bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predisposition of Wingless Subgroup Medulloblastoma for Primary Tumor Hemorrhage
Authors: Reisinger Dominik , Gojo Johannes , Kasprian Gregor , Haberler Christine , Peyrl Andreas , Azizi Amedeo A , Mayr Lisa , Chocholous Monika , Kool Marcel , Czech Thomas , Slavc Irene 
Published: April 2019

Abstract

BACKGROUND
Primary intratumoral hemorrhage as a presenting sign is rare in children with medulloblastomas but may result in severe complications. Given the distinct properties of molecular medulloblastoma subgroups, the impact on neurosurgical practice has still to be defined.

OBJECTIVE
To investigate both clinical and radiological presentation of intratumoral hemorrhage in medulloblastoma patients in the context of molecular subgroups.

METHODS
Data of all consecutive medulloblastoma patients treated at our institution between 1993 and 2018 (n = 104) were retrospectively reviewed in respect of clinical and radiological presentation as well as molecular subgroups. For cases with available tumor tissue (n = 86), subgroups were assigned by either 450 K methylation array or immunohistochemistry and CTNNB1 sequencing. Available imaging at diagnosis (n = 62) was reviewed by an experienced neuroradiologist.

RESULTS
Within the entire cohort, 4 patients (4%) presented with massive spontaneous hemorrhage. Although no patient died as a direct consequence of hemorrhage, all suffered from serious sequelae. Moreover, 3 additional patients displayed radiological evidence of significant hemorrhage. Interestingly, all 7 cases belonged to the wingless (WNT) subgroup (n = 13), resulting in intratumoral hemorrhage in 54% (7/13) of pediatric WNT medulloblastomas. In contrast, significant hemorrhage was absent in all other molecular subgroups.

CONCLUSION
Our results suggest that a substantial proportion of pediatric WNT medulloblastomas display significant intratumoral hemorrhage at the time of diagnosis. Consequently, the presence of significant hemorrhage in fourth ventricle childhood tumors is suggestive of WNT medulloblastoma and should lead to a less aggressive attempt for total resection in this prognostically favorable tumor type.
Role of plant protein in nutrition, wellness, and health
Authors: Ahnen Rylee T , Jonnalagadda Satya S , Slavin Joanne L 
Published: April 2019

AbstractPlant-based diets, and more specifically plant-based proteins, have been the subject of growing interest from researchers and consumers because of their potential health benefits as well as their positive environmental impact. Of course, plant proteins are found in plant foods, and positive health benefits of plant foods are linked to dietary fiber, vitamins, minerals, and phytochemicals. In epidemiological studies it is not possible to separate out the health benefits of plant foods in general as opposed to plant proteins specifically. Additionally, few vegans, who consume only plant-based proteins, are included in existing prospective cohort studies. Isolated plant proteins (soy, pea) have been used in intervention trials, but often to improve biomarkers linked to disease risk, including serum lipids or blood pressure. This review is an overview of plant proteins, the whole foods they are associated with, and the potential health benefits linked to consumption of protein from plant sources. Plant proteins and their potential for reducing the risk of developing metabolic syndrome, diabetes management, cancer prevention, and weight management are each discussed, as are the various rating systems currently used to determine protein quality from plant sources. Although additional research is needed that focuses specifically on the role that plant protein plays in the prevention and management of these chronic illnesses, rather than the role played by a more general plant-based diet, evidence suggests that plant proteins offer nutritional benefits to those who consume them. Limitations to plant proteins, including lower protein quality, must also be considered in this discussion.
Using Machine Learning and the Electronic Health Record to Predict Complicated Clostridium difficile Infection
Authors: Li Benjamin Y , Oh Jeeheh , Young Vincent B , Rao Krishna , Wiens Jenna 
Published: April 2019

Abstract

Background
Clostridium (Clostridioides) difficile infection (CDI) is a health care–associated infection that can lead to serious complications. Potential complications include intensive care unit (ICU) admission, development of toxic megacolon, need for colectomy, and death. However, identifying the patients most likely to develop complicated CDI is challenging. To this end, we explored the utility of a machine learning (ML) approach for patient risk stratification for complications using electronic health record (EHR) data.

Methods
We considered adult patients diagnosed with CDI between October 2010 and January 2013 at the University of Michigan hospitals. Cases were labeled complicated if the infection resulted in ICU admission, colectomy, or 30-day mortality. Leveraging EHR data, we trained a model to predict subsequent complications on each of the 3 days after diagnosis. We compared our EHR-based model to one based on a small set of manually curated features. We evaluated model performance using a held-out data set in terms of the area under the receiver operating characteristic curve (AUROC).

Results
Of 1118 cases of CDI, 8% became complicated. On the day of diagnosis, the model achieved an AUROC of 0.69 (95% confidence interval [CI], 0.55–0.83). Using data extracted 2 days after CDI diagnosis, performance increased (AUROC, 0.90; 95% CI, 0.83–0.95), outperforming a model based on a curated set of features (AUROC, 0.84; 95% CI, 0.75–0.91).

Conclusions
Using EHR data, we can accurately stratify CDI cases according to their risk of developing complications. Such an approach could be used to guide future clinical studies investigating interventions that could prevent or mitigate complicated CDI.
Measuring inequality
Authors: McGregor Thomas , Smith Brock , Wills Samuel 
Published: April 2019

AbstractInequality is important, both for its own sake and for its political, social, and economic implications. However, measuring inequality is not straightforward, as it requires decisions to be made on the variable, population, and distributional characteristics of interest. These decisions will naturally influence the conclusions that are drawn so they must be closely linked to an underlying purpose, which is ultimately defined by a social welfare function. This paper outlines important considerations when making each of these decisions, before surveying recent advances in measuring inequality and suggesting avenues for future work.
Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Acute Hospitalization: Randomized Clinical Trial Protocol
Authors: Falvey Jason R , Mangione Kathleen K , Nordon-Craft Amy , Cumbler Ethan , Burrows Kristine L , Forster Jeri E , Stevens-Lapsley Jennifer E 
Published: April 2019

Abstract

Background
Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined.

Objective
The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy.

Design
This will be a 2-arm randomized controlled clinical trial.

Setting
The setting will be participant homes.

Participants
A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate.

Intervention
Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions.

Measurements
Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel.

Limitations
The limitation is an inability to blind treating therapists to study allocation.

Conclusions
The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings.
SURVEY OF INDOOR RADON LEVELS IN SOME UNIVERSITIES IN SOUTH WESTERN NIGERIA
Authors: Ajayi Oladele Samuel , Owoola Eunice Oluwabunmi , Olubi Omodele Emmanuel , Dike Chidiebere Goodluck 
Published: April 2019

Abstract
Indoor radon investigation was carried out in offices of three university campuses located in South-Western part of Nigeria; Federal University of Technology Akure (FUTA), Ekiti State University (EKSU) and Federal University Oye-Ekiti (FUOYE) using CR39 detectors. The mean activity concentration of indoor radon for the investigated offices of all three university campuses was estimated to be 222 ± 44 Bq m−3, which was below the reference level of 300 Bq m−3 recommended by the International Commission on Radiological Protection (ICRP 115). For the three institutions, the probability of lung cancer induction at age 70 years with respect to age of exposure (40, 50, and 60 years) ranged between 1.06 × 10−7 and 6.24 × 10−5. The expected mortality rate due to exposure to a radon activity concentration ranging from 7 to 1358 Bq m−3 was estimated to range from 0 to 44 deaths among a population of 10,000 persons.
Prevalence and incidence of narcolepsy in a US health care claims database, 2008–2010
Authors: Scheer Darren , Schwartz Skai W , Parr Maria , Zgibor Janice , Sanchez-Anguiano Aurora , Rajaram Lakshminarayan 
Published: April 2019

AbstractStudy ObjectivesTo determine the prevalence and incidence of narcolepsy using a large US health care claims database.MethodsThe Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 years with continuous enrollment for years 2008–2010. THMCDD contains health claims information for more than 18 million people. Prevalence was expressed as cases/100 000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with multiple sleep latency test [MSLT], and the diagnosis) was expressed as new cases/100 000 persons/year.ResultsThere were 8 444 517 continuously enrolled patients and 6703 diagnosed with narcolepsy (prevalence overall: 79.4/100 000; without cataplexy: 65.4/100 000; with cataplexy: 14.0/100 000). On the basis of the three definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100 000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21–30 years age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central United States had the highest prevalence and incidence, whereas the West was the lowest.ConclusionWe found greater prevalence and incidence of narcolepsy (including without cataplexy) than most previous studies. The increased proportions in females, enrollees in their early 20s, and US regional differences require further study. Increased awareness and early identification is critical in the management of this burdensome condition.
Auto positive airway pressure therapy reduces pulmonary pressures in adults admitted for acute heart failure with pulmonary hypertension and obstructive sleep apnea. The ASAP-HF Pilot Trial
Authors: Sharma Sunil , Fox Henrik , Aguilar Francisco , Mukhtar Umer , Willes Leslee , Bozorgnia Benham , Bitter Thomas , Oldenburg Olaf 
Published: April 2019

AbstractObjectivesPulmonary hypertension (PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA), highly prevalent in congestive heart failure patients, may contribute to further elevated pulmonary pressures. This study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.MethodsA two-center randomized control trial comparing standard of care (SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.ResultsTwenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48-hour PAP therapy protocol. In the intervention arm, the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was −15.8 ± 3.2 (58.6 ± 2.5 mm Hg to 42.8 ± 2.7) versus the SOC arm where the mean PASP difference was −5.2 ± 2.6 (62.7 ± 3.3 mm Hg reduced to 57.5 ± 3.9) (p = 0.025). In addition, ejection fraction in the intervention arm improved (3.4 ± 1.5% versus −0.5 ± 0.5 %) (p = 0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic area in the intervention arm but not in NT-pro-BNP or 6-minute walk distance.ConclusionsIn patients with ADHF and OSA, addition of 48 hours of PAP therapy to SOC treatment significantly reduced PH. In addition, PAP therapy was able to improve right and left ventricular function.ClinicalTrials.gov identifier: NCT02963597.
Calciphylaxis: Diagnosis, Pathogenesis, and Treatment
Authors: Chang John J. 
Published: April 2019

ABSTRACT
Calciphylaxis is a cutaneous ischemic infarct caused by total occlusion of blood vessels initiated by vascular calcification. Until recently, treatments have been limited to controlling its risk factors and optimizing wound care. However, recent advances in clinical understanding of the mechanism of calciphylaxis have identified promising potential therapeutic targets. This article is a narrative review summarizing the clinical features, diagnosis, pathogenesis, and treatment of calciphylaxis.

GENERAL PURPOSE
To provide information on the pathogenesis, clinical features, diagnosis, and treatment of calciphylaxis.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant should be better able to:
1. Recognize the pathogenesis and clinical features of and risk factors for calciphylaxis.
2. Explain the diagnosis and management of a patient with calciphylaxis.
Professionals’ Knowledge, Attitudes, and Practices Related to Pressure Injuries in Canada
Authors: LeBlanc Kimberly , Woo Kevin , Bassett Katie , Botros Mariam 
Published: April 2019

ABSTRACT

BACKGROUND:
Pressure injuries (PIs) represent a significant burden on the healthcare system and have a negative impact on the quality of life of those affected by these wounds. Despite best practice guidelines and other protocols to help healthcare facilities prevent PIs, the prevalence of PIs in Canada across all healthcare settings is concerning.

OBJECTIVE:
To describe the pattern of PI prevention and identify national priorities and opportunities to address PIs.

METHODS:
A descriptive, cross-sectional, online survey was created between August and December 2017 to explore Canadian healthcare professionals’ knowledge, attitudes, and practices related to PIs.

RESULTS:
In total, 590 surveys were completed. Eighty-five percent of respondents confirmed that PIs occur in their work environments, and 29% claimed PIs are a frequent occurrence. Most of the respondents (91%) confirmed that they were part of a team that treats PIs. Of the 590 participants, 90% confirmed that they are aware of PI prevention devices and technologies. Between 80% and 90% attest to using offloading devices including prophylactic dressings to prevent PIs, but only 20% instituted measures to address moisture-associated skin damage.

CONCLUSIONS:
The findings from this survey have highlighted a disconnect between Canadian healthcare professionals’ awareness of PIs and the implementation of best practices for PI prevention. It is evident that, although the majority of respondents were aware of PIs and related treatment protocols, barriers still exist that impede optimized care and treatment.
A Histologic Perspective on Electrical and Thermal Burn-Injured Human Skin
Authors: Pielesz Anna , Gawłowski Andrzej , Biniaś Dorota , Bobiński Rafał , Kawecki Marek , Sama Ewa , Waksmańska Wioletta 
Published: April 2019

ABSTRACT

OBJECTIVE:
To analyze specific spectroscopic (FT-Raman) and thermal (limiting oxygen index) aspects of skin samples exposed to electrical injury compared with thermal injury.

METHODS:
An observational case-control study was conducted at the Dr Stanislaw Sakiel Center for Burns Treatment in Siemianowice, Silesia, Poland. A scanning electron microscope was used to diagnose and illustrate the topography of skin samples from electrical and thermal burns and the morphologic effects on damaged versus undamaged skin surfaces. In particular, researchers attempted to detect spectroscopic and thermal changes at the molecular level, namely, specific biomarkers of tissue degeneration and their regeneration under the influence of the applied modifiers (antioxidants and orthosilicic acid solutions).

RESULTS:
Modification with l-ascorbic acid and hydrogel of orthosilicic acid caused an increase in the intensity of the amide I Raman peaks, whereas modification with sodium ascorbate and orthosilicic acid resulted in the separation of the band protein side chains (1,440–1,448 cm−1), which is a part of tissue regeneration. The best result was obtained when the skin was treated with 7% orthosilicic acid (limiting oxygen index, 26%).

CONCLUSIONS:
Antioxidant treatment may be advantageous in minimizing injury in patients with thermal burns but not always in electrical burns.
Where Do You Think You Are? A Grounded Theory Study of the Critical Factors Triggering the Existence and Fueling the Persistence of Incivility in Nursing
Authors: Samson-Mojares Roselle Ann , Chin Claudette R. , Colvin Mary K. , Umadhay Tony 
Published: April 2019

Abstract

BACKGROUND
Incivility in health care settings was first identified in 1976. The Institute of Medicine has called for a safer health care environment, and the Joint Commission emphasizes that disruptive behavior compromises patient safety. Incivility in nursing is a topic of interest, yet it had not been explored as a social process.

AIM
The purpose of this study was to acquire an understanding and develop a theory to address incivility in nursing.

METHOD
Twenty-nine RNs were interviewed based on Charmaz’s constructionist grounded theory.

RESULTS
Four categories emerged (neglecting, alienating, relinquishing, and finding oneself) that developed into the theory of self-positioning.

CONCLUSION
To understand incivility in nursing, one must, immersed within the institution, profession, and society, find and position the self. It is only then that we can address the health and well-being of RNs, provide quality care, and ensure patient safety.
Sharing clinical notes with patients
Authors: Adelman Deborah S. , Fant Catherine , Conner Debbie Nogueras 
Published: April 2019

Abstract:
This article outlines a research project conducted to learn more about NPs' attitudes regarding sharing clinical notes with patients through a patient portal. Perceptions were positive overall. To achieve effective health outcomes, patient and family engagement is essential. Shared clinical notes provide an opportunity to achieve these goals.
Associations Between Physical Activity and Chronic Pain Severity in Youth With Chronic Abdominal Pain
Authors: Kichline Tiffany , Cushing Christopher C. , Ortega Adrian , Friesen Craig , Schurman Jennifer V. 
Published: April 2019

Objectives:
The present study aimed to: (1) better understand physical activity levels in youth with chronic abdominal pain and (2) investigate the relationship between day-level physical activity related to next day pain intensity to identify any intraindividual heterogeneity.

Methods:
Seventy-one youth (M=13.34 y, SD=2.67 y) with chronic abdominal pain provided reports of pain severity and continuous objective reports of sedentary behavior, moderate-to-vigorous physical activity (MVPA), and total sleep time using accelerometers over 14 days.

Results:
Findings revealed that youth with chronic abdominal pain do not meet recommended levels of MVPA per day (M=34.64 min, SD=33.31 min). Further, results indicated a random effect of the previous day’s MVPA predicting pain severity. There was a small significant negative effect of within-person total sleep time as a predictor of pain severity.

Discussion:
The current study highlights the importance of separating between-person and within-person differences when examining the relationship between physical activity and pain severity. Future studies should explore moderating factors that may help to explain random effects to better understand the types of individuals with positive or negative relationships between physical activity and pain severity.
Complications of Postoperative Epidural Analgesia For Oncologic Surgery
Authors: Su Jackson , Soliz Jose M. , Popat Keyuri U. , Gebhardt Rodolfo 
Published: April 2019

Objective:
The risks of epidural analgesia (EA) differ depending on the population studied. We describe our experience with postoperative EA for oncologic surgery.

Materials and Methods:
We searched our Acute Pain Medicine database for cases in which postoperative EA was used between 2003 and 2012. We used word search to identify and catalog cases of neurological changes, magnetic resonance imaging or computed tomography of the spine, electromyography studies, and neurologist or neurosurgeon consultations. Medical records of patients with documented persistent neurological deficits and patients who had spine imaging or neurology consultations were reviewed further. In addition, we cross-checked medical records with billing diagnosis codes for spinal epidural abscess or hematoma.

Results:
We reviewed 18,895 cases in which postoperative EA was used. Complications included neurological symptoms in 2436 cases (12.9%), epidural insertion site abnormalities in 1062 cases (5.6%), complete epidural catheter migration in 829 cases (4.4%), epidural replacement in 619 cases (3.3%), and inadvertent dura puncture in 322 cases (1.7%). There were 6 cases of persistent deficits of uncertain etiology, 4 deep spinal infections (1:4724), and 2 cases of catheter tip shearing. No spinal epidural hematomas were identified (95% confidence interval, 0-0.0002).

Discussion:
Our findings provide a contemporary review of some risks associated with the use of postoperative EA for patients undergoing oncologic surgery. Despite a not-uncommon incidence of neurological changes, serious complications resulting in prolonged sequelae were rare.