bluuebunny/crossref_metadata_2025_split huggingface dataset:
Culture-negative tricuspid valve endocarditis in an intravenous drug abuser masquerading as pulmonary tuberculosis in Nepal: a case report
Authors: Rajkarnikar Ruja , Sharma Shriya , Yadav Sumit , Ghimire Nirmal 
Published: March 2023

Introduction:
Infective endocarditis is an infection of the heart valves or endocardium caused by bacterial, viral, or fungal microorganisms. Blood cultures are used to detect the bacteria causing infective endocarditis, and echocardiography is performed to find the damaged heart valves. In blood culture-negative endocarditis, no endocarditis-causing organisms can be found in blood cultures, and blood cultures using usual laboratory methods remain sterile after inoculation of at least three independent blood samples.

Case presentation:
A 24-year-old male with a history of polysubstance abuse presented with complaints of fever, cough, and shortness of breath. He had a past history of pulmonary tuberculosis 4 years ago, for which he was treated with antitubercular therapy. High-resolution computed tomography of the chest revealed multiple cavitary lesions and consolidative areas in the bilateral lungs. Based on these findings, a provisional diagnosis of reactivation of pulmonary tuberculosis was considered, and antitubercular therapy was started. Due to his deteriorating condition, he was readmitted and evaluated. Bronchoalveolar lavage was done and sent for culture and sensitivity testing, which showed the presence of Staphylococcus aureus, and treatment was started accordingly. Despite continuing intravenous antibiotics for 5 days, the patient was not improving. Three sets of samples were withdrawn for blood culture and sensitivity testing, which came out to be negative. Transthoracic echocardiography was done, which revealed vegetation in the tricuspid valve. The patient was diagnosed with culture-negative tricuspid valve endocarditis based on the clinical criteria.

Discussion:
Blood culture-negative endocarditis is difficult to diagnose and presents challenges. When faced with a diagnosis like culture-negative endocarditis in the context of a condition that can appear very similar, like tuberculosis, a broad differential diagnostic approach is important.

Conclusion:
Intravenous drug use is the main cause of right-sided valvular infective endocarditis. Endocarditis should be considered in intravenous drug users even in the absence of positive blood cultures. An appropriate antibiotic regimen and long-term follow-up with a multidisciplinary team are necessary for a good outcome.
Lateral medullary syndrome: uncommon form of brainstem stroke
Authors: Ahmed Ibrahim Abdiwahid , Bakir Ahmet , Osman Sidow Nor , Mohamed Ali Abdiladhif , Farah Osman Mohamed , Ahmed Abdulkadir , Sheikh Hassan Mohamed 
Published: March 2023

Introduction and Importance:
Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source.

Case Presentation:
A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation.

Clinical Discussion:
LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner’s syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome.

Conclusion:
LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.
Interrupting Biases in the Experience and Management of Pain Nurses can help address challenges faced by racially and ethnically diverse patients and caregivers.
Authors: Booker Staja Q. , Baker Tamara A. , Epps Fayron , Herr Keela A. , Young Heather M. , Fishman Scott 
Published: March 2023

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.
The articles in this new installment of the series provide practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Booker, S.Q., et al. Interrupting Biases in the Experience and Management of Pain. Am J Nurs 2022; 122(9): 48-54.
Endometrial Carcinomas With Subclonal Loss of Mismatch Repair Proteins
Authors: Mendoza Rachelle P. , Wang Peng , Schulte Jefree J. , Tjota Melissa Y. , Jani Ina , Martinez Anna C. , Haridas Rishikesh , Wanjari Pankhuri , Steinhardt George , Brown Noah , Betz Bryan L. , Chapel David B. , Kertowidjojo Elizabeth , Yamada S.D. , Bennett Jennifer A. 
Published: March 2023

Subclonal loss of mismatch repair (MMR) proteins has been described in a small subset of endometrial carcinomas (ECs), but the genomic basis for this phenomenon has received limited attention. Herein, we retrospectively evaluated all ECs with MMR immunohistochemistry (n=285) for subclonal loss, and in those (n=6), performed a detailed clinicopathologic and genomic comparison of the MMR-deficient and MMR-proficient components. Three tumors were FIGO stage IA, and one each stage IB, II, and IIIC2. Patterns of subclonal loss were as follows: (1) 3 FIGO grade 1 endometrioid carcinomas with subclonal MLH1/PMS2, MLH1 promoter hypermethylation, and no MMR gene mutations; (2) POLE-mutated FIGO grade 3 endometrioid carcinoma with subclonal PMS2, and PMS2 and MSH6 mutations limited to the MMR-deficient component; (3) dedifferentiated carcinoma with subclonal MSH2/MSH6, as well as complete loss of MLH1/PMS2, MLH1 promoter hypermethylation, and PMS2 and MSH6 mutations in both components; (4) dedifferentiated carcinoma with subclonal MSH6, and somatic and germline MSH6 mutations in both components, but with a higher allele frequency in MMR-deficient foci. Recurrences occurred in 2 patients, one consisted of the MMR-proficient component from a FIGO 1 endometrioid carcinoma, while the other was from the MSH6-mutated dedifferentiated endometrioid carcinoma. At the last follow-up (median: 44 mo), 4 patients were alive and disease-free and 2 were alive with disease. In summary, subclonal MMR loss reflects subclonal and often complex genomic and epigenetic alterations, which may have therapeutic implications and therefore must be reported when present. In addition, subclonal loss can occur in both POLE-mutated and Lynch syndrome–associated ECs.
Suspected Nonfatal Cocaine-Involved Overdoses Overall and With Co-involvement of Opioids
Authors: Scholl Lawrence , Liu Stephen , Pickens Cassandra M. 
Published: March 2023

Context:
The Centers for Disease Control and Prevention (CDC) developed a syndrome definition for detection of suspected nonfatal cocaine-involved overdoses. The definition can be used to monitor trends and detect anomalies in emergency department (ED) syndromic surveillance data at the national, state, and local levels.

Objective:
This study describes the development of the nonfatal, unintentional/undetermined intent cocaine-involved overdose (UUCOD) definition and analysis of trends over time.

Design/Setting:
CDC developed the UUCOD definition to query ED data in CDC's National Syndromic Surveillance Program (NSSP). Data between 2018 and 2021 were analyzed from 29 states sharing data access in the Drug Overdose Surveillance and Epidemiology (DOSE) System via NSSP. Using Joinpoint regression, trends were analyzed for UUCOD overall, by sex and age group, and for UUCOD co-involving opioids.

Measures:
Time trends between 2018 and 2021 were analyzed by examining average monthly percentage change. Individual trend segments and trend inflection points were analyzed by examining monthly percentage change.

Results:
During 2018-2021, a total of 27 240 UUCOD visits were identified by the syndrome definition. Analyses identified different patterns in trends for males and females, with largely similar trends for persons aged 15 to 44 years and 45 years or older. Analyses also identified seasonal patterns with increases in spring/summer months in UUCOD overall and UUCOD co-involving opioids and declines for both in fall/winter months.

Conclusion:
This UUCOD syndrome definition will be useful for ongoing monitoring of suspected nonfatal overdoses involving cocaine and co-involving cocaine and opioids. Ongoing assessment of cocaine-involved overdose trends might identify anomalies requiring further investigation and inform deployment of resources.
Characterizing the Role of International Graduates of the Epidemic Intelligence Service in Increasing the Epidemiological Capacity and Diversity of the United States Public Health Workforce
Authors: Temate-Tiagueu Yvette , Winquist Andrea , Davis Meagan , Dietz Stephanie , Robinson Byron , Pevzner Eric , Arvelo Wences 
Published: March 2023

Context:
A trained and diverse public health workforce is needed to respond to public health threats. The Epidemic Intelligence Service (EIS) is an applied epidemiology training program. Most EIS officers are from the United States, but some are from other countries and bring unique perspectives and skills.

Objectives/Evaluation:
To characterize international officers who participated in the EIS program and describe their employment settings after training completion.

Design:
International officers were people who participated in EIS and who were not US citizens or permanent residents. We analyzed data from EIS's application database during 2009-2017 to describe officers' characteristics. We used data from the Centers for Disease Control and Prevention's (CDC's) workforce database for civil servants and EIS exit surveys to describe jobs taken after program completion.

Main Outcome Measures:
We described the characteristics of the international officers, jobs taken immediately after program completion, and duration of employment at CDC.

Results:
Among 715 officers accepted in EIS classes of 2009-2017, 85 (12%) were international applicants, with citizenships from 40 different countries. Forty (47%) had 1 or more US postgraduate degrees, and 65 (76%) were physicians. Of 78 (92%) international officers with available employment data, 65 (83%) reported taking a job at CDC after program completion. The remaining took a public health job with an international entity (6%), academia (5%), or other jobs (5%). Among 65 international officers who remained working at CDC after graduation, the median employment duration was 5.2 years, including their 2 years in EIS.

Conclusions:
Most international EIS graduates remain at CDC after program completion, which strengthens the diversity and capacity of CDC's epidemiological workforce. Further evaluations are needed to determine the effects of pulling away crucial talent from other countries needing experienced epidemiologists and to what extent retaining those persons can benefit public health globally.
An Evaluation of the Successes of the NASTAD Minority Leadership Program and Its Implications for Leadership in State Health Departments
Authors: Amutah-Onukagha Ndidiamaka , Gifuni-Koutsouris Jacqueline , Assan Maame Araba , Bryant Cierra , Galvan Rosy 
Published: March 2023

Objective:
The Minority Leadership Program (MLP) was developed by the National Alliance of State and Territorial AIDS Directors (NASTAD) to enhance leadership skills among public health professionals of color that work within HIV, viral hepatitis, or drug user health programs in health departments. The goal of the study was to analyze experiences of MLP alumni in their respective health departments, explore opportunities to address cultural issues, and explore leadership opportunities for alumni.

Design:
The research team conducted a mixed-methods approach to this study. It included qualitative data analysis of 2018-2019 MLP applicants (n = 32), online surveys to MLP alumni (n = 51), and key informant interviews with former MLP cohort members (n = 7). Thematic coding was conducted for all qualitative data collection tools using Dedoose.

Setting and Participants:
Study was conducted virtually between September 2020 and March 2021. A total of 90 individuals participated in this evaluation research study. These individuals were former cohort members of MLP by NASTAD.

Intervention:
No health intervention was conducted.

Main Outcome Measure:
Achievement of participant-level experiences after completion of MLP.

Results:
Microaggressions in the workplace, lack of diversity in the workplace, positive experiences participating in the MLP, and networking opportunities were common themes throughout the study. Other themes included challenges and successes experienced after MLP completion, and MLP's contribution to advancing professionally within the health department.

Conclusions:
Overall, participants had positive experiences participating in MLP and spoke highly of the networking opportunities available in the program. Individuals who participated recognized a lack of open dialogue and conversations surrounding racial equity, racial justice, and health equity within their respective departments. The research evaluation team recommends that NASTAD continue collaborating with health departments to address issues on racial equity and social justice with health department staff. Programs such as MLP are critical to diversifying the public health workforce to adequately address issues on health equity.
Rural Public Health Data Challenges During the COVID-19 Pandemic: The Case for Building Better Systems Ahead of a Public Health Crisis
Authors: Bekemeier Betty , Heitkemper Elizabeth , Backonja Uba , Whitman Gregory , Schultz Melinda , Jiang Yufei , Baquero Barbara , Turner Anne M. 
Published: March 2023

Context:
Rural public health personnel serve communities that have been particularly susceptible to COVID-19 and yet faced the pandemic with far less well-resourced capacity than their urban counterparts. A critical aspect of addressing local health inequities is access to high-quality population data and the capacity to effectively use data to support decision making. However, much of the data required to investigate inequities are not readily available to rural local health departments and the tools and training to analyze data are often lacking.

Program:
The purpose of our effort was to explore rural data challenges related to COVID-19 and provide recommendations for improving rural data access and capacity ahead of future crises.

Implementation:
We gathered qualitative data in 2 phases, more than 8 months apart, from rural public health practice personnel. Initial data were gathered in October-November 2020 regarding rural public health data needs during the COVID-19 pandemic and then to later identify whether the same findings held true in July 2021 or whether access to and capacity to use data to address the pandemic and related inequities improved as the pandemic progressed.

Evaluation:
In our 4-state exploration focused on access and use of data among rural public health systems to promote health equity in the Northwest United States, we found tremendous and ongoing unmet data needs, challenges with communicating data, and a lack of capacity to meet this public health crisis.

Discussion:
Recommendations for addressing these challenges include increasing dedicated resources specifically to rural public health systems, improving data access and infrastructure, and providing dedicated data-related workforce development.
With or without straps? A pilot study to investigate whether restraint devices affect the wheelchair basketball players' performance
Authors: Macchiarola Dario , Megna Marisa , Quarta Francesco , Bianchi Francesco Paolo , Cipriano Roberta , Andrani Michela , Ricci Vincenzo , Fiore Pietro , Ranieri Maurizio , Farì Giacomo 
Published: March 2023

Background:
Wheelchair basketball (WB) represents a great physical activity, rehabilitation, and integration opportunity for people with disability. Straps are wheelchair accessories used to ensure safeness and stability. Nevertheless, some athletes report feeling limited in movements because of these restraint devices. The aim of this study was thus to deepen whether straps could affect performance and cardiorespiratory effort in WB players' athletic gesture and furthermore whether sport performance could be influenced by experience, anthropometric features, or classification score.

Methods:
Ten WB elite athletes were enrolled in this observational cross-sectional study. Speediness, wheelchair maneuverability, and sport-specific skills were evaluated with 3 tests: 20-m straight line test (test 1), figure 8 test (test 2), and figure 8 with ball test (test 3); all tests were performed with and without straps. Cardiorespiratory parameters (blood pressure [BP], heart rate, and oxygen saturation) were registered before and after tests. Anthropometric data, classification score, and practice’s years were collected and compared with test results.

Results:
Performance significantly improved in all tests wearing straps (test 1 P = 0.007, test 2 P = 0.009, and test 3 P = 0.025). No significant variation in cardiorespiratory basic signs emerged before and after the tests, with or without straps (systolic BP P = 0.140, diastolic BP P = 0.564, heart rate P = 0.066, and oxygen saturation P = 0.564). A statistically significant relation between test 1 with straps and classification score (coefficient = −0.25; P = 0.008) and test 3 without straps and classification score (coefficient = 1.00; P = 0.032) was found. No further relations emerged between test results and anthropometric data, classification score, and practice’s years (P > 0.05).

Conclusions:
These findings demonstrated that straps, as well as ensuring safety and preventing injuries, also improve the WB performance, stabilizing the trunk and implementing upper limb skills, without exposing players to excessive cardiorespiratory and biomechanical stresses.
Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese
Authors: Nunes Maristela Lopes Gonçalves , Martins Lina , Conceição de Gouveia Santos Vera Lucia 
Published: March 2023

PURPOSE:To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version.DESIGN:Psychometric (methodologic) evaluation of the instrument.SUBJECTS AND SETTING:Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order.METHODS:The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors.RESULTS:The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r= 0.44;P= .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study.CONCLUSION:This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.