bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Exposure to Oxidant Gases and Mortality: Effect Modification by PM2.5 Transition Metals and Oxidative Potential
Authors: Toyib Olaniyan , Lavigne Eric , Traub Alison , Umbrio Dana , You Hongyu , Ripley Susannah , Pollitt Krystal , Shin Tim , Kulka Ryan , Jessiman Barry , Tjepkema Michael , Martin Randall , Stieb Dave M. , Hatzopoulou Marianne , Evans Greg , Burnett Richard T , Weichenthal Scott 
Published: September 2022

Background:
Populations are simultaneously exposed to outdoor concentrations of oxidant gases (i.e., O3 and NO2) and fine particulate air pollution (PM2.5). Since oxidative stress is thought to be an important mechanism explaining air pollution health effects, the adverse health impacts of oxidant gases may be greater in locations where PM2.5 is more capable of causing oxidative stress.

Methods:
We conducted a cohort study of 2 million adults in Canada between 2001 and 2016 living within 10 km of ground-level monitoring sites for outdoor PM2.5 components and oxidative potential. Ox exposures (i.e., the redox-weighted average of O3 and NO2) were estimated using a combination of chemical transport models, land use regression models, and ground-level data. Cox proportional hazards models were used to estimate associations between 3-year moving average Ox and mortality outcomes across strata of transition metals and sulfur in PM2.5 and three measures of PM2.5 oxidative potential adjusting for possible confounding factors.

Results:
Associations between Ox and mortality were consistently stronger in regions with elevated PM2.5 transition metal/sulfur content and oxidative potential. For example, each interquartile increase (6.27 ppb) in Ox was associated with a 14.9% (95% CI = 13.0, 16.9) increased risk of nonaccidental mortality in locations with glutathione-related oxidative potential (OPGSH) above the median whereas a 2.50% (95% CI = 0.600, 4.40) increase was observed in regions with OPGSH levels below the median (interaction P value <0.001).

Conclusion:
Spatial variations in PM2.5 composition and oxidative potential may contribute to heterogeneity in the observed health impacts of long-term exposures to oxidant gases.
Active smoking is associated with the development of adverse events of biological therapy in patients with inflammatory bowel disease
Authors: Theodoraki Eirini , Orfanoudaki Eleni , Petroulaki Eleni , Foteinogiannopoulou Kalliopi , Koutroubakis Ioannis E. 
Published: September 2022

Introduction
Smoking has been associated with lower levels of anti-TNF agents, higher antibodies and a reduced response to anti-TNF in patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the possible association between smoking and adverse events (AEs) of biologics in patients with IBD.

Material and methods
Consecutive IBD patients under biologics from a prospective, longitudinal registry of a tertiary center were included. A specially designed questionnaire including a wide range of AEs associated with biologics was also used.

Results
A total of 147 patients with IBD under biologics [median age (IQR) 46 (32.5–56) years, Crohn’s disease (CD) 109 (74%), female 51 (35%), under combination with immunosuppressants 60 (41 %), under intensified biologic therapy 50 (34%), under anti-TNF 132 (89%), vedolizumab 11 (7.5%), ustekinumab 3 (2%)] who had completed the questionnaire forms for AEs were included. There were 52 (35%) active smokers and 33 (22.5%) ex-smokers. The prevalence of all AEs was 88% in smokers, 87% in ex-smokers and 79% in nonsmokers. Active smoking was significantly associated with the presence of arthralgias and skin rashes (P = 0.01 and 0.002, respectively). These correlations were the same for the CD and ulcerative colitis (UC), except for arthralgias where there was a significant correlation only with CD (P = 0.001). There were no significant associations between smoking and other AEs (P > 0.05).

Conclusion
Active smoking is associated with the development of dermatological manifestations (both in UC and CD) and arthralgias (in CD) in IBD patients under biologics.
Factors associated with the development of extrahepatic malignancy in patients with nonalcoholic fatty liver disease: a single-center longitudinal study
Authors: Gumussoy Mesut , Koc Ozge , Karatas Gokturk , Ozercan Mubin , Ellik Zeynep , Duman Serkan , Kiremitci Saba , Gokcan Hale , Elhan Atilla Halil , Savas Berna , Idilman Ramazan 
Published: September 2022

Background and aims
The aim of the present study was to determine incident cases of extrahepatic malignancy in patients with nonalcoholic fatty liver disease (NAFLD) and to identify whether the factors are associated with cancer development.

Methods
Between 15 January 2001 and 14 March 2021, a total of 1365 patients had been diagnosed with NAFLD were enrolled in the study.

Results
The median follow-up period was 59.5 months. The mean age was 50.9 ± 10.9 years. The female gender was predominant (57%). During the follow-up period, 62 extrahepatic malignancies and 11 hepatocellular carcinomas were identified. Of all extrahepatic malignancies, 51 were solid organ malignancies and 11 were hematological malignancies. Female breast cancer was the most frequent (25.8%), followed by thyroid cancer (19.4%), lymphoma (12.9%), and lung cancer (9.7%). In univariate and multivariable analyses, after adjusting for age and sex, the presence of diabetes and high initial baseline gamma glutamyl transpeptidase (GGT) levels were significantly associated with the development of extrahepatic malignancies [hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.04–3.20, P = 0.036] and HR = 1.96, 95% CI: 1.14–3.38, P = 0.015, respectively). In 424 biopsy-proven NAFLD patients, the development of extrahepatic cancer was significantly associated with the severity of hepatic fibrosis (HR = 3.31, 95% CI: 1.36–8.07; P = 0.008).

Conclusion
Extrahepatic malignancies are frequently seen in patients with NAFLD. Diabetes mellitus, high baseline GGT levels, and significant hepatic fibrosis are associated with the development of extrahepatic cancer in patients with NAFLD.
The vermiform cecal appendix, expendable or essential? A narrative review
Authors: Vitetta Luis 
Published: September 2022

Purpose of review
The vermiform cecal appendix is a small thin pouch-like tube of intestinal tissue situated in the lower right abdomen. It is attached at the junction of the large intestine between the ascending colon and small intestine. Historically, the appendix has been labeled redundant with no significant function, a remnant of evolution. This idea was thought to represent a function that may have been critical for survival that became nonsignificant over time. Evolutionary biologists deemed it to be a vestigial organ that early in human evolution was a dedicated organ that was useful and exploited by herbivorous ancestors.

Recent findings
Currently, the vermiform cecal appendix has generated significant renewed research interest. As such it has been reported to present a site with a high concentration of lymphoid tissue and a biofilm microbiome that approximately mirrors that which is found in the large bowel.

Summary
Research suggests that the vermiform cecal appendix may be the site of a safe-house biofilm that could re-inoculate the large bowel. Given that the appendix has no known role in digestion, the network of lymphoid tissue and microbiome could constitute an initial site of bacterial translocations that can influence early life ontology and immunological tolerance. A dysbiotic microbiome in the appendix is posited to trigger inflammatory sequelae.
A great disturbance in the force: IL-2 receptor defects disrupt immune homeostasis
Authors: Hernandez Joseph D. , Hsieh Elena W.Y. 
Published: September 2022

Purpose of review
The current review highlights how inborn errors of immunity (IEI) due to IL-2 receptor (IL-2R) subunit defects may result in children presenting with a wide variety of infectious and inflammatory presentations beyond typical X-linked severe combined immune deficiency (X-SCID) associated with IL-2Rγ.

Recent findings
Newborn screening has made diagnosis of typical SCID presenting with severe infections less common. Instead, infants are typically diagnosed in the first days of life when they appear healthy. Although earlier diagnosis has improved clinical outcomes for X-SCID, atypical SCID or other IEI not detected on newborn screening may present with more limited infectious presentations and/or profound immune dysregulation. Early management to prevent/control infections and reduce inflammatory complications is important for optimal outcomes of definitive therapies. Hematopoietic stem cell transplant (HSCT) is curative for IL-2Rα, IL-2Rβ, and IL-2Rγ defects, but gene therapy may yield comparable results for X-SCID.

Summary
Defects in IL-2R subunits present with infectious and inflammatory phenotypes that should raise clinician's concern for IEI. Immunophenotyping may support the suspicion for diagnosis, but ultimately genetic studies will confirm the diagnosis and enable family counseling. Management of infectious and inflammatory complications will determine the success of gene therapy or HSCT.
Challenges in and ideas for diagnosing primary immunodeficiencies in Uganda
Authors: Barugahare Banson J. 
Published: September 2022

Purpose of review
Primary immunodeficiencies (PIDs) lately referred to as inborn errors of immunity, are consequences of mutations that affect the immune integrity and function. Globally, severe PIDs are more common in infants and are fatal if not timely – appropriately diagnosed and managed. PID programmes and policies vary from country to country. The purpose of this review is to highlight PIDs initiatives and activities in Uganda with a focus on challenges and ideas for diagnosis.

Recent findings
It is now established that appropriate PID diagnosis leads to best treatment options for quality of life for the patients. However, there are still global disparities with these great milestones. PID awareness remains a fundamental global challenge. Autoimmune cytopenia, haemogram and peripheral blood film may be critical PIDs diagnostic markers and tests, respectively, for low-income countries.

Summary
As awareness is a master key to appropriate PID diagnosis and management, there is a need to design multidisciplinary and sustainable strategies. Complete blood counts and immunoglobulin profile tests may be less expensive alternatives for early diagnosis of PIDs in Uganda and other low-income countries.
Adherence in transplantation
Authors: Kuntz Kristin , Engel Kristy 
Published: September 2022

Purpose of Review
Adequately managing a complex medical regimen is paramount to the success of organ transplants. When patients stray from their prescribed medical regimen posttransplant, graft rejection, and death can occur. Predictors of adherence have been studied for many years, and various factors have been identified as contributing to adequate or poor adherence. Both demographic and personal characteristics have been associated with adherence behavior. However, recent developments, such as the COVID-19 pandemic, increased use of mobile health interventions, and use of medical biomarkers have affected the way adherence is measured and applied.

Recent Findings
The COVID-19 pandemic affected patients’ comfort with accessing outpatient care and created a wider use of telehealth services. Measurement of adherence through serum lab levels continues to be reviewed as a potential objective assessment of adherence. Psychosocial factors continue to be identified as major contributors to nonadherence.

Summary
Adherence to antirejection medication, lab work, appointments, and exercise and dietary instructions remains critical to the health of the transplant patient. It is critical that providers involved in the selection process and posttransplant treatment of these patients remain well informed of potential new factors affecting adherence.
A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units
Authors: Beckman Rebecca J. , Hutton Scott , Czekanski Elizabeth , Vance Kelly , Mohr David C. 
Published: September 2022

OBJECTIVE
This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units.

BACKGROUND
Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units.

METHODS
This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures.

RESULTS
A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes.

CONCLUSIONS
Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.
Variations in Demonstrated Emotional Intelligence: Trainee to Experienced Faculty Member*
Authors: Loscalzo Steven M. , Lockman Justin L. , Spector Nancy D. , Boyer Donald L. 
Published: September 2022

OBJECTIVES:
To identify differences in emotional intelligence (EI)–related competencies between fellows and faculty in a cohort of pediatric critical care physicians.

DESIGN:
Single-center, cross-sectional observation study.

SETTING:
Seventy-two-bed multidisciplinary pediatric critical care unit at a quaternary children’s hospital (Children’s Hospital of Philadelphia, Philadelphia, PA).

SUBJECTS:
Forty-seven critical care physicians, including 19 fellows and 28 faculty members, were assessed. A multidisciplinary team of 83 physicians, nurses, and nurse practitioners contributed to the assessments.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A multirater EI assessment tool (Emotional and Social Competency Inventory 360) was used to measure EI competencies of participating physicians across 12 core competencies. Utilizing a priori scoring definitions, physician EI competencies were classified as strengths or areas for growth. Results were stratified based on provider experience, generating comparisons between fellow and faculty cohorts. Ninety-four percent (177/188) of distributed assessments were completed. Fellow strengths were identified as organization awareness, achievement orientation, and teamwork; areas for growth were influence and emotional self-awareness. Compared with fellows, faculty members demonstrated additional strengths in the domains of adaptability, emotional self-control, coach and mentor, positive outlook, inspirational leadership, and influence.

CONCLUSIONS:
This study provides the first characterization of EI competencies among trainees and faculty members using a validated multirater assessment tool. The descriptions of physician EI, based on years of experience, are an important piece of the foundation for future explorations into the advancement of physician EI and effective leadership.
Trends in Cause-Specific Mortality Among Veterans With HIV: A 35-Year (1982–2016) Analysis of the HIV Atlanta VA Cohort Study
Authors: Vyas Kartavya J. , Marconi Vincent C. , Moanna Abeer , Rimland David , Guest Jodie L. 
Published: September 2022

Background:
Causes of death and their trends among veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH.

Setting:
The HIV Atlanta VA Cohort Study includes all VWH who ever sought care at the Atlanta VA Medical Center.

Methods:
Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre-cART (1982–1996), early-cART (1997–2006), and late-cART (2007–2016) eras. Trends were assessed using Kaplan–Meier curves, cumulative incidence functions, and joinpoint regression models. Risk factors were identified by Cox proportional hazards models.

Results:
Of the 4674 VWH in the HIV Atlanta VA Cohort Study, 1752 died; of whom, 1399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-cART, early-cART, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non–AIDS-related mortality in the pre-cART era, followed by declines in the early-cART and late-cART eras. All-cause, AIDS-related, and non–AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre-cART to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non–AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV.

Conclusions:
In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging but also intervene and address lifestyle risk factors.
Reduced Iodinated Contrast Media Administration in Coronary CT Angiography on a Clinical Photon-Counting Detector CT System
Authors: Emrich Tilman , O'Doherty Jim , Schoepf U. Joseph , Suranyi Pal , Aquino Gilberto , Kloeckner Roman , Halfmann Moritz C. , Allmendinger Thomas , Schmidt Bernhard , Flohr Thomas , Varga-Szemes Akos 
Published: September 2022

Purpose
The aim of this study was to evaluate strategies to reduce contrast media volumes for coronary computed tomography (CT) angiography on a clinical first-generation dual-source photon-counting detector (PCD)-CT system using a dynamic circulation phantom.

Materials and Methods
Coronary CT angiograph is an established method for the assessment of coronary artery disease that relies on the administration of iodinated contrast media. Reduction of contrast media volumes while maintaining diagnostic image quality is desirable. In this study, a dynamic phantom containing a 3-dimensional-printed model of the thoracic aorta and coronary arteries was evaluated using a clinical contrast injection protocol with stepwise reduced contrast agent concentrations (100%, 75%, 50%, 40%, 30%, and 20% contrast media content of the same 50 mL bolus, resulting in iodine delivery rates of 1.5, 1.1, 0.7, 0.6, 0.4 and 0.3 gl/s) on a first-generation, dual-source PCD-CT. Polychromatic images (T3D) and virtual monoenergetic images were reconstructed in the range of 40 to 70 keV in 5-keV steps. Attenuation and noise were measured in the coronary arteries and background material and the contrast-to-noise ratio (CNR) were calculated. Attenuation of 350 HU and a CNR of the reference protocol at 70 keV were regarded as sufficient for simulation of diagnostic purposes. Vessel sharpness and noise power spectra were analyzed for the aforementioned reconstructions.

Results
The standard clinical contrast protocol (bolus with 100% contrast) yielded diagnostic coronary artery attenuation for all tested reconstructions (>398 HU). A 50% reduction in contrast media concentration demonstrated sufficient attenuation of the coronary arteries at 40 to 55 keV (>366 HU). Virtual monoenergetic image reconstructions of 40 to 45 and 40 keV allowed satisfactory attenuation of the coronary arteries for contrast concentrations of 40% and 30% of the original protocol. A reduction of contrast agent concentration to 20% of the initial concentration provided insufficient attenuation in the target vessels for all reconstructions. The highest CNR was found for virtual monoenergetic reconstructions at 40 keV for all contrast media injection protocols, yielding a sufficient CNR at a 50% reduction of contrast agent concentration.

Conclusions
Using virtual monoenergetic image reconstructions at 40 keV on a dual-source PCD-CT system, contrast media concentration could be reduced by 50% to obtain diagnostic attenuation and objective image quality for coronary CT angiography in a dynamic vessel phantom. These initial feasibility study results have to be validated in clinical studies.
Application of 3-Dimensional White-Light Scanning to Observe the Lip and Nose Morphology of Chinese Children
Authors: Zhang Songchunyuan , Zhang Shuai , Fang Cheng , Lan Dongyi , Dong Chenbin 
Published: September 2022

Objective:
To establish a database and study the growth and development of Chinese children’s nasolabial units by 3-dimensional (3D) white-light scanning technology.

Materials and Methods:
From January 2018 to January 2019, 528 patients were selected preoperatively in our hospital, without cranial or maxillofacial deformities. The patients were placed in supine positions in a state of sedation, and the authors used a 3D white-light scanner to scan the children’s faces to measure the 3D morphological structure of their nasolabial areas. The results were presented with Graphpad Prism 8.0.2 to explore correlations and analyze trends.

Results:
The selected Chinese children consisted of 356 males (67.4%) and 172 females (32.6%). All nasolabial subunits grew fastest at 0 to 2 years old and at a slower rate from 2 to 15 years old, whereas the relevant growth of different sex was similar among contemporaries.

Conclusions:
Three-dimensional white-light scanning can quickly and accurately gain 3D imaging of nasolabial soft tissue to build a normal morphology database. Furthermore, every nasolabial subunit grows fastest at the age of 0 to 2 years.
How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement
Authors: Christie S. Ariane , Zheng Dennis , Dissak-Delon Fanny , Kinge Thompson , Njock Richard , Nkusu Daniel , Tsiagadigui Jean-Gustave , Mbianyor Mbiarikai , Dicker Rochelle , Chichom-Mefire Alain , Juillard Catherine 
Published: September 2022

BACKGROUND
Injury deaths in sub-Saharan Africa are among the world's highest, but hospital data rarely have sufficient granularity to direct quality improvement. We analyzed clinical care patterns among trauma patients who died in a prospective, multicenter sub-Saharan cohort to pinpoint trauma quality improvement intervention targets.

METHODS
In-hospital trauma deaths in four Cameroonian hospitals between 2017 and 2019 were included. Trauma registry data on patient demographics, injury characteristics, and clinical care were analyzed to identify opportunities for systems improvements.

RESULTS
Among 9,423 trauma patients, there were 236 deaths. Overall, 83% of patients who died in the emergency department were living on arrival (LOA). Among 183 LOA patients, 30% presented with normal vital signs, but 11% had no vital signs taken, often because of lack of equipment (43%). Of LOA patients presenting with a Glasgow Coma Scale score of <9 (56%), few received neurosurgery consults (15%), C-collar placement (9%), or intubation (1%). The most common reason for lack of c-collar placement was failure to recognize that it was indicated (66%). Tracheal deviation, unequal breath sounds, or paradoxical chest movement were present in 63% of LOA patients, but only two patients had chest tubes placed. Hypotension or active bleeding was present in 80% of LOA patients; while crystalloid bolus was given to 96% of these patients, few received transfusion (8%), tourniquet placement for extremity injury (6%), or an operation (4%).

CONCLUSION
Primary survey interventions are underperformed in trauma nonsurvivors in Cameroon. Protocolizing early treatment for head injury, hemorrhagic shock, and chest wall trauma could reduce trauma mortality.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.