bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Generic Pharmacokinetic Model for Quantifying Mother-to-Offspring Transfer of Lipophilic Persistent Environmental Chemicals
Authors: Kapraun Dustin F , Zurlinden Todd J , Verner Marc-André , Chiang Catheryne , Dzierlenga Michael W , Carlson Laura M , Schlosser Paul M , Lehmann Geniece M 
Published: August 2022

Abstract
Lipophilic persistent environmental chemicals (LPECs) can accumulate in a woman’s body and transfer to her developing child across the placenta and via breast milk. To assess health risks associated with developmental exposures to LPECs, we developed a pharmacokinetic (PK) model that quantifies mother-to-offspring transfer of LPECs during pregnancy and lactation and facilitates internal dosimetry calculations for offspring. We parameterized the model for mice, rats, and humans using time-varying functions for body mass and milk consumption rates. The only required substance-specific parameter is the elimination half-life of the LPEC in the animal species of interest. We used the model to estimate whole-body concentrations in mothers and offspring following maternal exposures to hexachlorobenzene (HCB) and 2,2′,4,4′,5,5′-hexachlorobiphenyl (PCB 153) and compared these with measured concentrations from animal studies. We also compared estimated concentrations for humans to those generated using a previously published human LPEC PK model. Finally, we compared human equivalent doses (HEDs) calculated using our model and an allometric scaling method. Estimated and observed whole-body concentrations of HCB and PCB 153 in offspring followed similar trends and differed by less than 60%. Simulations of human exposure yielded concentration estimates comparable to those generated using the previously published model, with concentrations in offspring differing by less than 12%. HEDs calculated using our PK model were about 2 orders of magnitude lower than those generated using allometric scaling. Our PK model can be used to calculate internal dose metrics for offspring and corresponding HEDs and thus informs assessment of developmental toxicity risks associated with LPECs.
Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is Uncommon
Authors: Cummings Jason L. , Hosseinzadeh Pooya 
Published: August 2022

Background:
Historically, treatment for congenital vertical talus (CVT) has included open reduction of the talonavicular joint and extensive soft tissue release. In 2006, a new minimally invasive method consisting of serial manipulation and casting followed by percutaneous fixation of the talonavicular joint and percutaneous Achilles tenotomy was introduced. Although the early results of this new technique are promising, more research is needed to verify that the talonavicular correction is maintained with time.

Methods:
We conducted a retrospective chart review of all patients with idiopathic CVT who underwent minimally invasive correction by a single surgeon at a tertiary care institution. Radiographic evaluation of the preoperative, immediate postoperative, 1 year postoperative and latest follow-up appointments were performed. Complications and clinical outcomes were recorded. Radiographic recurrence of the deformity was defined as lateral talar axis-first metatarsal base angle >30 degrees. Statistical analysis was performed on the maintenance of radiographic correction and factors associated with recurrence.

Results:
Forty seven feet in 35 patients were included in the study with average follow-up of 45 months. The average preoperative lateral talar axis-first metatarsal base angle was 74±18 compared with 12±8 after initial surgical intervention. In addition, radiographic correction of all other measured angles was achieved in every child following the initial surgery. Radiographic recurrence of talonavicular deformity was seen in 4 feet (9%). No cases of recurrence required a second corrective surgery during the follow-up period. There was a significant association between patient age at the time of treatment and recurrence of talonavicular deformity with patients older than 12 months being more likely to experience recurrence (P=0.041).

Conclusions:
In this large series, we found that correction of talonavicular deformity can be achieved and maintained in a large majority of children with idiopathic CVT who undergo treatment with this minimally invasive technique and recurrences are uncommon. Treatment with this technique should be initiated as soon as a diagnosis of CVT is confirmed and the patient is medically stable to decrease the likelihood of experiencing recurrence of talonavicular deformity.

Level of Evidence:
Level III.
The Efficacy of Albumin Dialysis in the Treatment of Severe Cholestatic Drug-Induced Liver Injury
Authors: Narayanan Mechu , Vora Ravi S. , Flynn Mary M. , Subramanian Ram M. 
Published: August 2022

INTRODUCTION:
Drug-induced liver injury (DILI) is a significant cause of acute liver injury and can present as cholestatic injury with or without associated hepatitis. Although most patients with DILI recover with supportive care, some can develop severe refractory cholestasis that impairs recovery of hepatic function, with subsequent progression to acute or chronic liver failure. Current pharmacotherapy and extracorporeal therapies such as hemodialysis have limited benefit. Albumin dialysis is an emerging strategy in the extracorporeal treatment of intoxications caused by protein bound drugs and can be used for the removal of albumin bound bilirubin and bile acids.

CASES SERIES:
We describe the efficacy of albumin dialysis with the molecular adsorbent recirculating system (MARS) in the successful treatment of five patients with severe cholestatic DILI that was refractory to standard medical therapy. All patients had a sustained improvement in serum bilirubin levels after completing MARS therapy, with a complete resolution of their liver injury.

DISCUSSION:
Our case series demonstrates that albumin dialysis could provide an important treatment strategy in the setting of severe refractory cholestatic DILI and be considered as a novel therapeutic option in specific cases of drug hepatotoxicity in which the causative agent has high protein binding characteristics.
Mechanisms for blood pressure reduction following isometric exercise training: a systematic review and meta-analysis
Authors: Edwards Jamie J. , Wiles Jonathan , O’Driscoll Jamie 
Published: August 2022

Objective:
Isometric exercise training (IET) is established as an effective antihypertensive intervention. Despite this, the physiological mechanisms driving blood pressure (BP) reductions following IET are not well understood. Therefore, we aimed to perform the first meta-analysis of the mechanistic changes measured following IET.

Methods:
PubMed, Cochrane library and SPORTDiscus were systematically searched for randomized controlled trials published between January 2000 and December 2021 reporting the effects of IET on resting BP and at least one secondary mechanistic parameter following a short-term intervention (2–12 weeks).

Results:
Eighteen studies with a pooled sample size of 628 participants were included in the final analysis. IET produced significant reductions in resting systolic and diastolic BP of 9.35 mmHg (95% confidence interval [CI] = −7.80 to −10.89, P < 0.001) and 4.30 mmHg (CI = −3.01 to −5.60, P < 0.001), respectively. Mechanistically, IET produced a statistically significant reduction in resting heart rate (mean difference [MD]: −1.55 bpm, CI = −0.14 to −2.96, P = 0.031) and a significant increase in stroke volume (MD: 6.35 ml, CI = 0.35 to 12.60, P = 0.038), with no significant change in cardiac output. Conversely, total peripheral resistance (TPR) significantly decreased following IET (MD: −100.38 dyne s−1 cm5, CI = −14.16 to −186.61, P = 0.023), with significant improvements in the low frequency to high frequency heart rate variability ratio (MD: −0.41, CI = −0.09 to −0.73, P = 0.013) and baroreceptor reflex sensitivity (MD: 7.43 ms/mmHg, P < 0.001).

Conclusion:
This work demonstrates that a reduction in TPR, potentially mediated through enhanced autonomic vasomotor control, is primarily responsible for BP reductions following IET. Furthermore, this novel analysis suggests wall squat interventions to be the most effective IET mode, with clinically relevant differences in BP reductions compared to handgrip and leg extension IET; although future direct comparative research is required.
Effects of Repealing the ACA Individual Mandate Penalty on Insurance Coverage and Marketplace Enrollment
Authors: Oyeka Onyinye I , Lyu Wei , Wehby George L. 
Published: August 2022

Background:
Congress eliminated the individual mandate penalty of the Affordable Care Act (ACA) effective January 1, 2019.

Objective:
To examine the effects of repealing the ACA mandate penalty on private health insurance coverage and marketplace enrollment by leveraging state-based mandates in Massachusetts and New Jersey.

Research Design:
We employ synthetic control and difference-in-differences methods to compare insurance and enrollment changes separately in Massachusetts and New Jersey, which had insurance mandates effective in 2019, to other states without such mandates.

Subjects:
Adults aged 18–64 years with income of 150–300% and above 300% of the Federal Poverty Level who participated in the 2016–2019 American Community Survey (ACS) and adults aged 18–64 enrolled in insurance marketplaces based on state-level data from the 2016–2021 Marketplace Open Enrollment Period Public Use Files (MOEP-PUF).

Measures:
Any insurance, individually purchased coverage, and employer-sponsored coverage from the ACS and marketplace enrollment from the MOEP-PUF.

Results:
Changes in any coverage, individually purchased coverage, and employer-sponsored coverage rates are relatively small (generally in the range of 1–2 percentage points) and statistically nonsignificant in both Massachusetts and New Jersey compared with states without mandates. Furthermore, there is no discernable difference by eligibility for marketplace subsidies based on income level in the ACS data. Similarly, estimates for changes in marketplace enrollment are also small overall and statistically nonsignificant.

Conclusion:
Private insurance coverage rates and marketplace enrollment for adults 18–64 do not appear to have changed thus far owing to the 2019 repeal of the ACA individual mandate penalty.
How did Veterans’ Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?
Authors: Sterling Ryan A. , Liu Chuan-Fen , Hebert Paul L. , Fortney John C. , Swankoski Kaylyn E. , Katon Jodie G. , Wong Edwin S. 
Published: August 2022

Background:
The Veterans Community Care Program (VCCP) aims to address access constraints in the Veterans Health Administration (VA) by reimbursing care from non-VA community providers. Little existing research explores how veterans’ choice of VA versus VCCP providers has evolved as a significant VCCP expansion in 2014 as part of the Veterans Access, Choice, and Accountability Act.

Objectives:
We examined changes in reliance on VA for primary care (PC), mental health (MH), and specialty care (SC) among VCCP-eligible veterans.

Research Design:
We linked VA administrative data with VCCP claims to retrospectively examine utilization during calendar years 2016–2018.

Subjects:
1.78 million veterans enrolled in VA before 2013 and VCCP-eligible in 2016 due to limited VA capacity or travel hardship.

Measures:
We measured reliance as the proportion of total annual outpatient (VA+VCCP) visits occurring in VA for PC, MH, and SC.

Results:
Of the 26.1 million total outpatient visits identified, 45.6% were for MH, 29.9% for PC, and 24.4% for SC. Over the 3 years, 83.2% of veterans used any VA services, 23.8% used any VCCP services, and 20.0% were dual VA-VCCP users. Modest but statistically significant declines in reliance were observed from 2016–2018 for PC (94.5%–92.2%), and MH (97.8%–96.9%), and a more significant decline was observed for SC (88.5%–79.8%).

Conclusions:
Veterans who have the option of selecting between VA or VCCP providers continued using VA for most of their outpatient care in the initial years after the 2014 VCCP expansion.
The value of 68Ga-PSMA-11 PET/CT in patients with prostate cancer and inconclusive standard imaging at primary staging
Authors: Nalliah Surenth , Zacho Helle D. 
Published: August 2022

Objective
The current standard imaging recommended for primary staging of intermediate- and high-risk prostate cancer (PCa) consists of bone scintigraphy (BS) and computed tomography (CT). Some patients will have equivocal lesions or divergent findings on BS and CT, leading to inconclusive disease staging. Our aim was to investigate the value of 68Ga-PSMA-11 PET/CT in PCa with inconclusive disease stage based on standard imaging.

Methods
We made a single-center study of patients with newly diagnosed PCa who underwent a 68Ga-PSMA-11 PET/CT due to equivocal findings or discrepancies between BS and CT from 1 January 2017 to 31 December 2020. The value of 68Ga-PSMA-11 PET/CT was evaluated for each location of equivocal findings (regional lymphnode, nonregional lymphnodes, bones and other metastases) and on a patient level.

Results
Seventy-six patients were included in the study (62 patients with 72 equivocal lesions, 14 with discrepancy between BS and CT). Equivocal lesions were predominately in the bones (61%, 44/72), or in the regional lymph nodes (17%, 12/72). 68Ga-PSMA-11 PET/CT provided a conclusive diagnosis in 90% (65/72) of the equivocal lesions. All patients with discrepancies between BS and CT had definite answers after 68Ga-PSMA-11 PET/CT. 68Ga-PSMA-11 PET/CT also uncovered 32 additional sites of metastasis in 25 patients not visible by standard imaging.

Conclusion

68Ga-PSMA-11 PET/CT provides a definite disease stage in more than 90% of newly diagnosed patients with inconclusive standard imaging. Furthermore, it revealed additional sites of metastasis in 25 patients not detected by standard imaging.
Antibody-mediated rejection: prevention, monitoring and treatment dilemmas
Authors: Rodriguez-Ramirez Sonia , Al Jurdi Ayman , Konvalinka Ana , Riella Leonardo V. 
Published: August 2022

Purpose of review
Antibody-mediated rejection (AMR) has emerged as the leading cause of late graft loss in kidney transplant recipients. Donor-specific antibodies are an independent risk factor for AMR and graft loss. However, not all donor-specific antibodies are pathogenic. AMR treatment is heterogeneous due to the lack of robust trials to support clinical decisions. This review provides an overview and comments on practical but relevant dilemmas physicians experience in managing kidney transplant recipients with AMR.

Recent findings
Active AMR with donor-specific antibodies may be treated with plasmapheresis, intravenous immunoglobulin and corticosteroids with additional therapies considered on a case-by-case basis. On the contrary, no treatment has been shown to be effective against chronic active AMR. Various biomarkers and prediction models to assess the individual risk of graft failure and response to rejection treatment show promise.

Summary
The ability to personalize management for a given kidney transplant recipient and identify treatments that will improve their long-term outcome remains a critical unmet need. Earlier identification of AMR with noninvasive biomarkers and prediction models to assess the individual risk of graft failure should be considered. Enrolling patients with AMR in clinical trials to assess novel therapeutic agents is highly encouraged.
A Patient With Large Cavernous Hemangioma in the Cavernous Sinus Straddling the Saddle With Bilateral Optic Nerve Compression
Authors: Ye Tang , Chen Baodong , Wu Tao , Ma Yuqiang 
Published: August 2022

Background:
This report describes the removal of a giant cavernous hemangioma while protecting the blood vessels and nerves to the greatest degree of safety, relieving the intracranial space, and relieving the symptoms of the patient.

Methods:
Large cavernous hemangioma crossing into the cavernous sinus in a saddle surgery procedure was retrospectively analyzed, summarizing many cross-regional giant cavernous hemangioma treatments.

Results:
The patient underwent non-en bloc resection of the tumor with rapid removal. The internal carotid artery and adjacent nerves were safely preserved.

Conclusion:
Large cavernous hemangiomas spanning from the cavernous sinus to the area of the butterfly saddle require complete evaluation, and appropriate surgical entry should be selected. With the surgeon having rich surgical experience, the operation can protect the patient’s neurological function.
Trends in Facial Paralysis Management: A National Survey Study
Authors: Benyo Sarah , Saadi Robert A. , Shokri Tom , Lighthall Jessyka G. 
Published: August 2022

Introduction:
Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics.

Materials and Methods:
An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher’s exact tests.

Results:
The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management.

Conclusion:
Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.
Effective communication and patient safety among nurses in perioperative settings: a best practice implementation project
Authors: Nedelcu Catalin Marian , Niculiă Oana Otilia , Nedelcu Viorica , Zazu Mariana , Mazilu Doina Carmen , Klugarová Jitka , Klugar Miloslav 
Published: August 2022

ABSTRACT

Objectives:
The aim of this implementation project was to promote evidence-based best practice regarding effective communication and patient safety amongst nurses in perioperative settings.

Introduction:
One of the main causes of surgical errors is inadequate communication. To address this issue, published research has shown that effective communication among healthcare professionals (HCPs) within and between all phases of perioperative care, as well as the proper transfer of all patient information at all transition points, are essential for ensuring patient safety and quality of care.

Methods:
This best practice implementation project was conducted based on the JBI implementation model and included three phases of activity: a baseline audit, a strategies implementation stage and a follow-up audit. The audit criteria used were based on a JBI evidence summary and referred to: education, interdisciplinary team, conflict resolution, team communication, transfer of patient information and safety intraoperative processes. The project was carried out in the perioperative environment of a university hospital, and the sample included 52 nurses.

Results:
Eleven audit criteria were used in the baseline audit. For four of these criteria (on education and information transfer) the compliance was zero, for five criteria (on intraoperative processes) the compliance had values between 31 and 66% and for two criteria (on interdisciplinary team/conflict resolution documentation and team communication monitoring), the identified compliance was maximum (100%). Following the identification of four barriers to compliance and the implementation of targeted strategies, the follow-up audit showed complete compliance (100%) for all criteria except three, for which the identified compliance values were 96, 95 and 25%.

Conclusion:
The implementation of appropriate strategies in this project has led to a significant improvement in nurses’ compliance with all audit criteria except one, regarding the verbal transfer of patient information. However, future audits and strategies are needed not only to support the improvements obtained but also to significantly increase the compliance rate for the audit criterion for which only a slight increase in compliance was recorded.
Resting-state aperiodic neural activity as a novel objective marker of daytime somnolence
Authors: Cross Zachariah R. , Kang Teng Yuan , Lushington Kurt , Sarkar Paroma , Singh Parmjit , Johnston Sonya , Yeo Aeneas , Chatburn Alex 
Published: August 2022

AbstractStudy ObjectivesCurrent assessment of excessive daytime somnolence (EDS) requires subjective measurements such as the Epworth Sleepiness Scale (ESS), and/or resource intensive sleep laboratory investigations. Recent work 1,2 has called for more non-performance-based measures of EDS. One promising non-performance-based measure of EDS is the aperiodic component of electroencephalography (EEG). Aperiodic (non-oscillatory) activity reflects excitation/inhibition ratios of neural populations and is altered in various states of consciousness, and thus may be a potential biomarker of hypersomnolence.MethodsWe retrospectively analysed EEG data from patients who underwent a Multiple Sleep Latency Test (MSLT) and determined whether aperiodic neural activity is predictive of EDS. Participants having undergone laboratory polysomnogram and next day MSLT were grouped into MSLT+ (n = 26) and MSLT– (n = 33) groups (mean sleep latency of < 8min and > 10min, respectively) and compared against a non-clinical (Control) group of participants (n = 26).ResultsWhile the MSLT+ and MSLT– groups did not differ in their aperiodic activity, the Control group had a significantly flatter slope and larger offset compared to both MSLT+ and MSLT– groups. Logistic regression machine learning predicted group status (i.e., symptomatic, non-symptomatic) with 90% accuracy based on the aperiodic slope while controlling for age. Slow oscillation-spindle coupling was also significantly stronger in the Control group relative to MSLT+ and MSLT– groups.ConclusionsOur results provide first evidence that aperiodic neural dynamics and sleep-based cross-frequency coupling is predictive of EDS, thereby providing a novel avenue for basic and applied research in the study of sleepiness.