diet on Quality of Life in Women With Rheumatoid Arthritis
Authors: García-Morales José Manuel , Lozada-Mellado Mariel , Hinojosa-Azaola Andrea , Llorente Luis , Ogata-Medel Midori , Pineda-Juárez Juan Antonio , Alcocer-Varela Jorge , Cervantes-Gaytán Rocío , Castillo-Martínez Lilia 
Published: May 2019

ObjectiveTo assess the effect of a dynamic exercise program (DEP) in combination with a Mediterranean diet (MD) on health-related quality of life in women with rheumatoid arthritis (RA).MethodA randomized clinical trial including 144 women with RA diagnosis was performed. Patients were randomized into 4 groups: (1) MD + DEP (n = 36), (2) DEP (n = 37), (3) MD (n = 40), and (4) control (n = 31). All patients received conventional disease-modifying antirheumatic drugs. Health-related quality of life was assessed with 36-item Short Form Health Survey v2 (0–100 score) and disability with Health Assessment Questionnaire Disability Index at enrollment and after 24 weeks. Between-groups comparisons of the change in the quality of life scores from baseline to follow-up were performed using analysis of covariance in which baseline–to–follow-up was the dependent variable, and the intervention group was the independent variable.ResultsAll patients had low disease activity at the time of enrollment, with a mean 28-joint Disease Activity Score of less than 3.2. Patients who were included in the MD + DEP and DEP groups showed 15 points of increase in health-related quality of life global punctuation versus 3.5 in the MD group and −4.6 in the control group (p= 0.01). Also the scores in the physical component after 24 weeks of intervention in the MD + DEP group improved (15.5), in the DEP group (12) and MD group as well (5.1), whereas the control group showed a decrease of the score (−1.7) (p= 0.03 between groups).ConclusionsThe combination of MD + DEP could improve the quality of life in RA patients with low disease activity receiving conventional disease-modifying antirheumatic drugs.
A brief history of bird flu
Authors: Lycett Samantha J. , Duchatel Florian , Digard Paul 
Published: May 2019

In 1918, a strain of influenza A virus caused a human pandemic resulting in the deaths of 50 million people. A century later, with the advent of sequencing technology and corresponding phylogenetic methods, we know much more about the origins, evolution and epidemiology of influenza epidemics. Here we review the history of avian influenza viruses through the lens of their genetic makeup: from their relationship to human pandemic viruses, starting with the 1918 H1N1 strain, through to the highly pathogenic epidemics in birds and zoonoses up to 2018. We describe the genesis of novel influenza A virus strains by reassortment and evolution in wild and domestic bird populations, as well as the role of wild bird migration in their long-range spread. The emergence of highly pathogenic avian influenza viruses, and the zoonotic incursions of avian H5 and H7 viruses into humans over the last couple of decades are also described. The threat of a new avian influenza virus causing a human pandemic is still present today, although control in domestic avian populations can minimize the risk to human health.This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.
Clinically-relevant cell type cross-talk identified from a human lung tumor microenvironment interactome
Authors: Gentles Andrew J , Hui Angela Bik-Yu , Feng Weiguo , Azizi Armon , Nair Ramesh V. , Knowles David A. , Yu Alice , Jeong Youngtae , Bejnood Alborz , Forgó Erna , Varma Sushama , Xu Yue , Kuong Amanda , Nair Viswam S. , West Rob , van de Rijn Matt , Hoang Chuong D. , Diehn Maximilian , Plevritis Sylvia K. 
Published: May 2019

ABSTRACTTumors comprise a complex microenvironment of interacting malignant and stromal cell types. Much of our understanding of the tumor microenvironment comes from in vitro studies isolating the interactions between malignant cells and a single stromal cell type, often along a single pathway. To develop a deeper understanding of the interactions between cells within human lung tumors we performed RNA-seq profiling of flow-sorted malignant cells, endothelial cells, immune cells, fibroblasts, and bulk cells from freshly resected human primary non-small-cell lung tumors. We mapped the cell-specific differential expression of prognostically-associated secreted factors and cell surface genes, and computationally reconstructed cross-talk between these cell types to generate a novel resource we call the Lung Tumor Microenvironment Interactome (LTMI). Using this resource, we identified and validated a prognostically unfavorable influence of Gremlin-1 production by fibroblasts on proliferation of malignant lung adenocarcinoma cells. We also found a prognostically favorable association between infiltration of mast cells and less aggressive tumor cell behavior. These results illustrate the utility of the LTMI as a resource for generating hypotheses concerning tumor-microenvironment interactions that may have prognostic and therapeutic relevance.SummaryRNA-seq profiling of sorted populations from primary lung cancer samples identifies prognostically relevant cross-talk between cell types in the tumor microenvironment.
Fluorescent reporters for functional analysis in rice leaves
Authors: Luginbuehl Leonie H. , El-Sharnouby Sherif , Wang Na , Hibberd Julian M. 
Published: May 2019

AbstractFluorescent reporters have facilitated non-invasive imaging in multiple plant species and thus allowed analysis of processes ranging from gene expression and protein localization through to cellular patterning. However, in rice, a globally important crop and model species, there are relatively few reports of fluorescent proteins being used in leaves. Fluorescence imaging is particularly difficult in the rice leaf blade, likely due to a high degree of light scattering in this tissue. To address this, we investigated approaches to improve deep imaging in mature rice leaf blades. We found that ClearSee treatment, which has previously been used to visualise fluorescent reporters in whole tissues of plants, led to improved imaging in rice. Removing epidermal and subtending mesophyll cell layers was faster than ClearSee, and also reduced light scattering such that imaging of fluorescent proteins in deeper leaf layers was possible. To expand the range of fluorescent proteins suitable for imaging in rice, we screened twelve whose spectral profiles spanned most of the visible spectrum. This identified five proteins, mTurquoise2, mClover3, mNeonGreen, mKOκ and tdTomato that are robustly expressed and visible in mesophyll cells of stably transformed plants. Using microparticle bombardment, we show that mTurquoise2 and mNeonGreen can be used for simultaneous multicolour imaging of different sub-cellular compartments. Overall, we conclude that mTurquoise2, mClover3, mNeonGreen, mKOκ and tdTomato are suitable for high resolution live imaging of rice leaves, both after transient and stable transformation. Along with the rapid microparticle bombardment method, which allows transient transformation of major cell types in the leaf blade, these fluorescent reporters should greatly facilitate the analysis of gene expression and cell biology in rice.One sentence summaryWe report five fluorescent reporters suitable for functional analysis in rice leaves.
Inhibition of jasmonate-mediated plant defences by the fungal metabolite higginsianin B
Authors: Dallery Jean-Félix , Zimmer Marlene , Halder Vivek , Suliman Mohamed , Pigné Sandrine , Le Goff Géraldine , Gianniou Despoina D. , Trougakos Ioannis P. , Ouazzani Jamal , Gasperini Debora , O’Connell Richard J. 
Published: May 2019

AbstractInfection of Arabidopsis thaliana by the ascomycete fungus Colletotrichum higginsianum is characterised by an early symptomless biotrophic phase followed by a destructive necrotrophic phase. The fungal genome contains 77 secondary metabolism-related biosynthetic gene clusters (BGCs), and their expression during the infection process is tightly regulated. Deleting CclA, a chromatin regulator involved in repression of some BGCs through H3K4 trimethylation, allowed overproduction of 3 families of terpenoids and isolation of 12 different molecules. These natural products were tested in combination with methyl jasmonate (MeJA), an elicitor of jasmonate responses, for their capacity to alter defence gene induction in Arabidopsis. Higginsianin B inhibited MeJA-triggered expression of the defence reporter VSP1p:GUS, suggesting it may block bioactive JA-Ile synthesis or signalling in planta. Using the JA-Ile sensor Jas9-VENUS, we found that higginsianin B, but not three other structurally-related molecules, suppressed JA-Ile signalling by preventing degradation of JAZ proteins, the repressors of JA responses. Higginsianin B likely blocks the 26S proteasome-dependent degradation of JAZ proteins because it inhibited chymotrypsin- and caspase-like protease activities. The inhibition of target degradation by higginsianin B also extended to auxin signalling, as higginsianin B treatment reduced IAA-dependent expression of DR5p:GUS. Overall, our data indicate that specific fungal secondary metabolites can act similarly to protein effectors to subvert plant immune and developmental responses.HighlightA diterpene secondary metabolite produced by a fungal pathogen suppresses plant jasmonate defense signalling by preventing the proteasomal degradation of JAZ repressor proteins.