bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Outcome of Cerumen Removal in the Pediatric Emergency Department
Authors: Tavor Oren , Schnapp Zeev , Soffer Gili Palnizky , DeRowe Ari , Rimon Ayelet 
Published: May 2022

Objective
Cerumen obstructs the visualization of the tympanic membrane (TM) in up to 40% of children, sometimes posing a challenge to rule out the diagnosis of acute otitis media (AOM) as the source of otalgia (for verbal children), irritability, fever, and febrile seizures. We aim to determine the rate at which removing the cerumen from blocking the view of the TM could change the management of these patients in the pediatric emergency department (PED).

Methods
We retrospectively investigated all medical records of patients who underwent cerumen removal in the PED at a tertiary children's hospital from 2018 to 2019. We analyzed the effect of the procedure on the subsequent workup during their PED visit.

Results
Of 482 children who presented to the PED with otalgia, irritability, fever, and/or febrile seizures and who were referred to an otolaryngologist for subsequent treatment after preliminary evaluation in the PED, 176 were included in the study group after having the cerumen removed from one or both ears. Seventy-three of them were given a diagnosis of AOM, 93 had a normal-appearing TM, and 10 had external otitis. Twenty-one percent of those with AOM and 46% of those with a normal TM (P = 0.008) had blood drawn as part of their workup in their PED visit. The rate of chest x-rays was also significantly less for the AOM group (16% vs 30%, P = 0.03), and they also underwent fewer urine tests (P = NS).

Conclusion
Cerumen removal changes the management of children in the PED who present with a possible diagnosis of an ear infection. Cerumen removal could avoid unnecessary laboratory and imaging studies, which could save time, costs, and suffering.
Comparing Domain-Specific Self-Efficacy in Pediatric Physical Therapy Education Across Classroom-Based, Online, and Hybrid Curriculum Designs
Authors: Scott Kimberley , Wissinger Jennifer , Maus Elizabeth , Heathcock Jill 
Published: May 2022

Purpose:
To describe the pediatric curriculum across 3 years when different instructional designs were used, quantify change in self-efficacy (SE) after completing the curriculum, and define relationships between pediatric experience, SE, and interest in future pediatric practice.

Methods:
Students (N = 137) were included over 3 consecutive years. Instructional design varied across cohorts: classroom-based (n = 48), online (n = 44), and hybrid (n = 45). Pediatric content hours were analyzed. Measures were the Pediatric Communication and Handling Self-Efficacy Scale, pediatric experience, and interest in future pediatric practice.

Results:
Pediatric content hours met published recommendations. Significant growth in SE occurred for all cohorts, with no significant differences in SE scores based on instructional design. Experience and interest in pediatrics were significantly related to communication SE.

Conclusions:
The pediatric physical therapy curriculum delivered via classroom-based, online, or hybrid instruction can be effective in promoting pediatric-specific growth in student SE. Remote pediatric experiential learning is a feasible option for physical therapy programs with limited direct contact with children. What this adds to the evidence: When pediatric curricula meet recommended total hours of instruction, regardless of instructional method or amount of direct laboratory time with real children, pediatric-specific student SE increases. This supports the use of alternative approaches for experiential learning activities in programs with limited access and availability for direct in-person child interactions. Programs may expand integrated clinical experiences (ICE) opportunities to include telehealth when in-person ICE is limited due to distance or availability in nearby clinical settings. Online learning activities (asynchronous or synchronous) may be viable options for laboratory activities when live child volunteers are limited or unavailable. Use of multiple methods of instruction (classroom-based, online, or hybrid) can be beneficial in covering pediatric physical therapy content and improving SE. This evidence can help programs expand their options for exposing student physical therapists to pediatric practice.
Allergic Adverse Drug Events After Alert Overrides in Hospitalized Patients
Authors: Luri Marta , Gastaminza Gabriel , Idoate Antonio , Ortega Ana 
Published: May 2022

Objectives
This study aimed to assess how often overridden drug allergy alerts (ODAAs) lead to allergic adverse drug events (All-ADEs) and to evaluate the frequency with which drug allergy alerts (DAAs) were overridden and the reasons, as well as appropriateness of these overrides.

Methods
A retrospective observational study of DAA generated between 2014 and 2016 was conducted. The corresponding DAA records were reviewed to determine the frequency of alert overrides. A chart review was performed on a subset of 194 ODAA (the first of every 3 chronologically ordered ODAA) to identify All-ADEs and to evaluate the override reasons and the appropriateness of these overrides.

Results
A total of 2044 DAAs were overridden (override rate of 44.8%). Most were triggered by a nonexact match (93.81%), when ordering nervous system (21.1%) and cardiovascular system (19.6%) drugs and were generated by physicians (72.7%). The main override reason was that the patient was already taking the drug or had previously tolerated the drug. Only 9.28% of ODAAs were inappropriately overridden. Six All-ADEs (3.09%) were identified and were due to anti-infective (1), antineoplastic (1), and iodinated-contrast (4) drug administration. Most All-ADEs were cutaneous and were mild. None was life-threatening or fatal. The All-ADEs rate was higher among inappropriately ODAA (15.79%, P = 0.013).

Conclusions
Alert overrides are not exempt from clinical consequences, although few are associated with All-ADEs. It is necessary to identify the drugs involved in those reactions and to update allergy lists to generate only specific and important DAA and to avoid the negative consequences of overrides.
Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery
Authors: Harrison Reema , Johnson Judith , McMullan Ryan D. , Pervaz-Iqbal Maha , Chitkara Upma , Mears Steve , Shapiro Jo , Lawton Rebecca 
Published: May 2022

Background
Making a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence.

Methods
Systematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building.

Results
We identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing.

Conclusions
The Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences.
Lessons Learned in Implementing a Chronic Opioid Therapy Management System
Authors: Carlile Narath , Fuller Theresa E. , Benneyan James C. , Bargal Basma , Hunt Lindsay , Singer Sara , Schiff Gordon D. 
Published: May 2022

Objectives
Opioid misuse has resulted in significant morbidity and mortality in the United States, and safer opioid use represents an important challenge in the primary care setting. This article describes a research collaborative of health service researchers, systems engineers, and clinicians seeking to improve processes for safer chronic opioid therapy management in an academic primary care center. We present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization.

Methods
Using iterative improvement lifecycles and systems engineering principles, we developed a risk-based workflow model for patients on chronic opioids. Two key safe opioid use process metrics—percent of patients with recent opioid treatment agreements and urine drug tests—were identified, and processes to improve these measures were designed, tested, and implemented. Focus groups were conducted after the conclusion of implementation, with barriers and lessons learned identified via thematic analysis.

Results
Initial surveys revealed a lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 18 clinicians (69%) reported largely “inheriting” (rather than initiating) their chronic opioid therapy patients. We tracked 68 patients over a 4-year period. Although process measures improved, full adherence was not achieved for the entire population. Barriers included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus.

Conclusions
Safe primary care opioid prescribing requires ongoing monitoring and management in a complex environment. The application of a risk-based approach is possible but requires adaptability and redundancies to be reliable.
Determination of Contrast Timing by Time-Resolved Magnetic Resonance Angiography in Patients With Bidirectional Glenn and Hemi-Fontan Anastomoses
Authors: Yekeler Ensar , Ramirez-Suarez Karen I. , Rapp Jordan B. , White Ammie M. , Otero Hansel J. , Whitehead Kevin K. , Harris Matthew A. , Fogel Mark A. , Biko David M. 
Published: May 2022

Purpose
Children with single-ventricle congenital heart disease undergo a series of operations to maintain their pulmonary circulation including bidirectional Glenn (BDG) or hemi-Fontan in the second stage to create a superior cavopulmonary anastomosis. We aimed to optimize cardiovascular angiography protocols by determining optimal contrast timing of pulmonary and systemic circulation on magnetic resonance angiography (MRA) performed with the technique of time-resolved imaging with interleaved stochastic trajectories (TWIST).

Methods and Materials
Cardiac TWIST MRA with lower extremity (LE) contrast injection was analyzed in 92 consecutive patients with a BDG or hemi-Fontan anastomosis. Contrast arrival time to inferior vena cava was set to zero to determine the relative time-to-peak (TTP) of the target vessels. Time-to-peak of each vessel was compared by age (<2 or ≥2 y), ejection fraction (<54% or ≥54%), the median values of heart rate (<111 or ≥111 beats per minute), body surface area (BSA, <0.59 or ≥0.59), cardiac index (<6.04 or ≥6.04), and indexed ascending aorta flow (AscAo_i, <5.3 or ≥5.3). The TTP of the vessels was also correlated with the volumetric parameters.

Results
The mean age of 92 patients (32 female, 60 male) was 3.1 years (0.7–5.6 years). With LE injection, the first peak was depicted in AscAo. Time-to-peak of the pulmonary arteries was approximately 9 seconds later than AscAo. The TTP difference between pulmonary arteries and AscAo was shorter in high heart rate group (8.3 vs 10 seconds, P < 0.001). The TTP difference between AscAo and the mean of pulmonary arteries was significantly shorter in high cardiac index group (8.4 vs 9.9 seconds, P < 0.01) and high AscAo_i group (8.7 vs 9.7 seconds, P = 0.03). The TTP differences were not significant by age, ejection fraction, and BSA. Cardiac index and AscAo_i were negatively correlated with all TTPs except AscAo. The ejection fraction, stroke volume, and atrioventricular regurgitation fraction did not correlate with the TTP.

Conclusions
In patients with BDG or hemi-Fontan anastomosis, TTP of the pulmonary arteries on TWIST MRA via LE intravenous injection is approximately 9 seconds later than AscAo, approximately 8 and 10 seconds later in high and low heart rate groups, respectively. Cardiac index and AscAo_i have less effect on the TTP than the heart rate. There was no TTP difference of the pulmonary arteries by age, BSA, and ejection fraction and no correlation with ejection fraction, stroke volume, and atrioventricular regurgitation fraction. These data can be used to guide timing of pulmonary arterial enhancement of single-ventricle patients after BDG or hemi-Fontan anastomosis.
Ovarian Masses in Patients With Breast Cancer
Authors: Kang Kyung A. , Lee Jonghyun , Kim Hyun-Soo , Park Sung Yoon 
Published: May 2022

Purpose
The aim of the study was to investigate the characteristic findings of computed tomography (CT) or magnetic resonance imaging (MRI) to discriminate metastasis from primary ovarian tumors in patients with a history of breast cancer.

Methods
This retrospective study enrolled consecutive 72 patients with a history of breast cancer who underwent surgical confirmation of an ovarian mass detected on CT or MRI (primary ovarian tumors, n = 66; metastases, n = 6). Two independent readers analyzed the grade of solid portions of the ovarian mass using a 5-point scale on CT or MRI. A predominantly cystic mass was defined as a solid grade of 1 to 2. Cancer antigen 125 (CA 125) and the initial stage of breast cancer were also investigated.

Results
The proportions of predominantly cystic masses were significantly different between metastases (0% for both readers) and primary ovarian tumors (59% for reader 1 and 53% for reader 2, P < 0.05). For masses of solid portion grades 3 to 5, CA 125 was significantly higher for malignant epithelial tumors than for the other tumors (P < 0.001), and the initial stage of breast cancer was significantly higher for metastases than for the other tumors (P < 0.001), respectively.

Conclusions
In patients with a history of breast cancer, predominantly cystic masses detected on CT or MRI seem to be primary ovarian tumors. For the other masses, knowledge of CA 125 and initial breast cancer stage may help in the differential diagnosis.
Performance of Automated RAPID Intracranial Hemorrhage Detection in Real-World Practice: A Single-Institution Experience
Authors: Eldaya Rami W. , Kansagra Akash P. , Zei Markus , Mason Evan , Holder Derek , Heitsch Laura , Vo Katie D. , Goyal Manu S. 
Published: May 2022

Background and Purpose
Intracranial hemorrhage (ICH) is a common finding in patients presenting to the emergency department with acute neurological symptoms. Noncontrast head computed tomography (NCCT) is the primary modality for assessment and detection of ICH in the acute setting. RAPID ICH software aims to automatically detect ICH on NCCT and was previously shown to have high accuracy when applied to a curated test data set. Here, we measured the test performance characteristics of RAPID ICH software in detecting ICH on NCCT performed in patients undergoing emergency stroke evaluation at a tertiary academic comprehensive stroke center.

Materials and Methods
This retrospective study assessed consecutive patients over a 6-month period who presented with acute neurological symptoms suspicious for stroke and underwent NCCT with RAPID ICH postprocessing. RAPID ICH detection was compared with the interpretation of a reference standard comprising a board-certified or board-eligible neuroradiologist, or in cases of discrepancy, adjudicated by a consensus panel of 3 neuroradiologists. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RAPID ICH for ICH detection were determined.

Results
Three hundred seven NCCT scans were included in the study. RAPID ICH correctly identified 34 of 37 cases with ICH and 228 of 270 without ICH. RAPID ICH had a sensitivity of 91.9% (78.1%–98.3%), specificity of 84.4% (79.6%–88.6%), NPV of 98.7% (96.3%–99.6%), PPV of 44.7% (37.6%–52.1%), and overall accuracy of 85.3% (80.9%–89.1%).

Conclusions
In a real-world scenario, RAPID ICH software demonstrated high NPV but low PPV for the presence of ICH when evaluating possible stroke patients.
A Monte Carlo Estimation of the Narrow-Sense Heritability of COVID-19 Infection and Severity from AncestryDNA Survey Data
Authors: Averitt Amelia J. , Sharma Deepika , Cantor Michael 
Published: May 2022

AbstractRespiratory infectious diseases, such as COVID-19, demonstrate a host genetic component that contributes to interindividual differences of susceptibility and infection. At present, the relative effect of environmental and genetic factors of COVID-19 is unknown. This research presents a Monte Carlo (MC) estimation of the genetic narrow-sense heritability of COVID-19 infection and severity from AncestryDNA survey data. The results suggest a moderate genetic contribution to COVID-19 infection and a low genetic contribution for COVID-19 severity.
STAKEHOLDER PERCEPTION ABOUT ADOLESCENT REPRODUCTIVE HEALTH EDUCATION IN THE UPPER EAST REGION OF GHANA
Authors: Gariba Evans Bagura , Hadjez Esteban 
Published: May 2022

AbstractReproductive Health Education has been seen as a form of Comprehensive Sexual Education which combines health and right-based strategies to empower communities to enhance their well-being. From a health promotion perspective, this study explores stakeholder perception about Reproductive Health Education in the Upper East Region of Ghana where adolescent needs and outcome are challenged. These finding gives an in-depth understanding of reproductive health education from stakeholders’ perspective as being a double-edge sword.
O-GlcNAc transferase contributes to sex-specific placental deregulation in gestational diabetes
Authors: Cui Yiwen , Cruz Meredith , Palatnik Anna , Olivier-Van Stichelen Stephanie 
Published: May 2022

ABSTRACTFetal sex has been known to be associated with differential risks for adverse perinatal outcomes. Recently it has been highlighted as a risk factor for gestational diabetes (GDM), which carries short- and long-term cardiometabolic implications for the pregnant women and their offspring. Understanding the molecular mechanisms through which fetal sex can modulate placenta physiology can help identify novel molecular targets for future clinical applications. In this study, we investigated the nutrient-sensing O-GlcNAc pathway as a potential mediator of sex-driven placenta dysfunction due to the unique location of the O-GlcNAc transferase (OGT) enzyme on the X chromosome. Using banked placenta tissues, we demonstrated that placenta OGT is downregulated in women with GDM, especially when carrying a male offspring. We modeled our observation in vitro using male placenta trophoblast BeWo cells in which OGT was knocked down. A comprehensive transcriptomic profile via RNA sequencing demonstrated changes in hormonal, inflammatory and immunologic markers, toward GDM-like transcriptional signatures. Altogether, this study suggests that OGT deserves important consideration for sexual dimorphism observed in GDM and highlights the importance of O-GlcNAcylation in placenta endocrine physiology.
Candidate effector proteins from the maize tar spot pathogenPhyllachora maydislocalize to diverse plant cell compartments
Authors: Helm Matthew , Singh Raksha , Hiles Rachel , Jaiswal Namrata , Myers Ariana , Iyer-Pascuzzi Anjali S. , Goodwin Stephen B. 
Published: May 2022

ABSTRACTMost fungal pathogens secrete effector proteins into host cells to modulate their immune responses, thereby promoting pathogenesis and fungal growth. One such fungal pathogen is the ascomycetePhyllachora maydis, which causes tar spot disease on leaves of maize (Zea mays). Sequencing of theP. maydisgenome revealed 462 putatively secreted proteins of which 40 contain expected effector-like sequence characteristics. However, the subcellular compartments targeted byP. maydiseffector candidate (PmECs) proteins remain unknown and it will be important to prioritize them for further functional characterization. To test the hypothesis that PmECs target diverse subcellular compartments, cellular locations of super Yellow Fluorescent Protein (sYFP)-taggedP. maydiseffector candidate proteins were identified using aNicotiana benthamiana-based heterologous expression system. Immunoblot analyses showed that most of the PmEC-fluorescent protein fusions accumulated protein inN. benthamiana, indicating the candidate effectors could be expressed in dicot leaf cells. Laser-scanning confocal microscopy ofN. benthamianaepidermal cells revealed most of theP. maydisputative effectors localized to the nucleus and cytosol. One candidate effector, PmEC01597, localized to multiple subcellular compartments including the nucleus, nucleolus, and plasma membrane while an additional putative effector, PmEC03792, preferentially labelled both the nucleus and nucleolus. Intriguingly, one candidate effector, PmEC04573, consistently localized to the stroma of chloroplasts as well as stroma-containing tubules (stromules). Collectively, these data suggest effector candidate proteins fromP. maydistarget diverse cellular organelles and may thus provide valuable insights into their putative functions as well as host processes potentially manipulated by this fungal pathogen.