bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State
Authors: Montgomery Madeline C. , Raifman Julia , Nunn Amy S. , Bertrand Thomas , Uvin A. Ziggy , Marak Theodore , Comella Jaime , Almonte Alexi , Chan Philip A. 
Published: February 2017

Background
In Rhode Island, the Patient Protection and Affordable Care Act has led to over 95% of the state's population being insured. We evaluated insurance coverage and barriers to insurance use among patients presenting for services at the Rhode Island sexually transmitted disease (STD) clinic.

Methods
We analyzed factors associated with insurance coverage and utilization among patients presenting for STD services between July and December 2015.

Results
A total of 692 patients had insurance information available; of those, 40% were uninsured. Patients without insurance were more likely than those with insurance to be nonwhite (50% among uninsured, compared with 40% among insured; P = 0.014) and Hispanic or Latino/a (25%, compared with 16%; P = 0.006), and less likely to be men who have sex with men (27%, compared with 39%; P = 0.001). Of those with health insurance, 26% obtained coverage as a result of the Affordable Care Act, and 56% of those were previously uninsured. Among uninsured individuals, barriers to obtaining health insurance included cost and unemployment. Among those with insurance, 43% reported willingness to use insurance for STD services. Barriers to insurance use included concerns about anonymity and out-of-pocket costs.

Conclusions
Despite expanded insurance access, many individuals presenting to the Rhode Island STD Clinic were uninsured. Among those who were insured, significant barriers still existed to using insurance. STD clinics continue to play an important role in providing safety-net STD services in states with low uninsured rates. Both public and private insurers are needed to address financial barriers and optimize payment structures for services.
Suicides by Jumping Off Istanbul Bridges Linking Asia and Europe
Authors: Yurtseven Ayşe , Üzün İbrahim , Arslan Murat Nihat 
Published: February 2017

Aim
The aim of this study was to determine the injury spectrum and characteristics of people who committed suicide by jumping into water from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridges in Istanbul, Turkey.

Methods
This study included all of the jumpers from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridge who were autopsied by the Council of Forensic Medicine, Istanbul Morgue Department, between 2000 and 2013. All of the data were collected from archived case files. Trauma scores were calculated from the traumatic findings of the autopsy reports using the New Injury Severity Score (NISS).

Results
A total of 80 jumping suicides were identified. The male-to-female ratio was 9:1, and the mean age was 34.06 ± 9.6 years. Most suicides occurred in 2009. The suicide rates were higher in the winter, particularly in December. The most frequent injuries were skin lesions, rib fractures, and lung lacerations. In 12% of the cases, the trauma was minor (NISS range, 0–14; mean, 7 ± 5.67), and in 88% of the cases, it was major (NISS range, 17–66; mean NISS, 44.5 ± 12.46).

Conclusion
The sociodemographic features of the jumpers who committed suicide were quite similar to those reported in previous studies. Preventative measures (installation of barriers or banning pedestrian access to bridges) reduced the suicide rate but were not completely effective. Establishing early warning systems and rescue strategies could save the lives of jumpers who have minor trauma.
Validating Fall Prevention Icons to Support Patient-Centered Education
Authors: Leung Wai Yin , Adelman Jason , Bates David W. , Businger Alexandra , Dykes John S. , Ergai Awatef , Hurley Ann , Katsulis Zachary , Khorasani Sarah , Scanlan Maureen , Schenkel Laura , Rai Amisha , Dykes Patricia C. 
Published: February 2017

Introduction
Falls with injury are the most prevalent hospital adverse event. The objective of this project was to refine fall risk and prevention icons for a patient-centric bedside toolkit to promote patient and nurse engagement in accurately assessing fall risks and developing a tailored fall prevention plan.

Methods
Eighty-eight patients and 60 nurses from 2 academic medical centers participated in 4 iterations of testing to refine 6 fall risk and 10 fall prevention icons. During individual interviews, participants rated their satisfaction with the degree to which that icon represented the concept on a 4-point Likert scale, enabling computation of a Content Validity Index (CVI), and provided comments and suggestions for improvement. After reviewing CVI scores and feedback, the research team consulted with the illustrator to revise the icons.

Results
Content Validity Index scores improved after icon modifications. Icons that depicted multiple concepts required further iterations to be acceptable.

Discussion
Using icons to depict an accurate and easy-to-interpret fall risk assessment and intervention plan for all care team members including patients and family to follow should lead to improved adherence with that plan and decreased falls.

Conclusions
All 16 icons were refined and used to form the basis for a bedside fall prevention toolkit.
Suicide and Suicide Attempts on Hospital Grounds and Clinic Areas
Authors: Mills Peter D. , Watts Bradley V. , Hemphill Robin R. 
Published: February 2017

Objectives
The goal of this study was to describe suicide and suicide attempts that occurred while the patient was on hospital grounds, common spaces, and clinic areas using root cause analysis (RCA) reports of these events in a national health care organization in the United States.

Method
This is an observational review of all RCA reports of suicide and suicide attempts on hospital grounds, common spaces, and clinic areas in our system between December 1, 1999, and December 31, 2014. Each RCA report was coded for the location of the event, method of self-harm, if the event resulted in a death by suicide, and root causes.

Results
We found 47 RCA reports of suicide and suicide attempts occurring on hospital grounds, common spaces, or clinic areas. The most common methods were gunshot, overdose, cutting, and jumping, and we have seen an increase in these events since 2011. The primary root causes were breakdowns in communication, the need for improved psychiatric and medical treatment of suicidal patients, and problems with the physical environment.

Conclusions
Hospital staff should evaluate the environment for suicide hazards, consider prohibiting firearms, assist patients with no appointments, and promote good communication about high-risk patients.
Essential and Nonessential Blood Testing in the Clinical Teaching Unit
Authors: Sherren Cody , Day Andrew , Ilan Roy 
Published: February 2017

Objectives
The aim of the study was to evaluate the essential and nonessential blood tests ordered on the internal medicine clinical teaching units (CTUs) at Kingston General Hospital. Our aim was to establish a baseline performance measure identifying appropriate use of laboratory tests that could be used to inform improvement over time.

Methods
For an 8-week period, 14 CTU attending physicians at Kingston General Hospital were surveyed. They were asked for each of their patients, “What blood tests do you consider to be essential for tomorrow morning to maintain appropriate care for this patient?” The following day, blood tests that were ordered were compared with the “essential” list previously given by the attending physicians.

Results
Of 291 processed blood tests, 148 (51%) had not been considered essential by attending physicians; of the 203 tests considered essential, 60 (30%) were not ordered. Total agreement between “essential” and processed tests was poor (κ = 0.51; confidence interval, 0.45–0.56).

Conclusions
Inadequate use of blood tests for CTU patients is common. Quality improvement initiatives should aim to address the lack of observed consensus between attending physicians' views and the ordered tests and to streamline decision-making and the ordering/communication processes. Clinical standards and guidelines regarding ordering of laboratory tests should be clearly defined.
Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review
Authors: Schnock Kumiko O. , Biggs Bonnie , Fladger Anne , Bates David W. , Rozenblum Ronen 
Published: February 2017

Background
Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated.

Objective
Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety.

Methods
A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000–2016). Relevant articles were selected and reviewed by 4 researchers.

Results
After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow.

Conclusions
Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.
The Role of the Surgeon on Outcomes of Vaginal Prolapse Surgery With Mesh
Authors: Eilber Karyn S. , Alperin Marianna , Khan Aqsa , Wu Ning , Pashos Chris L. , Clemens J. Quentin , Anger Jennifer T. 
Published: February 2017

Introduction
Adverse outcomes after surgery for pelvic organ prolapse (POP) with mesh are often attributed to the mesh material with little attention paid to the influence of surgeon factors. We used a national data set to determine whether surgeon case volume and specialty influenced vaginal prolapse surgery outcomes with mesh.

Materials and Methods
Public Use File data on a 5% random national sample of female Medicare beneficiaries were obtained from the Centers for Medicare and Medicaid Services. Women with a diagnosis of POP who underwent surgery with mesh between 2007 and 2008 were identified by relevant International Classification of Diseases, 9th Revision, Clinical Modification and Current Procedural Terminology, 4th Edition procedure codes. Outcomes were compared by surgeon case volume and specialty.

Results
From 2007 to 2008, 1657 surgeries for POP were performed with mesh. Low-, intermediate-, and high-volume surgeons performed 881 (53%), 408 (25%), and 368 (22%) of the cases with mesh, respectively. The cumulative reoperation rates for low-, intermediate-, and high-volume providers were 6%, 2%, and 3%, respectively. The difference in reoperation rates between low and intermediate and low- and high-volume surgeons was statistically significant (P = 0.007 and 0.003, respectively). There was no significant difference in reoperation rates between gynecologists and urologists when vaginal mesh was implanted for POP surgery.

Conclusions
Low-volume surgeons performed most of the vaginal prolapse repairs with mesh and had significantly higher reoperation rates. Surgeon experience must be a consideration when reporting mesh-related complications of POP surgery.
Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction
Authors: Zoorob Dani , Higgins Margaret , Swan Kimberly , Cummings Jennifer , Dominguez Sarah , Carey Erin 
Published: February 2017

Objective
Chronic pelvic pain is a prevalent and debilitating condition with a wide range of etiologies. An estimated 30% to 70% of chronic pelvic cases involve musculoskeletal component pain including high-tone pelvic floor dysfunction (HTPFD). Pelvic floor physical therapy has been shown to be a beneficial treatment for HTPFD, yet many patients do not have access to this treatment. The objective of this study was to identify the barriers preventing patients from following through with the first-line management, physical therapy.

Methods
Participants with a diagnosis of HTPFD (n = 154) were identified from the list of referrals sent from the obstetrics and gynecology department to an affiliated PFPT center. Participants were contacted and asked to complete a phone survey addressing demographics and perceived barriers to care. Responses were collected in REDCap. Univariate and bivariate analyses were performed using a statistical analysis software.

Results
Seventy surveys were completed. The top barriers identified by participants were financial constraints (51.4%), perceived lack of utility (37.1%), time constraints (30.0%), and travel issues (18.6%); 84.4% of participants had 1 or more comorbid pain condition. Whereas 51.4% expressed some level of anxiety regarding the PFPT option, only 9.6% of participants did not start treatment because of fear of treatment.

Conclusions
The majority of treatment barriers identified were concrete restraints, with insurance noncoverage and time constraints being the top issues. A fair number of participants expressed anxiety about the treatment or felt they received unclear explanations of the treatment. These are areas in which providers can potentially alleviate some barriers to care.
Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study
Authors: Milani Rodolfo , Frigerio Matteo , Cola Alice , Beretta Carlo , Spelzini Federico , Manodoro Stefano 
Published: February 2017

Background
Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse.

Objectives
There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment. Our aim was to evaluate complications, anatomical, functional and subjective outcomes of high USL suspension for primary prolapse repair.

Methods
Data of patients who underwent vaginal hysterectomy followed by high USL suspension for pelvic organ prolapse were retrospectively analyzed. Operative data, as well as complications, were recorded. Anatomical recurrence was defined as descent of any compartment stage II or greater according to the Pelvic Organ Prolapse Quantification system. Functional outcomes focused on urinary, bowel, and sexual dysfunctions. International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, Wexner, and Patient Global Impression of Improvement questionnaires were collected.

Results
Data of 533 women were analyzed. Mean follow-up was 32 (SD, 19) months (dropout rate, 2.6%). Most frequent complication was ureteral kinking (2.6%). Total recurrence rate was 13.7%, with anterior compartment being the most frequent (9.4%), whereas reoperation for symptomatic prolapse recurrence was required in only 1% of patients. Improvement of urinary incontinence, voiding dysfunction, constipation, and dyspareunia was observed. Overall subjective satisfaction was high (Patient Global Impression of Improvement score, 1.3), ranging from “much improved” to “very much improved.”

Conclusions
Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and reoperation rate for recurrence was only 1%.
Autoimmune encephalitis in children: clinical phenomenology, therapeutics, and emerging challenges
Authors: Dale Russell C. , Gorman Mark P. , Lim Ming 
Published: February 2017

Purpose of review
Auto-antibodies that bind to conformational extracellular epitopes of neuronal receptors or synaptic proteins have provided clinicians with essential biomarkers in acute neurology. This review summarizes the current status and challenges in the field.

Recent findings
In children, anti-N-methyl-D-aspartate receptor encephalitis remains the most identifiable autoimmune encephalitis, although many patients have a clinical syndrome of brain inflammation in which no antibodies are identified. Anti-myelin oligodendrocyte glycoprotein antibody associated demyelination is now recognized as a major cause of monophasic and relapsing demyelination, often presenting with encephalopathy. We discuss the importance of auto-antibody detection methodology and the possible influence of intrathecal antibody synthesis on the speed of recovery and response to immune therapy. The current, often pragmatic rather than evidence-based therapeutic pathway will be discussed, highlighting key challenges such as the timing of second-line therapy, monitoring of disease activity, and identifying the patient who is responding poorly to treatment.

Summary
Although there have been significant developments, future priorities include the need for paediatric-specific consensus definitions for seronegative suspected autoimmune encephalitis, novel tools for monitoring patients with autoimmune encephalitis, consensus treatment recommendations, and neuroprotective strategies.
Detecting synaptic autoantibodies in psychoses: need for more sensitive methods
Authors: Masdeu Joseph C. 
Published: February 2017

Purpose of review
Schizophrenic psychosis affects near 1% of the population. It typically starts in the first three decades of life, leading most often to chronic disability: antipsychotic treatment is palliative, not curative. The neurobiological abnormalities underlying psychoses are likely to differ across patients, ranging from autosomal dominant genetic disease to substance abuse, but a decreased function of the N-methyl-D-aspartate (NMDA) receptor seems to be a common theme. Emerging evidence suggests that decreased NMDA receptor function may be caused by auto-antibodies against this receptor in some patients currently being diagnosed as having schizophrenia.

Recent findings
Studies searching for antibodies against the NMDA receptor in the sera of patients with schizophrenia have been either negative or found them in a very small minority of patients. Furthermore, similar antibodies have been detected in the general population. From these findings, however, it cannot be concluded that relevant auto-antibodies are not responsible for a subgroup of psychoses. Shortcomings in current antibody detection methodology may be responsible for the negative studies.

Summary
Given the high probability that a considerable proportion of patients with psychosis may have auto-antibodies not detectable with current methods and therefore harbour a potentially treatable disease, research to increase antibody detection sensitivity is urgently needed.
Locomotion induces stimulus-specific response enhancement in adult visual cortex
Authors: Kaneko Megumi , Fu Yu , Stryker Michael P. 
Published: February 2017

SUMMARYThe responses of neurons in the visual cortex (V1) of adult mammals have long been thought to be stable over long periods. Here, we investigated whether repeated exposure to specific stimuli would enhance V1 visual responses in mice using intrinsic signal imaging through the intact skull and two-photon imaging of calcium signals in single neurons. Mice ran on Styrofoam balls floating on air while viewing one of three different, high-contrast visual stimuli. V1 responses to the stimuli that were viewed by the animal were specifically enhanced, while responses to other stimuli were unaffected. Similar exposure in stationary mice, or in mice in which NMDA receptors were partially blocked, did not significantly enhance responses. These findings indicate that stimulus-specific plasticity in the adult visual cortex depends on concurrent locomotion, presumably as a result of the high-gain state of visual cortex induced by locomotion.Significance StatementWe report a rapid and persistent increase in visual cortical responses to visual stimuli presented during locomotion in intact mice. We first used a method that is completely non-invasive, intrinsic signal imaging through the intact skull. We then measured the same effects on single neurons using 2-photon calcium imaging and found that the increase in response to a particular stimulus produced by locomotion depends on how well the neuron is initially driven by the stimulus. To our knowledge, this is the first time such enhancement has been described in single neurons or using non-invasive measurements.
mTORC1 in AGRP neurons integrates exteroceptive and interoceptive food-related cues in the modulation of adaptive energy expenditure in mice
Authors: Burke Luke K , Darwish Tamana , Cavanaugh Althea R , Virtue Sam , Roth Emma , Moro Joanna , Liu Shun-Mei , Xia Jing , Dalley Jeffrey W. , Burling Keith , Chua Streamson , Vidal-Puig Toni , Schwartz Gary J , Blouet Clémence 
Published: February 2017

AbstractEnergy dissipation through interscapular brown adipose tissue (iBAT) thermogenesis is an important contributor to adaptive energy expenditure. However, it remains unresolved how acute and chronic changes in energy availability are detected by the brain to adjust iBAT activity and maintain energy homeostasis. Here we provide evidence that AGRP inhibitory tone to iBAT represents an energy-sparing circuit that integrates environmental food cues and internal signals of energy availability. We establish a role for the nutrient-sensing mTORC1 signaling pathway within AGRP neurons in the detection of environmental food cues and internal signals of energy availability, and in the bi-directional control of iBAT thermogenesis during nutrient deficiency and excess. Collectively, our findings provide insights into how mTORC1 signaling within AGRP neurons surveys energy availability to engage iBAT thermogenesis, and identify AGRP neurons as a neuronal substrate for the coordination of energy intake and adaptive expenditure under varying physiological and environmental contexts.