bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Report: Enhanced Normalization of CD4/CD8 Ratio With Earlier Antiretroviral Therapy at Primary HIV Infection
Authors: Thornhill John , Inshaw Jamie , Kaleebu Pontiano , Cooper David , Ramjee Gita , Schechter Mauro , Tambussi Giuseppe , Fox Julie , Samuel Miriam , Miro Jose M. , Weber Jonathan , Porter Kholoud , Fidler Sarah ,   On behalf of UK Register of HIV Seroconverters and SPARTAC Trial Investigators
Published: April 2016

Background:
Total CD4+ T-cell counts predict HIV disease progression but do not necessarily reflect normalization of immune function. CD4/CD8 ratio is a marker of immune dysfunction, a prognostic indicator for non-AIDS mortality, and reflects viral reservoir size. Despite antiretroviral therapy (ART), recovery of CD4/CD8 ratio in chronic HIV infection is incomplete; we hypothesize enhanced CD4/CD8 ratio recovery with earlier treatment initiation in recently infected individuals.

Methods:
CD4+ count and CD4/CD8 ratio were analyzed using data from 2 cohorts: SPARTAC trial and the UK HIV Seroconverters Cohort where primary HIV infection (PHI) was defined as within 6 months from estimated date of infection. Using time-to-event methods and Cox proportional hazard models, we examined the effect of CD4/CD8 ratio at seroconversion on disease progression (CD4 <350 cells per cubic millimeter/ART initiation) and factors associated with time from ART initiation to CD4/CD8 normalization (ratio >1.0).

Findings:
Of 573 seroconverters, 482 (84%) had abnormal CD4/CD8 ratios at HIV seroconversion. Individuals with higher CD4/CD8 ratio at seroconversion were significantly less likely to reach the disease progression endpoint [adjusted hazard ratio (aHR) (95% CI) = 0.52 (0.32 to 0.82), P = 0.005]. The longer the interval between seroconversion and ART initiation [HR (95% CI) = 0.98 per month increase (0.97, 0.99), P < 0.001], the less likely the CD4/CD8 ratio normalization. ART initiation within 6 months from seroconversion was significantly more likely to normalize [HR (95% CI) = 2.47 (1.67 to 3.67), P < 0.001] than those initiating later.

Interpretation:
Most individuals presenting in PHI have abnormal CD4/CD8 ratios. The sooner the ART is initiated in PHI, the greater the probability of achieving normal CD4/CD8 ratio.
Attrition and Opportunities Along the HIV Care Continuum: Findings From a Population-Based Sample, North West Province, South Africa
Authors: Lippman Sheri A. , Shade Starley B. , El Ayadi Alison M. , Gilvydis Jennifer M. , Grignon Jessica S. , Liegler Teri , Morris Jessica , Naidoo Evasen , Prach Lisa M. , Puren Adrian , Barnhart Scott 
Published: April 2016

Background:
Attrition along the HIV care continuum slows gains in mitigating the South African HIV epidemic. Understanding population-level gaps in HIV identification, linkage, retention in care, and viral suppression is critical to target programming.

Methods:
We conducted a population-based household survey, HIV rapid testing, point-of-care CD4 testing, and viral load measurement from dried blood spots using multistage cluster sampling in 2 subdistricts of North West Province from January to March, 2014. We used weighting and multiple imputation of missing data to estimate HIV prevalence, undiagnosed infection, linkage and retention in care, medication adherence, and viral suppression.

Results:
We sampled 1044 respondents aged 18–49. HIV prevalence was 20.0% (95% confidence interval: 13.7 to 26.2) for men and 26.7% (95% confidence interval: 22.1 to 31.4) for women. Among those HIV positive, 48.4% of men and 75.7% of women were aware of their serostatus; 44.0% of men and 74.8% of women reported ever linking to HIV care; 33.1% of men and 58.4% of women were retained in care; and 21.6% of men and 50.0% of women had dried blood spots viral loads <5000 copies per milliliter. Among those already linked to care, 81.7% on antiretroviral treatment (ART) and 56.0% of those not on ART were retained in care, and 51.8% currently retained in care on ART had viral loads <5000 copies per milliliter.

Conclusions:
Despite expanded treatment in South Africa, attrition along the continuum of HIV care is slowing prevention progress. Improved detection is critically needed, particularly among men. Reported linkage and retention is reasonable for those on ART; however, failure to achieve viral suppression is worrisome.
Coronary Artery Variants and Anomalies in Patients With Bicuspid Aortic Valve
Authors: Michałowska Ilona M. , Hryniewiecki Tomasz , Kwiatek Paweł , Stokłosa Patrycjusz , Swoboda-Rydz Urszula , Szymański Piotr 
Published: April 2016

Purpose:
The aim of this study was to assess the prevalence of variants and anomalies of the coronary arteries in patients with bicuspid aortic valve (BAV) and compare it with patients with tricuspid aortic valve (TAV).

Materials and Methods:
A total of 428 patients (193 with BAV, 235 with TAV) who underwent coronary computed tomography angiography were analyzed.

Results:
The right coronary artery was dominant in 360 (84.1%) cases, including 157 (81.34%) with BAV and 203 (86.38%) with TAV. Left dominance was observed in 51 (11.9%) patients, including 30 (15.54%) with BAV 21 (8.93%) with TAV (P=0.08), and codominance in 17 (4%). The mean length of the left main coronary artery (LMCA) in patients with BAV was 10.45±6.93 versus 12.02±5.12 mm in those with TAV (P=0.008). The absence of the LMCA with separate origins of the left artery descending and the left circumflex artery was observed in 18 cases, 14/193 (7.3%) with BAV and 4/235 (1.7%) with TAV (P=0.004). The ramus intermedius was present in 50 (11.7%) patients, 29 with BAV (15%) and 21 with TAV (8.9%) (P=0.05). Coronary artery anomalies were observed in 2.1% of all patients (5/193 with BAV vs. 4/235 with TAV, P=0.5).

Conclusions:
The prevalence of anomalies of coronary arteries was similar in both groups. Patients with BAV had a higher incidence of the absence of the LMCA and the presence of the ramus intrermedius. The mean length of the LMCA in patients with BAV was shorter than in patients with TAV. There was a trend for a higher incidence of left dominance in patients with BAV compared to those with TAV, but did not reach statistical significance.
Comparison of Psychophysiological Stress in Physiotherapy Students Undertaking Simulation and Hospital-Based Clinical Education
Authors: Judd Belinda Karyn , Alison Jennifer Ailsey , Waters Donna , Gordon Christopher James 
Published: April 2016

Introduction
Simulation-based clinical education often aims to replicate varying aspects of real clinical practice. It is unknown whether learners’ stress levels in simulation are comparable with those in clinical practice. The current study compared acute stress markers during simulation-based clinical education with that experienced in situ in a hospital-based environment.

Methods
Undergraduate physiotherapy students’ (n = 33) acute stress responses [visual analog scales of stress and anxiety, continuous heart rate (HR), and saliva cortisol] were assessed during matched patient encounters in simulation-based laboratories using standardized patients and during hospital clinical placements with real patients. Group differences in stress variables were compared using repeated measures analysis of variance for 3 time points (before, during the patient encounter, and after) at 2 settings (simulation and hospital).

Results
Visual analog scale stress and anxiety as well as HR increased significantly from baseline levels before the encounter in both settings (all P < 0.05). Stress and anxiety were significantly higher in simulation [mean (SD), 45 (22) and 44 (25) mm; P = 0.003] compared with hospital [mean (SD), 31 (21) and 26 (20) mm; P = 0.002]. The mean (SD) HR during the simulation patient encounter was 90 (16) beats per minute and was not different compared with hospital [mean (SD), 87 (15) beats per minute; P = 0.89]. Changes in salivary cortisol before and after patient encounters were not statistically different between settings [mean (SD) simulation, 1.5 (2.4) nmol/L; hospital, 2.5 (2.9) nmol/L; P = 0.70].

Conclusions
Participants’ experienced stress on clinical placements, irrespective of the clinical education setting (simulation vs. hospital). This study revealed that psychological stress and anxiety were greater during simulation compared with hospital settings; however, physiological stress responses (HR and cortisol) were comparable. These results indicate that psychological stress may be heightened in simulation, and health professional educators need to consider the impact of this on learners in simulation-based clinical education. New learners in their clinical education program may benefit from a less stressful simulation environment, before a gradual increase in stress demands as they approach clinical practice.
Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships
Authors: Schlegel Claudia , Bonvin Raphael , Rethans Jan-Joost , Van der Vleuten Cees 
Published: April 2016

Introduction
The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs.

Methods
The study was conducted using a qualitative research design, with semistructured individual in-depth interviews to understand the reactions, values, and perceptions that underlie and influence SP behavior. To cover SP perspectives from more than 1 SP program, a total of 15 SPs from 8 different nursing schools and medical schools in Switzerland were asked to participate.

Results
Standardized patients feel motivated, engaged, and willing to invest effort in their task and do not mind demands increasing as long as the social environment in SP programs is supportive. The role of the SP trainer and the use of feedback are considered very important.

Conclusions
Standardized patient programs require concepts in which the SP perspective has been integrated to better serve SPs' well-being. Standardized patients are valuable partners in the training of health professionals—we need to take care of them.
Creating a Simulated Pharmacy
Authors: Soto Cory , Stiner Jamie , Noji Daniel O. , Rusheen Jeffrey M. , Huang Yue Ming 
Published: April 2016

Introduction
The acquisition and use of pharmaceuticals in simulation is a common challenge for many institutions and simulation centers. There are 2 major avenues of obtaining medications, namely, via expired drugs donated by manufacturers or via purchasing simulated medication vials filled with inactive ingredients. Neither option is ideal to keep pace with busy simulation centers or to meet the specialized requirements of many educational programs. We describe an alternative solution through internal production of simulated drugs using readily available materials from laboratory suppliers.

Methods
Serum vials, stoppers, and flip off vial caps can be purchased in 2-, 5-, 10-, and 20-mL volumes. Vials can be filled with substances such as 0.9% NaCl or table salt to mimic a variety of available injectable drugs. Labels can be produced using the free online Web application, Simulated Online Pharmaceutical Image Editor (SOPHIE) and printed on glossy adhesive photo paper for application onto completed vials.

Results
A wide range of simulated drugs, customized to the needs of each center, can be produced in an affordable and reliable manner. The appearance of the vials can be tailored for each program to meet educational objectives and enhance fidelity in simulation.

Conclusions
Low-cost production of simulated drug vials increases learning opportunities for participants to practice skills related to drug delivery and preparation. Further expansion can include nonintravenous drugs, code syringes, or reconstitution devices used for blood factors. Simulation centers should consider safety, availability, affordability, and fidelity concerns before integrating an in-house simulated pharmacy.
Optimizing the Timing of Expert Feedback During Simulation-Based Spaced Practice of Endourologic Skills
Authors: Lee Jason Young , McDougall Elspeth M. , Lineberry Matthew , Tekian Ara 
Published: April 2016

Introduction
Provision of expert feedback is widely acknowledged to be an essential component of simulation-based training. However, little is known about the most effective and efficient ways to provide feedback to novices. Optimizing the timing of expert feedback may improve outcomes while reducing resource requirements. The main objective of this study was to determine the impact of providing early versus late expert feedback to novice learners engaged in a flexible ureteroscopy (fURS) training curriculum.

Methods
Senior medical students were recruited to participate in this study. Each student participated in a comprehensive fURS training curriculum that included 3 deliberate, independent practice sessions. Baseline and postcourse fURS skill was assessed for each student using a standardized fURS test task. Each student was randomized to either an early feedback group (EFG) or late feedback group (LFG). The EFG participants were provided expert feedback immediately after the baseline skill test, whereas LFG participants were given feedback before their final deliberate, independent practice session.

Results
Eighteen senior medical students completed the study (9 EFG and 9 LFG participants). There were no discernible demographic differences between the groups at baseline. When controlling for pretest performance, early rather than late feedback was associated with both shorter postcourse time to completion of the task (19.2 vs. 21.5 minutes, P < 0.01) and higher performance scores (13.1 vs. 10.5, P < 0.01).

Conclusions
This study offers preliminary evidence that novice learners may benefit more from early feedback when learning a novel skill. Further study is required.
Transanal Endoscopic Operation for Rectal Tumor: Short-term Outcomes and Learning Curve Analysis
Authors: Hur Hyuk , Bae Sung Uk , Han Yoon Dae , Kang Jeonghyun , Min Byung Soh , Baik Seung Hyuk , Lee Kang Young , Kim Nam Kyu 
Published: April 2016

Purpose:
We aim to report outcomes and learning curve of transanal endoscopic operation (TEO) for rectal tumors, using standard laparoscopic instruments under a magnifying laparoscopic monitor view.

Materials and Methods:
From January 2012 to July 2014, local excision was performed using a TEO system in 46 consecutive patients with rectal tumors. Patient and tumor characteristics and perioperative outcomes were prospectively assessed.

Results:
The median patient age was 56 years for 15 women and 31 men. The mean tumor size was 1.8 cm, and the mean distance from the anal verge was 7.8 cm. The mean operative time was 85 minutes, and the mean postoperative hospital stay was 4.5 days. The postoperative pathologic diagnosis was adenocarcinoma for 17 patients (37%), adenoma for 4 patients (9%), carcinoid tumor for 23 patients (50%), and leiomyoma and lipoma for the 2 remaining patients (2%). A positive resection margin was documented for 4 patients (9%). No mortality was associated with the procedure although postoperative bleeding, leakage, perianal fistula, fecal incontinence, and voiding difficulty developed in 8 patients. According to the cumulative sum (CUSUM) analysis, the operation time and hospital stay significantly decreased after 17 case experiences.

Conclusions:
TEO is a feasible and safe treatment option for local excision of rectal tumors. TEO has the advantage of being a precise surgical procedure with a stable and magnifying endoscopic view. However, TEO requires a learning period and a careful selection of patients through proper indications and preoperative diagnostics.
Pessary Practices of Nurse-Providers in the United States
Authors: O’Dell Katharine , Atnip Shanna , Hooper Gwendolyn , Leung Katherine 
Published: April 2016

Objectives
Our purposes were to describe pessary-care practices and education of a sample of nurse providers in the United States and identify a cohort of high-volume providers.

Methods
An e-mail survey was sent to members of 3 related nursing professional organizations. Questions addressed general pessary care within the respondent’s practice and specific pessary care choices of responding direct providers. Data were managed using REDCap electronic data capture tools.

Results
Of 323 respondents, 279 (86.4%) reported pessary care occurred in their office settings, 84.5% of which were urban or suburban, and 65.4% were private practices. Responders were evenly distributed through 4 regions of the United States and represented a variety of specialties. Physicians and advanced practice registered nurses provided the majority of care (up to 80%), along with registered and licensed practical nurses and medical assistants. Care routines varied, most often including 3-month-interval follow-up with speculum-assisted vaginal examinations and no routine use of vaginal products (eg, moisturizers, acidifiers, antimicrobials, or vaginal estrogens). On-the-job mentoring was the primary knowledge source (64%). Comparison of practice patterns suggested possible variation by region and certification.

Conclusions
This exploratory study provides data related to the pessary-care practices of nurse providers in the United States. The range of responses emphasizes a need for evidence-based guidelines for optimal care, based on patient outcomes, satisfaction, and costs of care. Findings also illustrate a need for effective, evidence-based educational programs and clinical mentorship options with experienced providers. A cohort of expert providers was identified to continue work toward these goals.
Outcomes in 450 Women After Minimally Invasive Abdominal Sacrocolpopexy for Pelvic Organ Prolapse
Authors: Mueller Margaret G. , Jacobs Kristin M. , Mueller Elizabeth R. , Abernethy Melinda G. , Kenton Kimberly S. 
Published: April 2016

Objective
To report outcomes and complications in approximately 450 women who underwent isolated minimally invasive abdominal sacrocolpopexy (ASC) for the management of pelvic organ prolapse (POP).

Material and Methods
We retrospectively reviewed the electronic medical records of women who underwent minimally invasive ASC (laparoscopic ASC [LASC] or robotic ASC [RASC]) for symptomatic POP at Loyola University Chicago Medical Center from 2007 to 2012. Polypropylene mesh was used and the decision to reperitonealize the mesh was left to surgeon discretion. Data collected included demographics, Pelvic Floor Distress Inventory questionnaire, intraoperative and postoperative details, and POP quantification.

Results
Four hundred twenty-eight women underwent minimally invasive ASC—232 LASC and 226 RASC. Most women (86%) did not undergo reperitonealization of the mesh. Median follow-up was 13 weeks (range, 2–268 weeks) for complications and 13 weeks (range, 2–104 weeks) for anatomic outcomes.
Postoperatively, 88.6% of women had stage 0/I, 10.7% had stage II, and 2 women had stage III POP. Twelve (2.6%) underwent reoperation, 6 for POP (3 posterior repairs, 2 repeat ASC, 1 perineorrhaphy) and 6 for bowel complications. Fourteen women had postoperative bowel complications; half of which resolved with conservative treatment. There were no differences between anatomic and functional outcomes or bowel complications between LASC and RASC. Reoperation rates for bowel complications in women who underwent reperitonealization of the mesh were similar to those who did not (1.5% vs 1.0%, P = 0.86).

Conclusions
Minimally invasive ASC without concomitant vaginal repair is an effective and safe procedure for the surgical management of POP with low rates of reoperation and complications.
Long-Term Outcomes After Repair of Transurethral Perforation of Midurethral Sling
Authors: Colhoun Andrew , Rapp David E. 
Published: April 2016

Objectives
The literature lacks long-term evaluation of outcomes after repair of transurethral midurethral sling (MUS) perforation.

Methods
We prospectively followed 5 patients undergoing repair of urethral perforation (International Continence Society–International Urogynecological Association classification 4B) after MUS (mean follow-up, 54 months). Outcomes assessment was composed of validated measures of urinary (International Consultation on Incontinence Questionnaire [ICIQ]-Female Lower Urinary Tract Symptoms), vaginal (ICIQ-Vaginal Symptoms), and quality of life (Incontinence Impact Questionnaire, Short Form) symptoms.

Results
Five patients underwent MUS (4 transobturator, 1 retropubic) with a mean of 41 months before referral. Primary referring complaints composed of hematuria (2), weak stream (2), and urgency (1). All but 1 patient reported transient urinary retention requiring catheterization after initial sling placement. Each patient underwent transvaginal sling excision and repair of urethral injury. Four of 5 patients experienced persistent postoperative stress urinary incontinence. Before final assessment, further treatment included observation, physical therapy, and autologous fascial sling in 1, 2, and 2 patients, respectively. ICIQ-Female Lower Urinary Tract Symptoms, ICIQ-Vaginal Symptoms, and Incontinence Impact Questionnaire, Short Form, assessment failed to demonstrate statistically significant improvements in comparison of baseline and multiple time point (6-week, 12-month, 54-month) assessments during long-term follow-up (P > 0.05).

Conclusions
Urethral perforation represents a significant complication after MUS placement. Many patients continue to have incontinence despite the use of physical therapy/salvage sling placement. Furthermore, subjective outcomes and quality of life do not seem to improve over time. Because of the rarity of urethral perforation, our small series is notable given the absence of reported data that include prospective, long-term follow-up with validated questionnaire evaluation.
Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study
Authors: Jallad Karl , Steele Sarah E. , Barber Matthew D. 
Published: April 2016

Objective
The aim of the study was to estimate risk factors associated with breakdown of perineal laceration repair after vaginal delivery.

Methods
This is a case-control study of women who sustained a breakdown of perineal laceration repair after vaginal delivery between 2002 and 2015. Cases were patients who sustained a perineal wound breakdown after vaginal delivery and repair of a second-, third-, or fourth-degree laceration. Controls, matched 1:1, were patients who either sustained a second-, third-, or fourth-degree perineal laceration and repair without evidence of breakdown and who delivered on the same day and institution as the case.

Results
A total of 104,301 deliveries were assessed for breakdown of perineal laceration. One hundred forty-four met the inclusion criteria. These were matched with 144 controls. Logistic regression analysis demonstrated that smoking is associated with increased risk for breakdown of perineal laceration (adjusted odds ratio [adj. OR], 6.4; 95% confidence interval [CI], 1.2–38.5), whereas a previous vaginal delivery is protective (adj. OR, 0.14; 95% CI, 0.05-0.3). In addition, third- or fourth-degree laceration (adj. OR, 4.0; 95% CI, 1.1–15.7), presence of episiotomy at time of delivery (adj. OR, 11.1; 95% CI, 2.9–48.8), operative delivery (adj. OR, 3.4; 95% CI, 1.2–10.3), midwife performing the laceration repair (adj. OR, 4.7; 95% CI, 1.5–15.8), and use of chromic suture (adj. OR, 3.9; 95% CI, 1.6–9.8) were independent risk factors for breakdown of perineal laceration.

Conclusions
Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are independent risk factors for breakdown of perineal laceration repair after vaginal delivery.