bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Bleeding Severity With Mortality in Extended Thromboprophylaxis of Medically Ill Patients in the MAGELLAN and MARINER Trials
Authors: Spyropoulos Alex C. , Raskob Gary E. , Cohen Alexander T. , Ageno Walter , Weitz Jeffrey I. , Spiro Theodore E. , Lu Wentao , Lipardi Concetta , Albers Gregory W. , Elliott C. Gregory , Halperin Jonathan L. , Hiatt William R. , Maynard Gregory , Steg P. Gabriel , Sugarmann Chiara , Barnathan Elliot S. 
Published: April 2022

Background:
Extended thromboprophylaxis has not been widely implemented in acutely ill medical patients because of bleeding concerns. The MAGELLAN (Multicenter, Randomized, Parallel Group Efficacy and Safety Study for the Prevention of Venous Thromboembolism in Hospitalized Medically Ill Patients Comparing Rivaroxaban With Enoxaparin) and MARINER (Medically Ill Patient Assessment of Rivaroxaban Versus Placebo in Reducing Post-Discharge Venous Thrombo-Embolism Risk) trials evaluated whether rivaroxaban compared with enoxaparin or placebo could prevent venous thromboembolism without increased bleeding. We hypothesized that patients with major bleeding but not those with nonmajor clinically relevant bleeding would be at an increased risk of all-cause mortality (ACM).

Methods:
We evaluated all bleeding events in patients taking at least 1 dose of study drug and their association with ACM in 4 mutually exclusive groups: (1) no bleeding, or first event was (2) nonmajor clinically relevant bleeding, (3) major bleeding, or (4) trivial bleeding. Using a Cox proportional hazards model adjusted for differences in baseline characteristics associated with ACM, we assessed the risk of ACM after such events.

Results:

Compared with patients with no bleeding, the risk of ACM for patients with nonmajor clinically relevant bleeding was not increased in MARINER (hazard ratio, 0.43;
P
=0.235) but was increased in MAGELLAN (hazard ratio, 1.74;
P
=0.021). Major bleeding was associated with a higher incidence of ACM in both studies, whereas trivial bleeding was not associated with ACM in either study.

Conclusions:
Patients with major bleeding had an increased risk of ACM, whereas nonmajor clinically relevant bleeding was not consistently associated with an increased risk of death. These results inform the risk-benefit calculus of extended thromboprophylaxis in medically ill patients.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: MAGELLAN, NCT00571649. URL:
https://www.clinicaltrials.gov
; Unique identifier: MARINER, NCT02111564.
Projecting current feelings into the past and future: Better current relationship quality reduces negative retrospective bias and increases positive forecasting bias
Authors: Peetz Johanna , Shimizu Justin P. K. , Royle Courtney 
Published: April 2022

We examine bias in how people perceive their romantic relationship over time. Participants appraised their relationship 6 months and 1 year ago on average more negatively than they had done at the time (retrospective bias) but showed no significant mean-level forecasting bias. Higher relationship quality at the time of appraisal was linked to less negative retrospective bias but to more positive forecasting bias (Study 1). Similarly, participants who were experimentally manipulated to focus on the high relationship quality aspects in their relationship (vs. considering challenging aspects of their relationship) showed more forecasting bias and less retrospective bias (Study 2). This pattern occurred due to participants’ projecting positive current feelings onto predicted relationship quality in the future and remembered relationship quality in the past. This projection reduced the overall negative bias in recalled relationship quality for those currently perceiving higher relationship quality but increased positive bias in forecasted relationship quality.
School performance in children at the time of new-onset seizures and at long-term follow-up: A retrospective cohort study
Authors: Datta Anita N. , Wong Peter K.H. 
Published: April 2022

Objective School-performance difficulties (SPD) are common in children with epilepsy. The objectives of this study were to determine if the rate of SPD in children with seizures change from seizure-onset to follow-up and differ from children with psychiatric disorders. Methods School-aged children who required an initial electroencephalography (EEG) test in 2016 were reviewed and separated into two groups based on the presence or absence of seizures. Developmental delay and SPD were compared between groups at initial assessment and SPD was assessed after 2–4 years of follow-up. Analysis was also performed on a sub-set of patients with psychiatric disorders. Results At baseline, the rate of SPD was similar between the seizure (n = 146) and non-seizure (n = 332) groups [26% vs. 27%]. At follow-up, the seizure (n = 119) group had a significantly higher rate of SPD than the non-seizure (n = 215) group (54% vs. 43%). There was no difference in the rate of SPD between the seizure (n = 119) and psychiatric (n = 69) groups at baseline (31% vs. 43%) or follow-up (54% vs. 55%). Conclusion Over time, children with recurrent seizures experience more SPD than children without seizures, but similar SPD to children with psychiatric disorders.
Americans’ Attitudes Toward COVID-19 Preventive and Mitigation Behaviors and Implications for Public Health Communication
Authors: Thompson Jessica , Squiers Linda , Frasier Alicia M. , Bann Carla M. , Bevc Christine A. , MacDonald Pia D. M. , McCormack Lauren A. 
Published: April 2022

Purpose Identifying drivers of behavior is essential to develop effective messaging around COVID-19 prevention and mitigation. Our study assessed for behavioral antecedents of social distancing, wearing face coverings, and sheltering in place during the onset of the COVID-19 pandemic. Although ours is an early assessment, understanding motivation for behavior will remain critical as U.S. vaccination uptake has stalled and variants continue to pose a health threat. Design Cross-sectional survey; Setting: Online assessments in April 10–13 and 17–20, 2020; Subjects: 2,279 U.S. adults identified through a national, probability-based web panel (34% response rate). Measures: self-reported behavior, perceived effectiveness and risk, worry, social norms, and knowledge. Analysis Multivariable regression analyses Results Most Americans reported social distancing (91%) and sheltering in place (86%). Just over half reported wearing face coverings (51%), whereas more (77%) said they intended to do so. Perceived effectiveness of the behavior was consistently associated with each outcome (OR = 2.34, 1.40, 2.11, respectively; all P < .01). Perceptions about the extent to which others should comply with behavior (social norms) were strongly associated with intentions to wear a face covering only (OR = 6.30, 95% CI 4.34-9.15; P < .001) and worry about getting COVID-19 was associated with sheltering in place and social distancing (OR = 2.63, 95% CI 1.15–5.00; 4.91, 95% CI 1.66, 14.50, respectively; all P < .05). Conclusion Behavioral constructs were strongly associated with COVID-19 preventive and mitigation behaviors and have implications for communication.
Use of Sodium Bicarbonate Purge Solution in Impella Devices for Heparin-Induced Thrombocytopenia
Authors: Al-Ayoubi Adnan M. , Bhavsar Kinnari , Hobbs Ryan A. , Smith Katharyn L. , Lee Leonard Y. , Ikegami Hirohisa , Singhal Arun K. 
Published: April 2022

Heparin purge solution is recommended to be used in Impella devices to prevent biomaterial buildup and subsequent device dysfunction. The use of sodium bicarbonate purge solution in an Impella device is described in two patients with heparin-induced thrombocytopenia (HIT). The first case details a patient with severe mitral regurgitation and cardiogenic shock who had an Impella CP placed who developed HIT. Heparin purge solution was replaced by sodium bicarbonate purge solution in addition to systemic direct thrombin inhibitor (DTI) initiation. There was no significant change in Impella purge pressure or flow over the 13 days of Impella use. The second case describes a patient who developed an acute myocardial infarction and subsequent cardiogenic shock for which an Impella CP was placed who also developed HIT. Heparin purge solution was replaced by sodium bicarbonate purge solution. There was no significant change in purge pressure, flow, or motor current spikes over 11 days of use. In conclusion, we describe the successful use of a novel sodium bicarbonate purge solution utilized in patients with HIT for Impella management alone and in combination with systemic direct thrombin inhibitor therapy. This resulted in no protein deposition in the device gaps or device dysfunction.
Impact of Palliative Care in End-of-Life of Fibrotic Interstitial Lung Disease Patients
Authors: Chai Gin Tsen , Neo Han Yee , Abisheganaden John , Hum Allyn Yin Mei 
Published: April 2022

Background: Interstitial lung disease (ILD) is associated with poor quality of life (QoL) and high symptom burden. Studies evaluating the benefits of palliative care examined mainly idiopathic pulmonary fibrosis (IPF) patients. We aim to examine the impact of palliative care on a broader group of fibrotic ILD patients. Methods: Single center retrospective cohort study comparing deceased ILD patients who received outpatient palliative care services (palliative-intervention group) against a usual care group. Results: Of 63 subjects, 26 (41%) were in the palliative-intervention group and 37 (59%) in the usual care group. Median time to palliative care referral was 8.6 (IQR .3–21.2) months. Dyspnea-related disability was greater in the palliative-intervention group [mMRC dyspnea score 3.5(IQR 2–4) vs 2(IQR 2–4), P = .039], with more patients requiring long term oxygen therapy (70% vs 30%, P < .001). There was no difference in the median number of hospitalizations or length of stay in the last 6 months of life. Patients in the palliative-intervention group had a higher uptake of advance care planning (ACP) (39% vs 11%, P = .014), lower frequency of intensive care unit (ICU) admissions (5% vs 19%, P = .102) and were prescribed more opioids (96% vs 27%, P < .001) and benzodiazepines (39% vs 14%, P = .022). The palliative-intervention group experienced a longer median survival of 23.9 months (95% confidence interval [CI] 14.1–33.7) compared to the usual group (11.4 months [95% CI 5.4–17.3] (log-rank test: P = .023). Male gender was a strong predictor of 1-year mortality. Conclusions: The palliative-intervention group received earlier pharmacologic intervention for symptom relief. Healthcare utilization was not increased despite greater dyspnea-related disability.
Fetal Vascular Ectasia Can be an Artifact of Placental Fixation
Authors: Katzman Philip J , Metlay Leon A 
Published: April 2022

Background Placentas from outlying hospitals are formalin-fixed en route to our laboratory. We identified that chorionic, stem villus, and umbilical vessels in these fixed placentas are ectatic with greater frequency than in our in-house fresh placentas. Methods We searched our LIS for third trimester placentas using keywords “ectasia” or “ectatic” over a 12-month period. We fixed incoming in-house placentas over a 2-week period for 24–72 hours and tabulated the presence or absence of vascular ectasia as defined by Parast et al, 2008. Results The LIS search identified 61% of placental cases from outlying hospitals that had ectatic vessels vs 3% of in-house placentas ( P < .001). Of 38 placentas fixed in a 2-week period, 45% had ectatic chorionic or stem villus vessels and 21% had umbilical vessel ectasia. In comparison, in the 2 subsequent weeks, 3.8% ( P < .001) of fresh placentas had vascular ectasia. Conclusion These data suggest that large fetal vessels in the placenta become engorged with blood at delivery and, if fixed soon after delivery, remain ectatic and congested when processed for pathology. The identification of artifactual ectasia is important because fetal vessel ectasia can suggest the presence of fetal vascular malperfusion (FVM) if diagnostic signs of FVM are present.
Living bioethics, theories and children’s consent to heart surgery
Authors: Alderson Priscilla , Bowman Deborah , Brierley Joe , Dedieu Nathalie , Elliott Martin J , Montgomery Jonathan , Wellesley Hugo 
Published: April 2022

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights.
High-linearity, ultralow-detection-limit, and rapid-response strain sensing yarn for data gloves
Authors: Huang Fei , Hu Jiyong , Yan Xiong , Meng Fenye 
Published: April 2022

Highly integrated, low-cost and multi-functional electronic data gloves have attracted extensive attention in the Age of the Internet of Things. While significant progress has been made in the design of strain sensors with wide strain ranges, it is challenging to integrate high linearity, broad strain sensing range, and fast response into a single type of strain sensor, and these sensing properties play a critical role in the development of high-performance data gloves. Herein, this study presents a highly flexible, stretchable, and sensitive silver nanoparticles/double covered yarn (AgNPs/DCY) composite yarn, and this yarn as strain sensor achieves broad strain sensing range (50%), ultralow detection limit (0.05%), high linear sensitivity (GF = 10), instant response time (24 ms) and high repeatability, simultaneously. Interestingly, the AgNPs of the AgNPs/DCY composite yarns fabricated by in situ reduction are observed to not only evenly distributed on the fiber surface of DCY, but also within core fiber, and this distribution and the DCY structure; that is, the cooperative sensing effect of microcrack propagation of conductive layer on fibers and the electrical contact resistance contributes to the good sensing performance. Additionally, this composite yarn as strain sensor is invisibly integrated into textile data gloves and the capability of real-time monitoring various finger motions and effectively recognizing sign languages demonstrates the good sensing performance and practicability of the developed composite yarn. Therefore, the composite yarn as strain sensor has great prospects in wearable electronics.
Rule-directed and discovery learning in SCUBA-diving
Authors: Möller Fabian , Hoffmann Uwe , Steinberg Fabian , Vogt Tobias 
Published: April 2022

Time efficiency is crucial when teaching SCUBA-diving with limited practice time. Safety skills must be learned with sufficient quality and still be mastered after long breaks and in critical situations. We hypothesized a rule-directed learning approach (RL), which provides the learners with information on the best way to perform a skill, to show good initial results but less stability over time. Discovery learning (DL), which enables learners to experience more variability and to find individual solutions, might support greater stability over time and higher robustness to stress and fatigue. 25 beginners (age:22.5 ± 2.7; 5 females) were randomly assigned to RL (N = 13) or DL (N = 12) and received the same general criteria for successful deployment of a surface marker buoy. Only RL got additional visual presentation and explicit instructions. Six acquisition trials were conducted. Three evaluation trials were performed, video-recorded, and independently rated for water-position/trim, time, and safety-aspects (Pre). Another three rated trials were performed after 45 (±5) days without further practice (Retention). Safety performance was rated higher for RL both during Pre (P < 0.001) and Retention (P < 0.001), but RL took significantly more time during Pre (P < 0.001) and Retention (P < 0.001) and reported a significantly higher perceived performance quality during Retention (P = 0.014) compared to DL. Trim performance improved for RL and deteriorated for DL from Pre to Retention. Performance quality in unique aspects of the new skill seems to benefit more from explicit instructions with a detriment for speed. The suspected higher learning for DL and robust performance in the Retention test could not be observed.
Surgery improves survival in bladder signet-ring cell carcinoma-a population-based study
Authors: Alradhi Mohammed , Safi Mohammed , Tao Shenghua , Al-danakh Abdullah , Almoiliqy Marwan , Baldi Salem , Li Xiancheng 
Published: April 2022

Objectives: The purpose of this study is to determine the therapeutic value of surgery in individuals with urinary bladder signet ring cell carcinoma (SRCC). Surgery has not been examined as a prognostic factor for urinary bladder cancer (SRCC). Materials and Methods: Using the Surveillance, Epidemiology, and End Results program (SEER), patients with urinary bladder SRCC who presented from 1975 to 2018 were included in a retrospective study. The effect of surgical therapy on cause-specific survival (CSS) and overall survival (OS) was examined using univariate and multivariate Cox regression models. We subdivided 595 patients with SRCC into 2 groups, as follows: 496 who underwent surgery; and 99 who did not undergo surgery. Results: Males had high predominance in all cases in both groups ( p = 0.04). Moderate and poor differentiation (III–IV) were observed in the majority of patients who underwent surgery (77.2 vs 58.6, p ⩽ 0.001) and had no insurance ( p ⩽ 0.001). By using KM, the OS and CSS of the surgery group were found to be significantly better than those of the non-surgery group ( p  = 0.001,%) after adjusting for the variables of age, race, sex, primary site, grade, stage, lymph node removal, chemotherapy record, radiotherapy record, insurance, and marital status in the multivariate Cox proportional hazard model (hazard ratio [HR]= 0. 592; 95% confidence interval [CI] = 0.449–0.782; p = 0.0001). In comparison with chemotherapy and radiation, which resulted in poorer survival rates, surgery considerably improved survival outcomes in urinary bladder SRCC. The nomogram prediction model was built with C-index values of 0.70 and 73 for OS and CSS prediction, respectively. AUC in OS values were 0.77, 0.76, and 0.74, whereas AUC in CSS were 0.83, 0.80, and 0.79 for the 1-, 3-, and 5-year survival nomograms, respectively. Conclusion: Surgery was a significant independent predictor of bladder SRCC survival. Patients who underwent surgery had higher CSS and OS than people who did not undergo surgery. Surgery also led to better survival than the combination of the different treatment modalities.
Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital
Authors: Rose Suzanne J. , Waggener Laurie , Kiely Sharon C. , Hedge Alan 
Published: April 2022

Objective: A comparative study was undertaken to survey nurses working in an acute care nursing unit before and after moving to a new hospital to investigate the impact of a nursing unit designed utilizing Planetree build criteria. Background: The physical and emotional demands of frontline practitioners is a serious concern for patient safety and staff retention as the environmental design of nursing units can influence human errors from fatigue and interruption. Method: A pre-move survey was conducted with acute care nurses in a conventional design nursing unit who were moving to a new facility. After the move to the new hospital design, the same survey was readministered to obtain comparative performance information. Qualitative responses were analyzed for triangulation with survey responses. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores were collected over a 5-year period. Results: There were statistically significant improvements for most of the survey questions, especially for work efficiency and productivity, the design of the patient room and of support spaces, the information systems, and the environmental conditions. There were statistically significant improvements in the HCHAPS and Press Ganey survey questions. Conclusions: The postoccupancy survey showed statistically significant improvements in most of the concerns highlighted in the pre-move survey and significant improvements in the workflow and overall satisfaction of nurses. Press Ganey results revealed all but five domains fell in the significantly improved category.
de Winter syndrome, a STEMI-equivalent ECG pattern leading to life-threatening arrhythmia: A case report from a non-cardiac catheterization laboratory hospital
Authors: Parthiban Nirmalatiban , Sani Huzairi 
Published: April 2022

de Winter syndrome is a rare but important electrocardiographic pattern to recognize in patients presenting with chest pain. Under-recognition and delayed revascularization in patients with de Winter syndrome may lead to poor clinical outcomes. Despite increasing evidence of its association with total occlusion of the left anterior descending artery, the role of thrombolysis in the absence of percutaneous coronary intervention is not specifically addressed in recent international guidelines. Herein, we report a case of a 50-year-old gentleman with no known medical illness who presented with excruciating chest pain associated with diaphoresis, nausea, and reduced effort tolerance. Clinical examination revealed a distressed patient with bibasal crepitations with no other significant findings. The first ECG was sinus bradycardia with poor R-wave progression. ECG repeated 6 h later revealed de Winter syndrome. Within minutes, the patient developed sustained pulse ventricular tachycardia requiring synchronized cardioversion. The patient was intubated for impending cardiorespiratory failure. We took the pharmacoinvasive approach. The patient received thrombolytic therapy as percutaneous coronary intervention (PCI) was not available and transferring to the nearest cardiac center was not possible within the therapeutic window. He was then subsequently transferred to the nearest cardiac center post thrombolysis for PCI. We report this case study to highlight the importance of recognizing this STEMI-equivalent ECG pattern in patients presenting with chest pain, and call for randomized control trials to evaluate the effectiveness of thrombolytic therapy as an alternative emergent reperfusion strategy in de Winter syndrome in non-cardiac centers.