bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viral Shedding and Transmission Potential of Asymptomatic and Paucisymptomatic Influenza Virus Infections in the Community
Authors: Ip Dennis K. M. , Lau Lincoln L. H. , Leung Nancy H. L. , Fang Vicky J. , Chan Kwok-Hung , Chu Daniel K. W. , Leung Gabriel M. , Peiris J. S. Malik , Uyeki Timothy M. , Cowling Benjamin J. 
Published: December 2016

Abstract

Background.
Influenza virus infections are associated with a wide spectrum of disease. However, few studies have investigated in detail the epidemiological and virological characteristics of asymptomatic and mild illness with influenza virus infections.

Methods.
In a community-based study in Hong Kong from 2008 to 2014, we followed up initially healthy individuals who were household contacts of symptomatic persons with laboratory-confirmed influenza, to identify secondary infections. Information from daily symptom diaries was used to classify infections as symptomatic (≥2 signs/symptoms, including fever ≥37.8°C, headache, myalgia, cough, sore throat, runny nose and sputum), paucisymptomatic (1 symptom only), or asymptomatic (none of these symptoms). We compared the patterns of influenza viral shedding between these groups.

Results.
We identified 235 virologically confirmed secondary cases of influenza virus infection in the household setting, including 31 (13%) paucisymptomatic and 25 (11%) asymptomatic cases. The duration of viral RNA shedding was shorter and declined more rapidly in paucisymptomatic and asymptomatic than in symptomatic cases. The mean levels of influenza viral RNA shedding in asymptomatic and paucisymptomatic cases were approximately 1–2 log10 copies lower than in symptomatic cases.

Conclusions.
The presence of influenza viral shedding in patients with influenza who have very few or no symptoms reflects their potential for transmitting the virus to close contacts. These findings suggest that further research is needed to investigate the contribution of persons with asymptomatic or clinically mild influenza virus infections to influenza virus transmission in household, institutional, and community settings.
Penile Immune Activation and Risk of HIV Shedding: A Prospective Cohort Study
Authors: Patel Eshan U. , Kirkpatrick Allison R. , Grabowski Mary Kate , Kigozi Godfrey , Gray Ronald H. , Prodger Jessica L. , Redd Andrew D. , Nalugoda Fred , Serwadda David , Wawer Maria J. , Quinn Thomas C. , Tobian Aaron A. R. 
Published: December 2016

Abstract

Background.
Genital immune activation is suspected to modulate local human immunodeficiency virus (HIV) RNA levels and the risk of sexual HIV transmission.

Methods.
A prospective, observational cohort study of 221 HIV-infected men undergoing male circumcision (MC) was conducted in Rakai, Uganda. Penile lavage samples collected from the coronal sulcus at baseline and 4 weekly visits after MC were assayed for pro-inflammatory cytokines and HIV RNA. The main analysis was limited to 175 men with detectable HIV plasma viral load (VL &gt; 400 copies/mL; n = 808 visits). The primary exposures of interest were individual and total cytokine detection at the previous postoperative visit. Adjusted prevalence risk ratios (adjPRR) of detectable HIV shedding (VL &gt; 40 copies/mL) were estimated by Poisson regression models with generalized estimating equations and robust variance estimators and included adjustment for plasma HIV VL.

Findings.
Among men with a detectable plasma VL, penile HIV shedding was detected at 136 visits (16.8%). Detectable interleukin (IL)-1β (adjPRR = 2.14; 95% confidence interval (CI) = 1.02–4.48), IL-6 (adjPRR = 2.24; 95% CI = 1.28–3.90), IL-8 (adjPRR = 2.42; 95% CI = 1.15–5.08), IL-10 (adjPRR = 2.51; 95% CI = 1.67–3.80), and IL-13 (adjPRR = 1.87; 95% CI = 1.15–3.03) were associated with penile HIV shedding at the subsequent visit. Men with 2–4 (adjPRR = 2.36; 95% CI = 1.08–5.14) and 5–7 (adjPRR = 3.00; 95% CI = 1.28–7.01) detectable cytokines had a greater likelihood of detectable penile HIV shedding at the subsequent visit, compared to men with ≤ 1 detectable cytokine. The total number of detectable cytokines was also associated with a higher penile log10 HIV VL at the subsequent visit among HIV shedders.

Interpretation.
Pro-inflammatory cytokine production had a dose-dependent and temporal association with penile HIV shedding, suggesting that genital immune activation may increase the risk of sexual HIV transmission by driving local HIV replication.
Mental models, communication, and engagement in marine projects
Authors: Boschetti Fabio , Andreotta Matthew 
Published: December 2016

AbstractIn a hypothetical decision-making situation in which a unique truth exists and each party’s aim in acquiring knowledge is to approach the truth, argumentation would be unnecessary because the best scientific theory would win the argument. Likewise, if truth is irrelevant and a perfect persuasion method is available, argumentation would also be pointless, because arguing parties, each possessing the perfect recipe, would lead a third party to switch sides endlessly. In the real world, argumentation matters because a unique truth rarely exists, information can be uncertain or vague, aims are often ambiguous if not contradictory, and acquiring knowledge can have other purposes besides approaching the truth. Marine scientists are increasingly expected to contribute to complex decision-making by providing not only scientific evidence, but also impact in the form of effective communication and persuasion. Here we review insights from different disciplines on how humans organise knowledge, beliefs, opinions, assumptions and worldviews, how these interrelate and how they affect decision-making as well as the reception of information. By focussing on the theory of mental models and the Causal Layered Analysis we also show how the structure underlying the organisation of scientific and non-scientific knowledge can be reduced to a fairly common framework. We conclude by reviewing some tools a marine scientist can employ in a stakeholder engagement process in order to better understand the audience to which scientific information needs to be delivered.
Colonization With Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy: A Systematic Review and Meta-Analysis
Authors: Alevizakos Michail , Gaitanidis Apostolos , Nasioudis Dimitrios , Tori Katerina , Flokas Myrto Eleni , Mylonakis Eleftherios 
Published: December 2016

Abstract

Background
Vancomycin-resistant enterococci (VRE) cause severe infections among patients with malignancy, and these infections are usually preceded by gastrointestinal colonization.

Methods
We searched the PubMed and EMBASE databases (up to May 26, 2016) to identify studies that reported data on VRE gastrointestinal colonization among patients with solid or hematologic malignancy.

Results
Thirty-four studies, reporting data on 8391 patients with malignancy, were included in our analysis. The pooled prevalence of VRE colonization in this population was 20% (95% confidence interval [CI], 14%–26%). Among patients with hematologic malignancy, 24% (95% CI, 16%–34%) were colonized with VRE, whereas no studies reported data solely on patients with solid malignancy. Patients with acute leukemia were at higher risk for VRE colonization (risk ratio [RR] = 1.95; 95% CI, 1.17–3.26). Vancomycin use or hospitalization within 3 months were associated with increased colonization risk (RR = 1.92, 95% CI = 1.06–3.45 and RR = 4.68, 95% CI = 1.66–13.21, respectively). Among the different geographic regions, VRE colonization rate was 21% in North America (95% CI, 13%–31%), 20% in Europe (95% CI, 9%–34%), 23% in Asia (95% CI, 13%–38%), and 4% in Oceania (95% CI, 2%–6%). More importantly, colonized patients were 24.15 (95% CI, 10.27–56.79) times more likely to develop a bloodstream infection due to VRE than noncolonized patients.

Conclusions
A substantial VRE colonization burden exists among patients with malignancy, and colonization greatly increases the risk for subsequent VRE bloodstream infection. Adherence to antimicrobial stewardship is needed, and a re-evaluation of the use of vancomycin as empiric therapy in this patient population may be warranted.
The Impact of an Academy of Medical Educators on the Culture of an American Health Sciences Campus
Authors: Corral Janet , Guiton Gretchen , Aagaard Eva 
Published: December 2016

Purpose
During the last two decades in the United States, academies of medical educators (AMEs) have proliferated as formal organizations within faculties of health professions education to recognize teaching excellence, support faculty development, and encourage scholarly activity. AMEs have been effective at rewarding faculty for educational excellence and providing faculty development. However, the impact of an AME on campus culture remains unclear.

Method
A qualitative case study asked, How has an AME shaped organizational culture? The authors investigated the University of Colorado health sciences campus AME given its clear mandate to impact organizational culture. The authors interviewed a purposeful sample of 26 AME members and non-AME campus faculty and educational leaders during the 2014–2015 academic year. Two reviewers employed content analysis to code the transcripts.

Results
The AME has positively impacted organizational culture by being a symbol of institutional commitment to the educational mission, and by asserting education as an evidence-based practice. At the faculty member level, the AME’s impact includes creating a home and community for educators to network. Individual faculty influence departments and programs across campus through teaching and interpersonal connections. However, the AME has not impacted all of campus, due to only reaching self-identified educators, and the siloed nature of departments on campus.

Conclusions
Although limited to a single campus and an early established AME, this study contributes significant insight by describing how an AME as a structural unit impacts individual faculty members, who in turn impact organizational campus culture regarding the educational mission.
Determining Optimal Route of Hysterectomy for Benign Indications
Authors: Schmitt Jennifer J. , Carranza Leon Daniel A. , Occhino John A. , Weaver Amy L. , Dowdy Sean C. , Bakkum-Gamez Jamie N. , Pasupathy Kalyan S. , Gebhart John B. 
Published: December 2016

OBJECTIVE:
To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.

METHODS:
A retrospective postrobot cohort of benign hysterectomies (2009–2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded the laparoscopic hysterectomy route. A prerobot cohort (2004–2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated.

RESULTS:
Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the prerobot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the postrobot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%) robot-assisted; and 136 (11.4%) abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when a vaginal approach was expected. Robotic hysterectomies had longer operations (141 compared with 59 minutes, P<.001) and higher rates of surgical site infection (4.7% compared with 0.2%, P<.001) and urinary tract infection (8.1% compared with 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years.

CONCLUSION:
When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible.
Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs
Authors: Hofler Lisa G. , Cordes Sarah , Cwiak Carrie A. , Goedken Peggy , Jamieson Denise J. , Kottke Melissa 
Published: December 2016

OBJECTIVE:
To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program.

METHODS:
This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences.

RESULTS:
At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.

CONCLUSION:
Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.
Maternal Morbidity After Previable Prelabor Rupture of Membranes
Authors: Dotters-Katz Sarah K. , Panzer Alexis , Grace Matthew R. , Smid Marcela C. , Keku J. Adeolu , Vladutiu Catherine J. , Boggess Kim A. , Manuck Tracy A. 
Published: December 2016

OBJECTIVE:
To identify risk factors for maternal morbidity after previable prelabor rupture of membranes (PROM).

METHODS:
We conducted a case–control study of singleton and twin pregnancies complicated by previable PROM (14.0–22.9 weeks of gestation) at a single tertiary care referral institution, 2000–2015. Pregnancies complicated by fetal anomalies, previable PROM within 2 weeks of chorionic villus sampling or amniocentesis, and those with contraindications to expectant management (eg, chorioamnionitis) were excluded. Cases were women with the primary outcome of composite maternal morbidity (defined as having at one or more of the following: sepsis, intensive care unit admission, acute renal insufficiency, uterine curettage, hysterectomy, deep vein thrombosis, pulmonary embolus, blood transfusion, readmission, or maternal death). Controls were women without the primary composite morbidity. Bivariate analysis compared demographic, clinical, and management characteristics of women in the case group and those in the control group. Multivariable logistic regression models were developed to quantify the association between maternal characteristics and composite severe maternal morbidity.

RESULTS:
During the study period, 174 women presented with by previable PROM and were candidates for expectant management. Sixty-five (37%) women opted for immediate delivery; 109 (63%) elected expectant management. Twenty-five of 174 (14%) experienced one or more components of the composite maternal morbidity (cases) and were compared with 149 (86%) women in the control group. Women in the case group were more not more likely to elect expectant management (68% compared with 59%, P=.40), but were more likely to be aged 35 years or older (40% compared with 14%, P=.002) or to be carrying twins (52% compared with 16%, P<.01). In the regression model, twin gestation and age 35 years or older were both significantly associated with increased odds of composite maternal morbidity (odds ratio [OR] 5.62, 95% confidence interval [CI] 2.21–14.3 and OR 4.00, 95% CI 1.48–10.8, respectively).

CONCLUSION:
Antenatal counseling of women with previable PROM should include that one in seven women experience significant morbidity. Although expectant management was not associated with increased risk in this cohort, women with twins or those aged 35 years or older were at substantially increased risk.
Avoiding Radical Surgery in Elderly Patients With Rectal Cancer Is Cost-Effective
Authors: Rao Christopher , Sun Myint Arthur , Athanasiou Thanos , Faiz Omar , Martin Antony Paul , Collins Brendan , Smith Fraser McLean 
Published: December 2016

BACKGROUND:
Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes.

OBJECTIVE:
The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy.

DESIGN:
Decision analytical modeling and a Markov simulation were used to model long-term costs, quality-adjusted life-years, and cost-effectiveness after watch and wait and radical surgery. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters.

SETTINGS:
A third-party payer perspective was adopted.

PATIENTS:
Patients included in the study were a 60-year–old male cohort with no comorbidities, 80-year–old male cohorts with no comorbidities, and 80-year–old male cohorts with significant comorbidities.

INTERVENTIONS:
Radical surgery and watch-and-wait approaches were studied.

MAIN OUTCOME MEASURES:
Incremental cost, effectiveness, and cost-effectiveness ratio over the entire lifetime of the hypothetical patient cohorts were measured.

RESULTS:
Watch and wait was more effective (60-year–old male cohort with no comorbidities = 0.63 quality-adjusted life-years (95% CI, 2.48–3.65 quality-adjusted life-years); 80-year–old male cohort with no comorbidities = 0.56 quality-adjusted life-years (95% CI, 0.52–1.59 quality-adjusted life-years); 80-year–old male cohort with significant comorbidities = 0.72 quality-adjusted life-years (95% CI, 0.34–1.76 quality-adjusted life-years)) and less costly (60-year–old male cohort with no comorbidities = $11,332.35 (95% CI, $668.50–$23,970.20); 80-year–old male cohort with no comorbidities = $8783.93 (95% CI, $2504.26–$21,900.66); 80-year–old male cohort with significant comorbidities = $10,206.01 (95% CI, $2762.014–$24,135.31)) independent of patient cohort age and comorbidity. Consequently, watch and wait was more cost-effective with a high degree of certainty (range, 69.6%–89.2%) at a threshold of $50,000/quality-adjusted life-year.

LIMITATIONS:
Long-term outcomes were derived from modeled cohorts. Analysis was performed for a United Kingdom third-party payer perspective, limiting generalizability to other healthcare contexts.

CONCLUSIONS:
Watch and wait is likely to be cost-effective compared with radical surgery. These findings strongly support the discussion of organ-preserving strategies with suitable patients.
Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest
Authors: Wells Katerina O. , Hawkins Alexander T. , Krishnamurthy Devi M. , Dharmarajan Sekhar , Glasgow Sean C. , Hunt Steven R. , Mutch Matthew G. , Wise Paul , Silviera Matthew L. 
Published: December 2016

BACKGROUND:
Adjuvant chemotherapy for T3N0 colon cancer is controversial. National guidelines recommend its use in patients with stage II with high-risk features, including lymph node harvest of less than 12, yet this treatment is underused.

OBJECTIVE:
The purpose of this study was to demonstrate that the use of adjuvant chemotherapy in patients with T3N0 adenocarcinoma with inadequate lymph node harvest is beneficial.

DESIGN:
This was a retrospective population-based study of patients with resected T3N0 adenocarcinoma of the colon.

SETTINGS:
The National Cancer Database was queried from 2003 to 2012.

PATIENTS:
A total of 134,567 patients with T3N0 colon cancer were included in this analysis.

MAIN OUTCOME MEASURES:
The use of chemotherapy, short-term outcomes, and overall survival was evaluated. Clinicopathologic factors associated with omission of chemotherapy were also analyzed.

RESULTS:
Inadequate lymph node harvest was observed in 23.3% of patients, and this rate decreased over the study period from 46.8% in 2003 to 12.5% in 2012 (p < 0.0001). Overall 5-year survival for patients with T3N0 cancer was 66.8%. Inadequate lymph node harvest among these patients was associated with lower overall 5-year survival (58.7% vs 69.8%; p < 0.001). The use of adjuvant chemotherapy among patients with T3N0 cancer after inadequate lymph node harvest was only 16.7%. In a multivariable analysis, factors associated with failure to receive chemotherapy included advanced age (OR = 0.44 (95% CI, 0.43–0.45)), increased comorbidities (OR = 0.7 (95% CI, 0.66–0.76)), and postoperative readmission (OR = 0.78 (95% CI, 0.67–0.91)). Patients with inadequate lymph node harvest who received adjuvant chemotherapy had improved 5-year survival (chemotherapy, 78.4% vs no chemotherapy, 54.7%; p < 0.001). Even when controlling for all of the significant variables, the administration of chemotherapy remained a predictor of decreased mortality (HR = 0.57 (95% CI, 0.54–0.60); p < 0.001).

LIMITATIONS:
This study was limited by its retrospective, population-based design.

CONCLUSIONS:
Patients with T3N0 colon cancer with inadequate lymph node harvest who receive adjuvant chemotherapy have increased overall survival. Despite this survival benefit, a fraction of these patients receive adjuvant chemotherapy. Barriers to chemotherapy are multifactorial.