bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Kidney Function Associated With Daily Tenofovir Disoproxil Fumarate/Emtricitabine for HIV Preexposure Prophylaxis Use in the United States Demonstration Project
Authors: Tang Eric C. , Vittinghoff Eric , Anderson Peter L. , Cohen Stephanie E. , Doblecki-Lewis Susanne , Bacon Oliver , Coleman Megan E. , Buchbinder Susan P. , Chege Wairimu , Kolber Michael A. , Elion Richard , Shlipak Michael , Liu Albert Y. 
Published: October 2017

Background:
HIV preexposure prophylaxis (PrEP) using daily oral tenofovir-disoproxil-fumarate/emtricitabine (TDF/FTC) is effective for preventing HIV acquisition, but concerns remain about its potential kidney toxicity. This study examined kidney function in individuals using PrEP in real-world clinical settings.

Setting:
Demonstration project in 2 sexually transmitted infection clinics and a community health center.

Methods:
We evaluated kidney function among men who have sex with men and transgender women taking tenofovir-disoproxil-fumarate/emtricitabine PrEP for up to 48 weeks. Serum creatinine and urine dipstick for protein were obtained at 12-week intervals. Kidney function was estimated using creatinine clearance (CrCl) (Cockcroft–Gault) and estimated glomerular filtration rate (eGFR) (CKD-EPI).

Results:
From October 2012 to January 2014, we enrolled 557 participants (median age 33). Mean creatinine increased from baseline to week 12 by 0.03 mg/dL (4.6%) (P < 0.0001); mean CrCl decreased by 4.8 mL/min (3.0%) (P < 0.0001). These changes remained stable through week 48 (P = 0.81, P = 0.71 respectively). There were 75/478 (15.7%) participants who developed worsening proteinuria at week 12 compared with baseline (P < 0.0001), and this percent remained stable through week 48 (P = 0.73). Twenty-five participants (5.1%) developed new-onset eGFR <70 mL/min/1.73 m2; independent predictors of this outcome were age ≥40 years (OR 3.79, 95% CI: 1.43 to 10.03) and baseline eGFR <90 mL/min/1.73 m2 (OR 9.59, 3.69–24.94).

Conclusions:
In a demonstration setting, daily tenofovir-disoproxil-fumarate/emtricitabine PrEP leads to reduced CrCl and eGFR; however, these eGFR changes are based on very small changes in serum creatinine and seem to be nonprogressive after the first 12 weeks. Future studies are needed to understand the prognostic significance of these small changes.
Predictors of HIV, HIV Risk Perception, and HIV Worry Among Adolescent Girls and Young Women in Lilongwe, Malawi
Authors: Price Joan T. , Rosenberg Nora E. , Vansia Dhrutika , Phanga Twambilile , Bhushan Nivedita L. , Maseko Bertha , Brar Savvy K. , Hosseinipour Mina C. , Tang Jennifer H. , Bekker Linda-Gail , Pettifor Audrey 
Published: October 2017

Background:
Adolescent girls and young women (AGYW) in sub-Saharan Africa have high HIV prevalence and incidence. We sought to understand which HIV risk factors individually and in combination contribute to risk, and whether these factors are associated with HIV worry and risk perception.

Setting:
This study is ongoing at 4 public health centers in Lilongwe, Malawi (2016–2017).

Methods:
AGYW of 15–24 years old were recruited to participate in a study assessing 4 models of service delivery. At each health center, participants completed a baseline survey assessing socioeconomic, behavioral, biomedical, and partnership characteristics; self-reported HIV status; and, if HIV-uninfected, HIV risk perception (high versus low or none) and HIV worry (any versus none). We analyzed associations between baseline characteristics and HIV prevalence, risk perception, and worry.

Results:
Among 1000 AGYW, median age was 19 years (IQR: 17–21). Thirty-three participants reported being HIV-infected. Fifteen characteristics were associated with HIV infection. Having more risk factors was associated with higher HIV prevalence (≤4 factors, 0.5%; 5–8 factors, 6%; >8 factors, 21%). Having more risk factors was also associated with higher risk perception (P < 0.001) and higher worry (P < 0.001). However, among those with ≥8 risk factors, 52% did not consider themselves to be at high risk and 21% did not report any HIV worry.

Conclusions:
Most AGYW perceive little risk of HIV acquisition, even those at highest risk. As a critical gap in the HIV prevention cascade, accurate risk perception is needed to tailor effective and sustained combination prevention strategies for this vulnerable population.
Using Discrete-Event Simulation to Promote Quality Improvement and Efficiency in a Radiation Oncology Treatment Center
Authors: Famiglietti Robin M. , Norboge Emily C. , Boving Valentine , Langabeer James R. , Buchholz Thomas A. , Mikhail Osama 
Published: October 2017

Background:
To meet demand for radiation oncology services and ensure patient-centered safe care, management in an academic radiation oncology department initiated quality improvement efforts using discrete-event simulation (DES). Although the long-term goal was testing and deploying solutions, the primary aim at the outset was characterizing and validating a computer simulation model of existing operations to identify targets for improvement.

Methods:
The adoption and validation of a DES model of processes and procedures affecting patient flow and satisfaction, employee experience, and efficiency were undertaken in 2012-2013. Multiple sources were tapped for data, including direct observation, equipment logs, timekeeping, and electronic health records.

Results:
During their treatment visits, patients averaged 50.4 minutes in the treatment center, of which 38% was spent in the treatment room. Patients with appointments between 10 am and 2 pm experienced the longest delays before entering the treatment room, and those in the clinic in the day's first and last hours, the shortest (<5 minutes). Despite staffed for 14.5 hours daily, the clinic registered only 20% of patients after 2:30 pm. Utilization of equipment averaged 58%, and utilization of staff, 56%.

Conclusion:
The DES modeling quantified operations, identifying evidence-based targets for next-phase remediation and providing data to justify initiatives.
The Affordable Care Act and Its Effects on Physician Leadership: A Qualitative Systematic Review
Authors: Sterbenz Jennifer M. , Chung Kevin C. 
Published: October 2017

Objectives:
The Affordable Care Act (ACA) shifted the focus in medical care from quantity to quality. This qualitative systematic review aimed to determine the key skills necessary for effective physician leaders after the implementation of the ACA, and to compare them with key skills identified prior to its implementation.

Methods:
A qualitative systematic review was conducted. A systematic literature search on leadership skills for physicians returned 26 articles published between 2009 and 2016. Thematic analysis was used to categorize the data presented in each article. The results from the thematic analysis were then compared with a similar article published before the implementation of the ACA.

Results:
Teamwork and team-building, communication, and self-awareness skills were mentioned most often. The percentage of articles mentioning teamwork and team-building skills (61.5%) was significantly greater than the percentage (25%) reported before the implementation of the ACA (P ≤ .04).

Conclusion:
With the shift toward quality of patient care, health care workers at all levels should strive to work as a team to provide the best quality of care at all stages of patient care.
Does Hospital Size Affect Patient Satisfaction?
Authors: McFarland Daniel C. , Shen Megan Johnson , Parker Patricia , Meyerson Sandra , Holcombe Randall F. 
Published: October 2017

Background:
Centers for Medicare & Medicaid Services reimbursement is now contingent on quality measures such as patient satisfaction as determined by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In providing patient-centered care that is guided by patient satisfaction measures, it is critical to understand system-level factors that may influence how patients assess their care experiences. One important system-level influence to consider is hospital size.

Methods:
HCAHPS scores, number of hospital beds, and nursing magnet status were obtained from publically available Hospital Compare, American Hospital Directory, and Magnet Hospitals Web sites, respectively. An aggregate score for patient satisfaction was created across all domains of the HCAHPS. Multilevel regression modeling was performed to examine the associations between hospital size and HCAHPS aggregate and individual dimensions.

Results:
Hospital size was significantly associated with patient satisfaction such that larger size was associated with lower satisfaction (β = −.312, P < .001). Hospital size was most strongly associated with less patient satisfaction on the following HCAHPS items: “receiving help as soon as needed” (β = −.441, P < .001), “room and bathroom cleanliness” (β = −.286, P < .001), and doctor communication (β = −.213, P < .001), whereas nurse communication (β = .194, P < .001) was the one modifiable dimension that was associated with more favorable ratings in larger hospitals. Magnet nursing designation was significantly associated with larger hospital size (P < .001).

Conclusion:
Patient satisfaction scores may be lower in large hospitals because of patients' perceptions of hospital cleanliness, receiving help on time, and doctor communication. Focusing on improving these factors may improve patient satisfaction scores for larger hospitals.
Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians
Authors: Gan Tianyi , Zhang Yuhui , Liu Nini , Huang Yuhui , Liang Tuo , Zhao Xuemei , Zhang Jian 
Published: October 2017

Objective:
We investigated the current level of knowledge of Chinese heart failure (HF) guidelines among physicians, as a reference for the promotion and transformation of HF knowledge.

Methods and Results:
Physicians from 88 hospitals in 27 provinces of China completed our survey between July and December 2014. The questions covered the main points included in the Chinese HF diagnosis and treatment guidelines (2014). A total of 2146 physicians, aged 20 to 62 years (35.6 ± 7.6 years), completed the survey. The correctness rate of their answers to the 15 multiple-choice questions in the HF questionnaire was generally low (mean 32.6%). The mean correctness rate for 10 blank-filling questions about the target doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and β-blockers was 42.5%. On the basis of their responses, physicians whose knowledge of the guidelines was “excellent,” “good,” “medium,” and “bad” accounted for 1.1%, 11.4%, 14.2%, and 73.4%, respectively. Physicians who possessed a higher level of qualifications had significantly greater awareness of HF guidelines than those with relatively low qualifications (P < .001). A statistically significant association was found between hospital level and adherence to treatment guidelines (P < .001). A significant difference was also observed among physicians in different practice scopes (P < .001).

Conclusions:
The survey found an obvious deficiency in physicians' mastery of fundamental knowledge about HF. There is a need to improve physicians' education about HF in China.
Management of Traumatic Brain Injury in the Emergency Department: Guideline Adherence and Patient Safety
Authors: Vedin Tomas , Edelhamre Marcus , Karlsson Mathias , Bergenheim Michael , Larsson Per-Anders 
Published: October 2017

Background:
Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low.

Aim:
To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines.

Methods:
Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months.

Results:
A total of 694 patients were registered at the emergency department. A total of 161 questionnaires were analyzed; 50.9% did not use guidelines, 39% before intermission, and 60.5% after. When Canadian CT Head Rule was applied, 30.4% of patients with no loss of consciousness were referred to computed tomography, violating guideline recommendation.

Conclusion:
Guidelines are designed to improve performance but are not always applied correctly or as frequently as intended. Information and education did not increase guideline adherence. To improve guideline adherence, more innovative measures than formal guidelines must be undertaken. To find out what these measures are, we suggest qualitative studies to elucidate interventions that will have bigger impact on performance.
Clinically Acceptable Optimized Dose Reduction in Computed Tomographic Imaging of Necrotizing Pancreatitis Using a Noise Addition Software Tool
Authors: Jaffe Tracy A. , Tian Xiaoyu , Bashir Mustafa R. , Marin Daniele , Patel Bhavik N. , Ho Lisa M. , Samei Ehsan 
Published: October 2017

Objective
This study aimed to determine potential radiation dose reduction of contrast-enhanced computed tomography (CECT) for imaging necrotizing pancreatitis (NP) using a noise addition tool.

Methods
Eighty-four patients were identified with at least 1 abdominopelvic CECT for NP within a 2-year period. Sixty consecutive scans were selected as reference radiation dose data sets. A noise addition software was used to simulate 4 data sets of increased noise. Readers rated confidence for identifying (i) anatomic structures, (ii) complications of NP, and (iii) diagnostic acceptability. Noise and dose levels were identified at acceptability threshold where observer scores were statistically indistinguishable from full-dose computed tomographies.

Results
Observers' perception of image tasks decreased progressively with increasing noise (P < 0.05). Acceptability and statistical analysis indicated that noise can be increased from 10 to 25 HU corresponding to an 84% reduction in dose without change in observer perception (P < 0.05).

Conclusions
Higher image noise levels may be tolerated in CECT in patients with NP.
Vertical Maxillary Measurements using a Virtual External Reference Point in Orthognathic Surgery: Technical Innovation
Authors: Espinosa S Sebastián 
Published: October 2017

Abstract
It is extremely important to achieve vertical position of the upper jaw in orthognathic surgery. A common method used is measuring distances at surgery using external reference points. Unfortunately, surgeons have been making mistakes when calculating the goal distance of our external reference systems. A possible explanation is that when the author measure the baseline and goal vertical distances, the author usually do not consider the variations produced by the triangulation effect generated due the horizontal or/and transverse movements of the maxilla. A method is proposed to fix this phenomenon in an easy way through the virtual customization of the ERP in computer-assisted surgical simulation. The technique entails creating, in the planning software, the same reference system one will use at surgery. In this virtual system, one measures the difference between the baseline and target distances, and then uses them at surgery.
A Novel Presentation of Bladder Mass: Self-palpation by a Patient With Cystocele
Authors: Feloney Michael , Wu Jocelyn A. , Brush Thomas , Dietz Nick 
Published: October 2017

Introduction
This case describes diagnosis of a T2 transitional cell carcinoma in an 89-year-old woman with known cystocele and urinary retention managed with clean intermittent self-catheterization.

Case
While self-catheterizing, the patient noted a palpable mass in her cystocele. She eventually pursued urologic evaluation of this mass, which ultimately led to her diagnosis. This is the first reported case of transitional cell carcinoma being found on self-examination by palpating a cystocele.
Gut Permeability and Glucose Absorption Are Affected at Early Stages of Graft Rejection in a Small Bowel Transplant Rat Model
Authors: Stringa Pablo , Romanin David , Lausada Natalia , Papa Gobbi Rodrigo , Zanuzzi Carolina , Martín Pedro , Abate Juan Cruz , Cabanne Ana , Arnal Nathalie , Vecchio Leandro , Milesi Verónica , Portiansky Enrique , Gondolesi Gabriel , Rumbo Martin 
Published: October 2017

Background
Intestinal transplantation (ITx) faces many challenges due to the complexity of surgery and to the multiple immunological reactions that lead to the necessity of rigorous follow-up for early detection of acute cellular rejection (ACR). Our aim was to determine the kinetics of ACR using an experimental ITx model, with emphasis in the characterization of the process using different approaches, including the use of functional assays of absorptive and barrier function.

Methods
ITx in rats conducting serial sampling was performed. Clinical monitoring, graft histology, proinflammatory gene expression, and nitrosative stress determination were performed. Also, glucose absorption, barrier function using ovalbumin translocation, and contractile function were analyzed.

Results
The model used reproduced the different stages of ACR. Allogeneic ITx recipients showed signs of rejection from postoperative day (POD) 5, with increasing severity until 12 POD. Histological evaluation showed mild rejection in early sampling and severe rejection at late stages, with alterations in all graft layers. IL-6, CXCL 10, IFNg, and nitrite plasmas levels showed behavior coincident with histopathology. Remarkably, allogeneic grafts showed a marked alteration of glucose absorptive capacity from POD 5 that was sustained until endpoint. Coincidently, barrier function alteration was evidenced by luminal ovalbumin translocation to serum. Contractile function was progressively impaired along ACR.

Conclusions
Glucose absorption and barrier function are altered at early stages of ACR when histological alterations or gene expression changes were much subtle. This observation may provide simple evaluation tools that could be eventually translated to the clinics to contribute to early ACR diagnosis.
Hypothesis: Potential Utility of Serum and Urine Uromodulin Measurement in Kidney Transplant Recipients?
Authors: Bostom Andrew G. , Steubl Dominik , Friedman Allon N. 
Published: October 2017

Abstract
Seventy years after its discovery, studies of the myriad properties, and potential disease associations of uromodulin are now burgeoning. Although normative ranges for serum/plasma uromodulin concentrations were established over 30 years ago, their external validation occurred only in very recent, larger studies. As tubular function indices, serum and urinary uromodulin may be more sensitive indicators of kidney graft dysfunction undetected by glomerular filtration markers, or proteinuria. Moreover, 2 sizable, just published longitudinal reports revealed that lower serum uromodulin levels were associated with cardiovascular disease (CVD) outcomes, total mortality, and infectious disease deaths, in patients with known or suspected coronary heart disease. Preliminary longitudinal studies have reported that reduced levels of plasma or serum uromodulin were linked to progression to end-stage renal disease in chronic kidney disease patients, and graft failure in kidney transplant recipients (KTRs). Conflicting data on the associations, or lack thereof, between lower urinary uromodulin concentrations and accelerated loss of renal function, or renal failure, in nontransplant chronic kidney disease patients, are perhaps due, in part, to analytical limitations in determining urine uromodulin. Potential longitudinal associations between serum and urinary uromodulin concentrations, and CVD outcomes, graft failure, and all-cause mortality, await validation in large, diverse cohorts of chronic KTRs. Taking advantage of an efficient case-cohort design scheme, we demonstrate how the completed FAVORIT clinical trial cohort might be ideally suited to evaluate these associations. Using available case-cohort sample data, statistical power simulations are provided to detect relative risk estimates of 1.50 for CVD (n = 309 events), 1.56 for graft failure (n = 223 events) or 1.50 for death from any cause (n = 320 events), comparing values below the median, to values equal to or above the median for serum uromodulin values. Edifying data such as these would advance our understanding of the hypothetical utility of uromodulin measurement in KTRs considerably.
Adapting the Surgical Apgar Score for Perioperative Outcome Prediction in Liver Transplantation: A Retrospective Study
Authors: Pearson Amy C. S. , Subramanian Arun , Schroeder Darrell R. , Findlay James Y. 
Published: October 2017

Background
The surgical Apgar score (SAS) is a 10-point scale using the lowest heart rate, lowest mean arterial pressure, and estimated blood loss (EBL) during surgery to predict postoperative outcomes. The SAS has not yet been validated in liver transplantation patients, because typical blood loss usually exceeds the highest EBL category. Our primary aim was to develop a modified SAS for liver transplant (SAS-LT) by replacing the EBL parameter with volume of red cells transfused. We hypothesized that the SAS-LT would predict death or severe complication within 30 days of transplant with similar accuracy to current scoring systems.

Methods
A retrospective cohort of consecutive liver transplantations from July 2007 to November 2013 was used to develop the SAS-LT. The predictive ability of SAS-LT for early postoperative outcomes was compared with Model for End-stage Liver Disease, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation III scores using multivariable logistic regression and receiver operating characteristic analysis.

Results
Of 628 transplants, death or serious perioperative morbidity occurred in 105 (16.7%). The SAS-LT (receiver operating characteristic area under the curve [AUC], 0.57) had similar predictive ability to Acute Physiology and Chronic Health Evaluation III, model for end-stage liver disease, and Sequential Organ Failure Assessment scores (0.57, 0.56, and 0.61, respectively).
Seventy-nine (12.6%) patients were discharged from the ICU in 24 hours or less. These patients’ SAS-LT scores were significantly higher than those with a longer stay (7.0 vs 6.2, P < 0.01). The AUC on multivariable modeling remained predictive of early ICU discharge (AUC, 0.67).

Conclusions
The SAS-LT utilized simple intraoperative metrics to predict early morbidity and mortality after liver transplant with similar accuracy to other scoring systems at an earlier postoperative time point.
Five-Year-Old Boy With Behavioral Changes and Papilledema
Authors: Ram Radha , Jones Jeremy Y. , Mohila Carrie A. , Shah Veeral S. 
Published: October 2017

Abstract:
A 5-year-old boy had initial symptoms of behavioral changes, nausea, vomiting, headache, weight loss, and progressive vision failure. Brain MRI revealed abnormal signal intensity in both optic nerves, the optic chiasm, the right medial temporal lobe, and tissues surrounding the right supraclinoid internal carotid artery with associated leptomeningeal and spinal cord enhancement. After nondiagnostic dural and spinal arachnoid biopsies, a temporal lobe biopsy was diagnostic for a rare malignant peripheral nerve sheath tumor.