bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syndromic Panel Testing Among Patients With Infectious Diarrhea: The Challenge of Interpreting Clostridioides difficile Positivity on a Multiplex Molecular Panel
Authors: Pender Melissa , Throneberry S Kyle , Grisel Nancy , Leung Daniel T , Lopansri Bert K 
Published: April 2023

Abstract

Background
Including Clostridioides difficile (CD) in gastrointestinal multiplex molecular panels (GIPCR) presents a diagnostic challenge. Incidental detection by polymerase chain reaction (PCR) without consideration of pretest probability (PTP) may inadvertently delay diagnoses of other treatable causes of diarrhea and lead to prescription of unnecessary antibiotics.

Methods
We conducted a retrospective study to determine the frequency at which clinicians characterize PTP and disease severity in adult patients who test positive for CD by GIPCR. We organized subjects into cohorts based on the status of their CD PCR, glutamate dehydrogenase enzyme immunoassay (GDH), and toxin A/B detection, as well as by high, moderate, or low CD PTP. We used multivariable regression models to describe predictors of toxin positivity.

Results
We identified 483 patients with positive CD PCR targets. Only 22% were positive for both GDH and CD toxin. Among patients with a low PTP for CDI, 11% demonstrated a positive CD toxin result compared to 63% of patients with a high PTP. A low clinician PTP for CD infection (CDI) correlated with a negative CD toxin result compared to cases of moderate-to-high PTP for CDI (odds ratio, 0.19 [95% confidence interval, .10–.36]). Up to 64% of patients with negative GDH and CD toxin received CD treatment. Only receipt of prior antibiotics, fever, and a moderate-to-high clinician PTP were statistically significant predictors of toxin positivity.

Conclusions
Patients with a positive CD PCR were likely to receive treatment regardless of PTP or CD toxin results. We recommend that CD positivity on GIPCR be interpreted with caution, particularly in the setting of a low PTP.
Approaching COVID-19 as an Environmental Ethical Problem: A Perspective from African Relational Animal Ethics
Authors: Chemhuru Munamato 
Published: April 2023

Abstract
After the discovery of the origins of the new coronavirus disease 2019 (COVID-19) to be possibly wet markets in Wuhan, China, the normative questions of what ought to be the ethical relations between human beings and non-human animals have started to attract renewed interest among environmentalists. Although these are not new questions in environmental philosophy, the impact of COVID-19 across the world is challenging human beings to seriously reconsider some of these often-neglected questions. In this article, I examine COVID-19 as essentially an environmental ethical challenge. Specifically, I consider the extent to which the relationships between human and non-human animals can effectively impact the health and lives of humanity and the environment at large. I then provide some alternative ways by which human beings ought to re-think their relationships with non-human animals to avoid future catastrophes like COVID-19. I argue that the African view of animal ethics could at least provide a valuable lens through which to view correct relations between human beings and non-human animals. Ultimately, I set forth and defend an African environmental ethic for the right relations between human beings and animals and to show how such an ethic better places humanity in confronting future zoonoses.
Responding to the Injustice of Climate Change
Authors: Dwyer James 
Published: April 2023

Abstract
Climate change continues to have profound impacts on people’s health, lives and life prospects. For the most part, people who are at highest risk from the impacts of climate change have contributed very little to the problem. This is the crux of the injustice. After I discuss the risks and contributions associated with the injustice of climate change, I turn to the issue of responsiveness: of why and how people should respond to this injustice. I avoid discussions of legal liability and focus more attention on the need to take political action to change social structures and habits. However, I realize how political engagement can prove to be ineffective, burdensome and dangerous. So in the last section, I say more about the reasons and changes that limit the effectiveness of political engagement. I suggest how we might change both the perception and practice of politics. At the end, I note two issues that I have not addressed in this limited article.
Beliefs of rheumatologists and general practitioners on urate lowering therapy: a cross-sectional study
Authors: Veenstra Frouwke , Vriezekolk Johanna E , van den Bemt Bart J F , Schers Henk J , Sloot Bart , van den Ende Cornelia H M , van Herwaarden Noortje , Flendrie Marcel 
Published: April 2023

Abstract

Objective
To describe beliefs of physicians and patients in primary and secondary care about urate-lowering therapy (ULT), to examine differences in physicians’ medication beliefs and to examine the association of physicians’ medication beliefs with the prescribed dosage of ULT, gout outcomes and patients’ medication beliefs.

Methods
We conducted a cross-sectional study among rheumatologists and general practitioners (GPs) and their patients using ULT in The Netherlands. All participants filled out the Beliefs About Medication Questionnaire (BMQ). Demographics of physicians were collected through questionnaires. Patient and disease characteristics were collected through questionnaires and electronic medical records. Differences between rheumatologists and GPs in the BMQ subscales Necessity and Concern and the necessity–concern difference (NCD) score were analysed by two-sample t-tests. Multilevel analyses were performed to examine the association of physicians’ BMQ scores with the prescribed dosage of ULT, gout outcomes (number of gout flares, serum urate) and patients’ BMQ scores.

Results
A total of 28 rheumatologists, 443 rheumatology patients, 45 GPs and 294 GP patients were included. The mean NCD scores were 7.1 (s.d. 3.6), 4.0 (s.d. 4.0), and 4.2 (s.d. 5.0) for rheumatologists, GPs and patients, respectively. Rheumatologists scored higher on necessity beliefs [mean difference 1.4 (95% CI 0.0, 2.8)] and lower on concern beliefs [mean difference −1.7 (95% CI −2.7, −0.7)] compared with GPs. No associations between physicians’ beliefs and prescribed dosage of ULT, gout outcomes or patients’ beliefs were found.

Conclusion
Rheumatologists had higher necessity and lower ULT concern beliefs compared with GPs and patients. Physicians’ beliefs were not related to prescribed ULT dosage and patient outcomes. The role of physicians’ beliefs in gout management in patients using ULT seems limited. Future qualitative research can provide more insights into physicians’ views of gout management.
Et Tu, Brute? Unraveling the puzzle of deception and broken trust in close relations
Authors: Shulman David , Grayson Kent 
Published: April 2023

Abstract
Embeddedness theory and relational work theory propose that people in close social relations naturally have better information about partners, which helps safeguard and optimize their relationships. Yet, researchers have noted that despite access to better information, broken trust still occurs. Why? We identify two factors that systematically keep access to information from working as anticipated: detection errors, which prevent people from effectively accessing and processing information, and associational dilemmas, which hinder using the information to report and punish deception. We also consider how relational work can sustain or amplify these factors and foster relational matches that give the false impression of being based on shared meanings and understandings. For example, detection errors and associational dilemmas can place victims into illusory solidarity where, despite appearing close, they are stuck with opportunistic partners.
The availability of gonadotropin therapy from FDA-approved pharmacies for men with hypogonadism and infertility
Authors: Borgert Benjamin J , Bacchus Michael W , Hernandez Alexandra D , Potts Shelby N , Campbell Kevin J 
Published: April 2023

AbstractBackgroundRecent changes to the Biologics Price Competition and Innovation Act of 2009 have created barriers to accessing therapy for men utilizing gonadotropins for hypogonadism and infertility.AimIn this study we sought to investigate ways to decrease disparities in the treatment of male hypogonadism by increasing access to gonadotropin therapy by identifying 503b outsourcing pharmacies which currently provide gonadotropin therapy.MethodsA review of 503b compounding pharmacies was performed using the online published registry available from the US Food and Drug Administration (FDA). Each pharmacy was contacted regarding their ability to provide gonadotropin therapy. Pharmacies were also queried regarding the impact of FDA-related legal changes and cost considerations.OutcomesThe study outcomes were the number and location of FDA-approved 503b compounding pharmacies supplying human chorionic gonadotrophin (hCG) and/or follicle-stimulating hormone (FSH) for the treatment of male hypogonadism and infertility.ResultsThe 81 503b-compounding pharmacies approved by the FDA to produce hCG and FSH therapy were identified using the FDA registry. Seventy-five of the 81 pharmacies responded to the survey (response rate 92.6%). Of the contacted pharmacies, 5 provided hCG (6.67%). Of the pharmacies offering compounded hCG, 4 offered FSH. No additional pharmacies offered compounded FSH. Eight pharmacies had previously provided hCG and FSH. Six of the 8 pharmacies that stopped making hCG and FSH cited the 2020 FDA mandate as the reason for halting compounding services. Of the 75 pharmacies that responded, only 1 pharmacy provided the cost for FSH ($287 per 100-IU vial), and 3 pharmacies provided the cost for hCG ($50-$83 per 10 000-IU vial).Clinical ImplicationsThere are few FDA-approved outsourcing pharmacies currently providing male gonadotropin therapy, and increasing awareness of these pharmacies may decrease barriers to care for patients with male hypogonadism and infertility.Strengths and LimitationsThe strengths of this article are the clinical utility of the data presented, as this article may serve as a tool for clinicians to increase patient access to therapy. All FDA-approved 503b outsourcing pharmacies were contacted, and 92.6% participated in this project. Limitations of this article were the following: no non-FDA–approved compounding pharmacies such as 503a pharmacies were contacted, participant-reported outcomes were utilized, and only 3 contacted outsourcing pharmacies provided a cost for FSH or hCG, allowing for an unknown degree of cost variability between outsourcing pharmacies.ConclusionsThere currently exists limited access to FDA-approved compounded gonadotropin therapies for hypogonadism and male infertility, and these results demonstrate the barriers to hCG and FSH access and the need for additional treatment options for this vulnerable patient population.
The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life
Authors: Egami Susan , Highfield Martha E. Farrar 
Published: April 2023

Background:
Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).

Purpose:
To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL.

Methods:
Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks.

Results:
Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported.

Implications for Practice and Research:
Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.
NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants
Authors: Hwang Sunah S. , Weikel Blair W. , Palau Mauricio A. , Greenfield Jennifer C. , Klawetter Susanne , Neu Madalynn , Roybal Kristi L. , Scott Jessica , Shah Pari , Bourque Stephanie L. 
Published: April 2023

Background:
Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge.

Purpose:
For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge.

Methods:
A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis.

Results:
Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices.

Implications for Practice and Research:
Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.
Effect Of Unintended Tissue Injury On The Development Of Thigh Symptoms After Lateral Lumbar Interbody Fusion In Patients With Adult Spinal Deformity
Authors: Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Banno Tomohiro , Oe Shin , Arima Hideyuki , Ide Koichiro , Yamada Tomohiro , Kurosu Kenta , Nakai Keiichi , Matsuyama Yukihiro 
Published: April 2023

Study design.
Retrospective case series.

Objective.
This study aimed to investigate the effects of lateral lumbar interbody fusion (LLIF)-induced unintended tissue damage, including cage subsidence, cage malposition, and hematoma in the psoas major muscle, on the development of thigh symptoms.

Summary of Background Data.
Thigh symptoms are the most frequent complications after LLIF and are assumed to be caused by lumbar plexus compression and/or direct injury to the psoas major muscle. However, the causes and risk factors of thigh symptoms are yet to be fully understood.

Methods.
Adult patients with spinal deformity who underwent two-stage surgery using LLIF and a posterior open fusion for the first and second stages, respectively, were included. Computed tomography and magnetic resonance imaging were routinely performed after LLIF before posterior surgery to investigate cage subsidence, cage malposition, and hematoma in the psoas muscle. We evaluated the development of thigh symptoms after LLIF and examined the effects of tissue injury on the occurrence of thigh symptoms. The differences in demographics and surgical and tissue damage parameters were compared between the groups with and without thigh symptoms using unpaired t-tests and chi-square tests. Factors associated with the development of thigh symptoms and muscle weakness were also assessed using logistic regression analysis.

Results.
Overall, 130 patients (17 men and 113 women; mean age, 68.7 [range, 47–84]) were included. Thigh symptoms were observed in 52 (40.0%) patients, including muscle weakness and contralateral side symptoms in 20 (15.4%) and 9 (17.3%) patients, respectively. The factors significantly associated with thigh symptoms identified following multiple logistic regression analysis included hematoma (odds ratio 2.27, 95% confidence interval (CI) 1.03–5.01) and approach from the right side (odds ratio 2.64, 95% CI 1.21–5.75). The presence of cage malposition was the only significant factor associated with muscle weakness. (odds ratio 4.12, 95% CI 1.37–12.4).

Conclusions.
We found unintended tissue injury during LLIF was associated with thigh symptoms. We found that hematoma in the psoas major muscle and cage malposition were factors associated with thigh symptoms and muscle weakness, respectively.

Level of Evidence.
4
Minimum Clinically Important Difference in Patient-reported Outcome Measures in de novo Degenerative Lumbar Scoliosis
Authors: Yuan Lei , Li Weishi , Zeng Yan , Chen Zhongqiang 
Published: April 2023

Study Design.
A retrospective analysis.

Objectives.
The objective of this study was to calculate the range of minimum clinically important difference threshold values using anchor-based and distribution-based methods for back pain, leg pain, the Oswestry Disability Index (ODI), and the Scoliosis Research Society 22R instrument (SRS-22R) in patients with de novo degenerative lumbar scoliosis (DNDLS) who underwent long-segment fusion surgery. Then, we sought to determine a statistically sound meaningful, minimum clinically important difference in patient-reported outcome measures (PROMs) and compare our results with previously reported values for other adult spine deformity (ASD) populations.

Summary of the Background Data.
Minimum clinically important difference thresholds for back pain, leg pain, and the ODI and SRS-22R have not been widely described in patients with ASD.

Materials and Methods.
PROMs were obtained preoperatively and two years postoperatively in 128 patients with DNDLS. We applied different minimum clinically important difference calculation methods to the data, and the results were compared.

Results.
There was a statistically significant improvement in the two-year postoperative PROM scores compared with the preoperative scores. Different preoperative calculation methods yielded an ~10-fold range of values. Minimum clinically important difference values were established as 1.9 for back pain, 1.5 for leg pain, 18.9 for the ODI, 0.8 for SRS-22R pain, 0.5 for SRS-22R activity, 1.6 for SRS-22R appearance, 0.8 for SRS-22R mental, and 0.98 for the SRS-22R subtotal. Compared with the previously reported minimum clinically important differences in ASD, the values for back pain, ODI, and SRS-22R appearance were higher in patients with DNDLS.

Conclusions.
Sensitivity-based and specificity-based methods provide statistically sound minimum clinically important difference thresholds for the DNDLS population. The minimum clinically important difference thresholds for PROMs in patients with DNDLS were different from the threshold values previously reported for adult patients with spinal deformities.
Early Bacterial Coinfections in Patients Admitted to the ICU With COVID-19 or Influenza: A Retrospective Cohort Study
Authors: Bergmann Felix , Gabler Cornelia , Nussbaumer-Pröll Alina , Wölfl-Duchek Michael , Blaschke Amelie , Radtke Christine , Zeitlinger Markus , Jorda Anselm 
Published: April 2023

IMPORTANCE:
Previous findings suggest that bacterial coinfections are less common in ICU patients with COVID-19 than with influenza, but evidence is limited.

OBJECTIVES:
This study aimed to compare the rate of early bacterial coinfections in ICU patients with COVID-19 or influenza.

DESIGN, SETTING AND PARTICIPANTS:
Retrospective propensity score matched cohort study. We included patients admitted to ICUs of a single academic center with COVID-19 or influenza (January 2015 to April 2022).

MAIN OUTCOMES AND MEASURES:
The primary outcome was early bacterial coinfection (i.e., positive blood or respiratory culture within 2 d of ICU admission) in the propensity score matched cohort. Key secondary outcomes included frequency of early microbiological testing, antibiotic use, and 30-day all-cause mortality.

RESULTS:
Out of 289 patients with COVID-19 and 39 patients with influenza, 117 (n = 78 vs 39) were included in the matched analysis. In the matched cohort, the rate of early bacterial coinfections was similar between COVID-19 and influenza (18/78 [23%] vs 8/39 [21%]; odds ratio, 1.16; 95% CI, 0.42–3.45; p = 0.82). The frequency of early microbiological testing and antibiotic use was similar between the two groups. Within the overall COVID-19 group, early bacterial coinfections were associated with a statistically significant increase in 30-day all-cause mortality (21/68 [30.9%] vs 40/221 [18.1%]; hazard ratio, 1.84; 95% CI, 1.01–3.32).

CONCLUSIONS AND RELEVANCE:
Our data suggest similar rates of early bacterial coinfections in ICU patients with COVID-19 and influenza. In addition, early bacterial coinfections were significantly associated with an increased 30-day mortality in patients with COVID-19.