bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Stepwise Haemostasis Intraoperative Protocol Driven Reduction of Haematoma Rate Following Symptomatic Carotidendarterectomy
Authors: Baker Daryll M , Jacob Lebeth , Busuttil Andrew 
Published: October 2022

Introduction Carotid endarterectomy (CEA) for symptomatic stenosis reduces further stroke risk. Post-CEA haematoma increases the risk of complications including stroke. There are few studies considering protocols aimed at reducing post-CEA haematoma rates. Presented are the outcomes of a protocol developed to reduce this surgical complication. Method The protocol was implemented in 112 consecutive CEA. It involves stepwise additional measures to ensure haemostasis before wound closure. Attention to bleeding points is followed by light compression for 10 min. Protamine is then given if haemostasis has not been achieved. If after 20 min the problem persists Tranexamic acid is given. Following a further 20 min if haemostasis is not yet achieved a platelet transfusion is undertaken. Haematoma rates, return to theatre for post-operative haematoma and other complications were compared with 100 consecutive pre-protocol introduction CEA cases. Results Of 112 CEA patients, 19 received protamine, 8 protamine and tranexamic acid. One case required platelet transfusion. Neck haematoma rate fell from 10 to 3 cases ( P = .02, OR: 0.25 [95% CI .07-.94]), of which returned to theatre for haematoma evacuation fell from 6 to 1 case ( P = .03, OR: 0.14 [95% CI .02-1.19]). 30 day stroke and death rate reduced from 5% to 1.8% ( P = .11, OR: 0.35 [95% CI .07-1.82]). Conclusion The stepwise haemostasis intraoperative protocol can reduce post-CEA haematoma rates.
Racial Disparities in Charges, Length of Stay, and Complications Following Adult Inpatient Epistaxis Treatment
Authors: Randhawa Avneet , Randhawa Karandeep S. , Tseng Christopher C. , Fang Christina H. , Baredes Soly , Eloy Jean Anderson 
Published: October 2022

Background Although recent studies have identified an association between race and adverse outcomes in head and neck surgeries, there are limited data examining the impact of racial disparities on adult inpatient outcomes following epistaxis management procedures. Objective To analyze the association between race and adverse outcomes in hospitalized patients undergoing epistaxis treatment. Methods This retrospective cohort analysis utilized the 2003 to 2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify cases with a primary diagnosis of epistaxis that underwent a procedure for epistaxis control. Cases with missing data were excluded. Higher total charges and prolonged length of stay (LOS) were indicated by values greater than the 75th percentile. Demographics, hospital characteristics, Elixhauser comorbidity score, and complications were compared among race cohorts using univariate chi-square analysis and one-way analysis of variance (ANOVA). The independent effect of race on adverse outcomes was analyzed using multivariate binary logistic regression while adjusting for the aforementioned variables. Results Of the 83 356 cases of epistaxis included, 80.3% were White, 12.5% Black, and 7.2% Hispanic. Black patients had increased odds of urinary/renal complications (odds ratio [OR] 2.148, 95% confidence interval [CI] 1.797-2.569, P < .001) compared to White patients. Additionally, Black patients experienced higher odds of prolonged LOS (OR 1.227, 95% CI 1.101-1.367, P < .001) and higher total charges (OR 1.257, 95% CI 1.109-1.426, P < .001) compared to White patients. Similarly, Hispanic patients were more likely to experience urinary/renal complications (OR 1.605, 95% CI 1.244-2.071, P < .001), higher total charges (OR 1.519, 95% CI 1.302-1.772, P < .001), and prolonged LOS (OR 1.157, 95% CI 1.007-1.331, P = .040) compared to White patients. Conclusion Race is an important factor associated with an increased incidence of complications in hospitalized patients treated for epistaxis.
A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries
Authors: Nizeyimana Eugene , Joseph Conran , Plastow Nicola , Dawood Gouwa , Louw Quinette A 
Published: October 2022

Objective To scope all published information reporting on the feasibility, cost, access to rehabilitation services, implementation processes including barriers and facilitators of telerehabilitation (TR) in low- and middle-income countries (LMICs) and high-income countries (HICs). Methods A comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library, EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric, MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well as ProQuest databases were conducted. To maximise the coverage of the literature, the reference lists of included articles identified through the search were also screened. The analysis included both descriptive summary and inductive thematic analysis. Results Twenty-nine studies were included. TR was reported to be feasible, cost-saving and improved access to rehabilitation services in both HICs and LMICs settings. Asynchronous methods using different mobile apps (Skype, WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were the most common mode of TR delivery. Barriers to the implementation were identified and categorised in terms of human, organisational, technical and clinical practice related factors. Facilitators for health professionals and patients/caregivers’ dyads were also identified. Conclusion TR could be considered a feasible service delivery mode in both HICs and LMICs. However, the mitigation of barriers such as lack of knowledge and technical skills among TR providers and service users, lack of secure platform dedicated for TR, lack of resources and connectivity issues which are particularly prevalent in LMICs will be important to optimise the benefits of TR.
Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States?
Authors: Sharma Arjun , Basu Sanjay 
Published: October 2022

Introduction: Rural counties in the United States have lower life expectancy than their urban counterparts and comprise the majority of primary care provider (PCP) shortage areas. We evaluated whether PCP availability mediates the relationship between rurality and lower life expectancy. Methods: We performed a mediation analysis on a panel dataset which included county-level estimates (N = 3103) for the years 2010, 2015, and 2017, and on a subset containing only rural counties (N = 1973), with life expectancy as the outcome variable, urbanity as the independent variable, and PCP density as the mediating variable. County-level socio-demographic data were included as covariates. Results and Conclusions: PCP density mediated 10.1% of the relationship between urbanity and life expectancy in rural counties. Increasing PCP density in rural counties with PCP shortages to the threshold of being a non-shortage county (>1 physician/3500 population, as defined by the Health Resources and Services Administration) would be expected to increase mean life expectancy in the county by 26.1 days (95% confidence interval [CI]: 11.4, 49.3) and increasing it to the standards recommended by a Secretarial Negotiated Rulemaking Committee would be expected to increase mean life expectancy by 65.3 days (95% CI: 42.6, 87.5). PCP density is a meaningful mediator of the relationship between urbanity and life expectancy. The mediation effect observed was higher in rural counties compared to all counties. Understanding how PCP density may be increased in rural areas may be of benefit to rural life expectancy.
Obesity and Patient Activation: Confidence, Communication, and Information Seeking Behavior
Authors: Chang Ji Eun , Lindenfeld Zoe , Chang Virginia W. 
Published: October 2022

Introduction/Objectives: Patient activation describes the knowledge, skills, and confidence that allow patients to actively engage in managing their health. Prior studies have found a strong relationship between patient activation and clinical outcomes, costs of care, and patient experience. Patients who are obese or overweight may be less engaged than normal weight patients due to lower confidence or stigma associated with their weight. The objective of this study is to examine whether weight status is associated with patient activation and its sub-domains (confidence, communication, information-seeking behavior). Methods: This repeated cross-sectional study of the 2011 to 2013 Medicare Current Beneficiary Survey (MCBS) included a nationally representative sample of 13,721 Medicare beneficiaries. Weight categories (normal, overweight, obese) were based on body mass index. Patient activation (high, medium, low) was based on responses to the MCBS Patient Activation Supplement. Results: We found no differences in overall patient activation by weight categories. However, compared to those with normal weight, people with obesity had a higher relative risk (RRR 1.24; CI 1.09-1.42) of “low” rather than “high” confidence. Respondents with obesity had a lower relative risk (RRR 0.82; CI 0.73-0.92) of “low” rather than “high” ratings of communication with their doctor. Discussion and Conclusions: Though patients with obesity may be less confident in their ability to manage their health, they are more likely to view their communication with physicians as conducive to self-care management. Given the high receptivity among patients with obesity toward physician communication, physicians may be uniquely situated to guide and support patients in gaining the confidence they need to reach weight loss goals.
Retrospective Analysis of Ulnar Collateral Ligament Reconstructions in Major League Baseball Pitchers: A Comparison of the “Tall and Fall” Versus “Drop and Drive” Pitching Styles
Authors: Beaudry Mason F. , Beaudry Anna G. , Bradley James P. , Davis Scott , Baker Brent A. , Holland Glenn , Jacobson Bradley R. , Chetlin Robert D. 
Published: October 2022

Background: Previous pilot research has investigated differences in elbow valgus torque between the “tall and fall” (TF) and “drop and drive” (DD) pitching styles. Whether one of these pitching styles is associated with a greater rate of ulnar collateral ligament reconstruction (UCLR) is currently unknown. Purpose: To determine the proportion of Major League Baseball (MLB) pitchers using the TF and DD pitching styles who underwent UCLR over a 10-year period. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The demographic characteristics of pitchers who underwent UCLR between 2007 and 2017 were obtained via the open-source database MLB Player Analysis Tommy John Surgery List. Other information, such as previous UCLR and pitching videos and graphics, was obtained from other open-source databases. A comprehensive, 2-dimensional, kinesiology-based multicomponent definition of each pitching style was formulated and used to categorize the included pitchers into the TF and DD groups. Statistical comparisons and contrasts were made using chi-square and Pearson correlation tests. Results: Included were 223 MLB pitchers (mean ± SD age, 27.5 ± 3.6 years; body mass index [BMI], 27.6 ± 2.2; throwing velocity, 92.9 ± 2.6 mph [149.5 ± 4.2 km/h]) who underwent UCLR between 2007 and 2017. Of these pitchers, 162 were categorized as TF pitchers (72.6%) and 61 as DD pitchers (27.4%). Pitching velocity for injured pitchers was significantly correlated to BMI ( P < .001). We found no significant associations of pitching style with year of UCLR ( P = .941), BMI ( P = .549), age ( P = .647), handedness ( P = .501), or average pitch velocity ( P = .921). Conclusion: The study findings demonstrated that a higher proportion of UCL-injured MLB pitchers (72.6%) used the TF pitching style. Further research is needed to explore the potential association between pitching style and UCL injury.
Do multinational enterprises with better social performance have a higher likelihood of cross-border acquisition completion? Analyzing the role of reputation for social performance in cross-border acquisitions
Authors: Waqar Wafa Tariq , Ma Yan 
Published: October 2022

The social performance (SP) of a firm is associated with many positive organizational outcomes. Nonetheless, little is known about the effect of the SP of a multinational enterprise (MNE) on the likelihood of cross-border acquisition completion (CBAC). Investigating the link between MNEs’ SP and the likelihood of CBAC is important because it will increase our understanding of how stakeholders reward MNEs with better reputations. Drawing on the signaling and reputation for SP literature, we explore how acquisition complexity, reputational risk, and firm visibility influence CBAC. Based on a sample of 578 cross-border deals undertaken by acquirers in the noncyclical consumer industry (NCCI), our results support a positive relationship between MNEs’ SP and the likelihood of CBAC and strengthening moderating effects of acquirer size and public targets. JEL CLASSIFICATIONS: G34, M16
The use of bladder voiding efficiency in assessing benign prostatic enlargement
Authors: Kapesa Philimon , Bowa Kasonde 
Published: October 2022

AbstractBackgroundThe management of benign prostatic enlargement (BPE) in low resource settings poses a major challenge in Africa. The objective of the study was to investigate the accuracy of Bladder Voiding Efficiency (BVE) to assess lower Urinary Tract Symptoms (LUTS) among BPE patients in a low resource setting.MethodsFrom December 2017 to March 2018, patients with benign prostatic enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS) were recruited into the study. The study was a prospective cross-sectional study. Participants had the International Prostate Symptom Score (IPSS) recorded followed by evaluation of their Bladder Voiding Efficiency (BVE). The BVE was calculated as the ratio of the volume of Urine voided over total volume of Urine in the bladder at the time of the void. The data were analysed to show the Sensitivity and Specificity of BVE in symptomatic LUTS. The Pearson correlation co-efficient between IPSS and BVE was analysed.ResultsThe study recruited 94 participants. The age range was 45 to 85 year. The mean age was 68.1 years. The sensitivity of BVE to detect severe LUTS was 97.97%, while the specificity of BVE to detect mild to moderate disease was 97.78%. The correlation coefficient between IPSS and BVE was negatively correlated at 0.89, and this was statistically significant (P < 0.001).ConclusionThe Bladder Voiding Efficiency (BVE) is a highly sensitive and specific test in our population to detect LUTS. It is well correlated to the International Prostate Severity Score in this study population.
Comparing diagnostic performance of Cantonese-Chinese version of Rome IV criteria and a short Reference Standard for functional dyspepsia in China
Authors: Ho Leonard , Chen Shuijiao , Ho Fai Fai , Wong Charlene H. L. , Ching Jessica Y. L. , Cheong Pui Kuan , Wu Irene X. Y. , Liu Xiaowei , Leung Ting Hung , Wu Justin C. Y. , Chung Vincent C. H. 
Published: October 2022

Abstract
Introduction
Functional dyspepsia (FD) is diagnosed based on self-reported symptoms and negative upper gastrointestinal endoscopic findings. The Rome criteria were not adopted as a diagnostic instrument in clinical guidelines due to their complexity. Different guidelines used relatively simple symptom assessment schemes with contents that vary significantly. A previously evaluated short Reference Standard may serve as a more standardised tool for guidelines. We evaluated its diagnostic accuracy against the Rome IV criteria in a cross-sectional study in Hong Kong.

Methods
A total of 220 dyspeptic patients sampled consecutively from a tertiary hospital and the community completed the Rome IV diagnostic questionnaire, which was translated into Cantonese-Chinese, and the Reference Standard. Sensitivity, specificity, positive and negative likelihood ratios (LRs), and area under the receiver operating characteristics curve (AUC), with 95% confidence intervals (CIs), were calculated.

Results
Among the participants, 160 (72.7%) fulfilled the Reference Standard with negative upper gastrointestinal endoscopic results. The Reference Standard identified patients with Rome IV-defined FD with 91.1% (95% CI 82.6%–96.4%) sensitivity and 37.6% (95% CI 29.6%–46.1%) specificity. The positive and negative LRs were 1.46 (95% CI 1.26–1.69) and 0.24 (95% CI 0.11–0.49), respectively. The AUC value was 0.64 (95% CI 0.59–0.69).

Conclusions
The Reference Standard can rule out patients without Rome IV-defined FD. It may be used as an initial screening tool for FD in settings where the use of the Rome IV criteria is impractical. It may also provide a uniform definition and diagnostic rule for future updates of clinical guidelines.
Long-term outcome of lamivudine/dolutegravir dual therapy in HIV-infected, virologically suppressed patients
Authors: Maggiolo Franco , Gulminetti Roberto , Pagnucco Layla , Digaetano Margherita , Cervo Adriana , Valenti Daniela , Callegaro Annapaola , Mussini Cristina 
Published: October 2022

Abstract
Background
The use of DTG-containing two-drug regimens is one of the most promising solutions to the need to ease the management of HIV treatment without harming its efficacy and safety. We report long- term results in patients switched, while virologically suppressed, to the combination of dolutegravir (DTG) plus lamivudine (3TC).

Methods
This is a prospective, clinical, uncontrolled cohort enrolling ART-experienced people living with HIV (PLWH) with HIV-RNA < 50 copies/ml for 6 months or longer, negative hepatitis B virus surface antigen, and without known M184V/I mutations. Kaplan-Meiers curves are used to describe persistency of virological suppression on therapy and a Cox regression model to evaluate baseline characteristics and the risk of stopping therapy.

Results
218 individuals switched their regimen since 2015. The mean estimated follow-up was of 64.3 months (95% CI 61.3–67.3) for approximately 1000 patient/years. After 5 years of follow-up, 77.1% were still on the DTG-3TC combination. No virologic failure was detected throughout the whole study period, and only 15 subjects presented single isolated viral blips above 50 copies/ml. Most patients stopped therapy because of reasons unrelated to study drugs (lost to follow-up; patients’ decision; moved to other Centers), but due to the unselected nature of the casuistry; 11 subjects died in the 5 years of follow-up mostly because of pre-existing co-morbidities (6 neoplastic diseases and 2 end-stage liver disease). The median baseline CD4 count was 669 cells/mcl (IQR 483–927). After 5 years it raised to 899 cells/mcl (IQR 646–1160) (P < 0.001) without a significant change of CD8 counts that lowered from 767 cells/mcl (IQR 532–1034) to 683 cells/mcl (IQR 538–988). Consequently, the CD4/CD8 ratio varied from 0.93 (IQR 0.60–1.30) to 1.15 (IQR 0.77–1.45) (P < 0.0001). A non-significant (P = 0.320) increment of mean creatinine, 0.06 mg/dl in magnitude, was observed over the whole follow-up.

Conclusion
These long-term results over 5 years reinforce the durability and good tolerability of DTG-3TC. Our results continue to support the recommended switch use of this 2DR as a well-accepted treatment option for ART-experienced PLWH.
Improving chronic kidney disease detection and treatment in the United States: the chronic kidney disease cascade of care (C3) study protocol
Authors: Lamprea-Montealegre Julio A. , Joshi Priya , Shapiro Abigail S. , Madden Erin , Navarra Krista , Potok O. Alison , Gregg L. Parker , Podchiyska Tanya , Robinson Amy , Goldstein Mary K. , Peralta Carmen A. , Jassal Simerjot K. , Navaneethan Sankar D. , Rifkin Dena. E. , Wang Virginia , Shlipak Michael G. , Estrella Michelle M. 
Published: October 2022

Abstract
Background
There are major gaps in the implementation of guideline-concordant care for persons with chronic kidney disease (CKD). The CKD Cascade of Care (C3) initiative seeks to improve CKD care by improving detection and treatment of CKD in primary care.

Methods
C3 is a multi-modal initiative deployed in three major academic medical centers within the Department of Veterans Affairs (VA) Health Care System: San Francisco VA, San Diego VA, and Houston VA. The main objective of the first phase of C3 described in this protocol is to establish the infrastructure for universal CKD detection among primary care patients at high-risk for CKD with a triple-marker screen comprising cystatin C, creatinine, and albuminuria. Across the three sites, a comprehensive educational intervention and the integration of primary care-based clinical champions will be employed with the goal of improving CKD detection and treatment. The San Francisco VA will also implement a practice-facilitation intervention leveraging telehealth and health informatics tools and capabilities for enhanced CKD detection. Parallel formative evaluation across the three sites will assess the feasibility and acceptability of integrating cystatin C as part of routine CKD detection in primary care practice. The effectiveness of the interventions will be assessed using a pre-post observational design for change in the proportion of patients tested annually for CKD. Secondary outcomes will assess change in the initiation of cardio-kidney protective therapies and in nephrology referrals of high-risk patients.

Discussion
The first phase of C3 is a multi-facility multi-modal initiative that aims to improve CKD care by implementing a triple-marker screen for enhanced CKD detection in primary care.
Effects of urinary extracellular vesicles from prostate cancer patients on the transcriptomes of cancer-associated and normal fibroblasts
Authors: Sadovska Lilite , Zayakin Pawel , Bajo-Santos Cristina , Endzeliņš Edgars , Auders Jānis , Keiša Laura , Jansons Juris , Lietuvietis Vilnis , Linē Aija 
Published: October 2022

Abstract
Background
Increasing evidence suggests that cancer-derived extracellular vesicles (EVs) alter the phenotype and functions of fibroblasts and trigger the reprogramming of normal fibroblasts into cancer-associated fibroblasts (CAFs). Here, we for the first time studied the effects of urinary EVs from PC patients and healthy males on the transcriptional landscape of prostate CAFs and normal foreskin fibroblasts.

Methods
Patient-derived prostate fibroblast primary cultures PCF-54 and PCF-55 were established from two specimens of PC tissues. EVs were isolated from urine samples of 3 patients with PC and 2 healthy males and used for the treatment of prostate fibroblast primary cultures and normal foreskin fibroblasts. The EV-treated fibroblasts were subjected to RNA sequencing analysis.

Results
RNA sequencing analysis showed that the fibroblast cultures differed significantly in their response to urinary EVs. The transcriptional response of foreskin fibroblasts to the urinary EVs isolated from PC patients and healthy controls was very similar and mostly related to the normal functions of fibroblasts. On the contrary, PCF-54 cells responded very differently - EVs from PC patients elicited transcriptional changes related to the regulation of the cell division and chromosome segregation, whereas EVs from healthy males affected mitochondrial respiration. In PCF-55 cells, EVs from both, PC-patients and controls induced the expression of a number of chemokines such as CCL2, CCL13, CXCL1, CXCL8, whereas pathways related to regulation of apoptotic signaling and production of cell adhesion molecules were triggered specifically by EVs from PC patients.

Conclusion
This study demonstrates that urinary EVs from PC patients and healthy controls elicit distinct transcriptional responses in prostate CAFs and supports the idea that EVs contribute to the generation of functional heterogeneity of CAFs. Moreover, this study suggests that the changes in the gene expression pattern in EV recipient cells might serve as a novel type of functional cancer biomarkers.