bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Telomere Length and Indicators of Oxidative Stress in Critically Ill Mechanically Ventilated Adults – A Pilot Study
Authors: Liang Zhan , Saugar Elaine E. , Alamian Arsham , Ferreira Tanira , Downs Charles A. 
Published: October 2022

Background Telomeres are structures at the end of chromosomes that shorten with each cell division. The purpose of this pilot project is to report changes in telomere length (T/S ratio), indicators of oxidative stress (serum protein carbonyl, vitamin C, GSH:GSSG, and total antioxidant capacity) from Intensive Care Unit (ICU) admission to ICU discharge, and to explore their association with ICU-related morbidities among critically ill mechanically ventilated adults. Methods Blood was collected from mechanically ventilated patients ( n = 25) at enrollment and within 48 hours of ICU discharge. Telomere length from peripheral blood mononuclear cells (PBMCs) was determined using RTqPCR. ELISAs were used to measure indicators of oxidative stress. Descriptive analysis, paired t-tests, and Pearson’s correlations were performed. Results Mean age was 62.0 ± 12.3 years, 28.6% were male, and 76.2% were White with disease severity using APACHE III (74.6 ± 24.6) and SOFA (7.6 ± 3.2). Mean T/S ratios shortened (ICU: 0.712, post-ICU: 0.683, p < 0.001, n = 19) and serum protein carbonyl increased (ICU: 7437 nmol/mg ± 3328, post-ICU: 10,254 nmol/mg ± 3962, p < 0.005) as did the oxidative stress index (protein carbonyl/GSH:GSSG, ICU: 1049.972 ± 420.923, post-ICU: 1348.971 ± 417.175, p = 0.0104). T/S ratio was positively associated with APACHE III scores (ICU: r = 0.474, post-ICU: r = 0.628, p < 0.05). Conclusions Pilot findings suggest that critical illness significantly correlates with telomere attrition, perhaps due to increased oxidative stress. Future larger and longitudinal studies investigating mechanisms of telomere attrition and associations with clinical outcomes are needed to identify potential modifiable factors for subsequent intervention to improve outcomes for critically ill patients.
Changes of symptomatology, tear film and ocular surface integrity one week during Somofilcon-A and Omafilcon-A lens wear
Authors: Pena-Verdeal Hugo , Noya-Padin Veronica , Losada-Oubiña Martin , Saborido-Rey Marcos , Vilas-Alonso Manuel , Giraldez Maria J. 
Published: October 2022

Purpose Clinicians play a key role in prescribing contact lenses that best suited for fitting which materials had an impact on ocular surface parameters. The present study aimed to evaluate the impact on symptomatology, tear film dynamics and ocular surface integrity of a silicone-hydrogel (Somofilcon-A) and a hydrogel (Omafilcon-A) lens before and after wearing for one week in contact lens neophyte participants. Methods A Somofilcon-A and Omafilcon-A were randomly fitted to one or other the eye on an initial group of 28 participants. Subjects were scheduled for three sessions: basal session previous fitting, second session after 4-wear hours, and final session after 7-wear days for up to 10 h. In each session, CLDEQ-8, tear meniscus height and hyperemia with and without lenses, as well as lipid layer thickness and corneal/conjunctival staining without lenses were assessed. Values were compared between lenses and sessions. Results In intrasession comparison, there were no differences in any parameter between materials on any session with or without lenses (all p≥0.176), except on the conjunctival staining where values obtained during Somofilcon-A wear (all p ≤ 0.006). In intersession analysis, CLDEQ-8 score, tear meniscus height and lipid layer thickness showed a statistical difference during both materials wear (all p ≤ 0.009), while conjunctival hyperemia does not (p  =  0.237); corneal staining showed differences during Omafilcon-A wear (p  =  0.037), contrary to conjunctival staining which showed differences only during Somofilcon-A wear (p < 0.001). Conclusion Contact lenses wear had an impact on ocular parameters that have some specific influences of the material on which lenses were manufactured.
Drivers of variation in telemedicine use during the COVID-19 pandemic: The experience of a large academic cardiovascular practice
Authors: Koos Harrison , Parameswaran Vijaya , Claire Sahej , Chen Chelsea , Kalwani Neil , Osmanlliu Esli , Qureshi Lubna , Dash Rajesh , Scheinker David , Rodriguez Fatima 
Published: October 2022

Background COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center. Methods We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve. Results Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis. Conclusion Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference.
Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis
Authors: Pini Rodolfo , Faggioli Gianluca , Paraskevas Kosmas I. , Campana Federica , Sufali Gemmi , Rocchi Cristina , Palermo Sergio , Gallitto Enrico , Gargiulo Mauro 
Published: October 2022

Background: Carotid artery stenting (CAS) in the treatment of significant stenosis is a cause of stroke due to both plaque prolapse and cerebral embolization. New types of stents with a double-layer structure have been designed to minimize plaque prolapse and embolization; these double-layer stents (DLSs) should be able to reduce the stroke risk; however, definite data on their performance are scarce in the literature. Methods: A systematic search was performed through PubMed, Scopus, and Cochrane Library, according to PRISMA guidelines; all studies on CAS with DLS (Roadsaver/Casper or CGuard) up to January 1, 2022, with a cohort of at least 20 patients were considered eligible. The present meta-analysis was approved and registered on PROSPERO register (CRD42022297512). Patients with tandem lesions or complete carotid occlusion were excluded from the study. The 30-day stroke rate after CAS was analyzed evaluating the preoperative symptomatic status and DLS occlusion. The estimated pooled rate of events was calculated by random effect model and moderators were evaluated. Results: A total of 14 studies were included in the meta-analysis for a total of 1955 patients. The estimated overall (95% confidence interval [CI]) stroke rate was 1.4% (0.9%–2.2%, I2 = 0%), which was not influenced by the type of DLS used: CGuard 0.8% (0.4%–1.8%, I2 = 0%) versus Roadsaver/Casper 1.5% (0.7%–3.2%, I2 = 0%), p=0.30. The 30-day estimated stroke rate was 1.5% (0.8%–2.9%, I2 = 0%) in asymptomatic and 1.9% (1.0%–3.6%, I2 = 0%) in symptomatic patients, with no influence by moderators. The 30-day DLS occlusion rate was 0.8% (0.4%–1.8%, I2 = 0%). The publication bias assessment identified asymmetry in the asymptomatic populations. Conclusion: The overall 30-day stroke rate in CAS with DLS is low (1.4%), with similar results in symptomatic and asymptomatic patients. Acute occlusion of DLS is rare (0.8%). Further studies are necessary to reduce the publication bias for asymptomatic patients. Clinical Impact CAS with DLS is associated to a low rate of 30-day stroke in both symptomatic (1.9%) and asymptomatic (1.5%) patients. The type of DLS (CGuard or Roadsaver/Casper) did not affect the 30-day stroke rate.
Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke
Authors: Stein Laura K. , Mayman Naomi , Jette Nathalie , Tuhrim Stanley , Dhamoon Mandip S. 
Published: October 2022

Background and Purpose: We assessed risk and determinants of new-onset depression in acute ischemic stroke (AIS) patients of all ages and no known history of depression. Additionally, we assessed patterns of post-stroke depression (PSD) treatment with pharmacotherapy. Methods: Retrospective cohort study of de-identified Marketscan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Datasets for adults age ≥18 years admitted with AIS from July 1, 2016-July 1, 2017. We created Kaplan-Meier curves of cumulative risk of PSD up to 1.5 years following index AIS admission. We performed Cox regression to report hazard ratios for determinants of PSD up to 1.5 years following AIS. We summarized proportions treated with pharmacotherapy and identified the most commonly prescribed medications. Results: Of 8089 AIS patients, 1059 were diagnosed with PSD. At 1 year, cumulative risk of PSD was 13.4% (standard error .4) and 15.3% (standard error .5) at 1.5 years. History of anxiety was most strongly associated with PSD and discharge home least. Among those with PSD, 68.8% were prescribed an antidepressant and 8.4% an antipsychotic. The most commonly prescribed antidepressant was sertraline (28.5%). Conclusions: Among AIS patients of all ages, there is a persistently elevated cumulative risk of new diagnosis of PSD in the 1.5 years following AIS. Of the >2/3 treated with an antidepressant, sertraline was most commonly prescribed. Screening and treatment strategies for PSD require further study.
Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children
Authors: Spear Matthew B. , Miller Kristen , Press Craig , Ruzas Christopher , LaVelle Jaime , Mourani Peter M. , Bennett Tellen D. , Maddux Aline B. 
Published: October 2022

Background and Purpose Long-term outcomes after pediatric neurocritical illness are poorly characterized. This study aims to characterize the frequency and risk factors for post-discharge unplanned health resource use in a pediatric neurocritical care population using insurance claims data. Methods Retrospective cohort study evaluating children who survived a hospitalization for an acute neurologic illness or injury requiring mechanical ventilation for >72 hours and had insurance eligibility in Colorado’s All Payers Claims database. Insurance claims identified unplanned readmissions and emergency department [ED] visits during the post-discharge year. For patients without pre-existing epilepsy/seizures, we evaluated for post-ICU epilepsy identified by claim(s) for a maintenance anti-seizure medication during months 6-12 post-discharge. Multivariable logistic regression identified factors associated with each outcome. Results 101 children, median age 3.7 years (interquartile range (IQR) .4-11.9), admitted for trauma (57%), hypoxic-ischemic injury (17%) and seizures (15%). During the post-discharge year, 4 (4%) patients died, 26 (26%) were readmitted, and 48 (48%) had an ED visit. Having a pre-existing complex chronic condition was independently associated with readmission and emergency department visit. Admission for trauma was protective against readmission. Of those without pre-existing seizures (n = 86), 25 (29%) developed post-ICU epilepsy. Acute seizures during admission and prolonged ICU stays were independently associated with post-ICU epilepsy. Conclusions Survivors of pediatric neurocritical illness are at risk of unplanned healthcare use and post-ICU epilepsy. Critical illness risk factors including prolonged ICU stay and acute seizures may identify cohorts for targeted follow up or interventions to prevent unplanned healthcare use and post-ICU epilepsy.
A qualitative study to explore the acceptability and usefulness of personalized biofeedback to motivate physical activity in cancer survivors
Authors: Brannon Grace E. , Ray Madison , Cho Patrick , Baum Miranda , Beg Muhammad Shaalan , Bevers Therese , Schembre Susan M. , Basen-Engquist Karen , Liao Yue 
Published: October 2022

Objective Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages. Methods In-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors ( n = 16, 94% female, 94% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders. Results All participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors’ medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body. Conclusions This study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.
Exploring enablers and inhibitors of eHealth educational tools: The needs of women searching for HPV and cervical cancer information
Authors: Bitar Hind , Alismail Sarah 
Published: October 2022

Objective This study explored the information women want to know about HPV and cervical cancer, and the enablers or inhibitors that may contribute to, or prevent, seeking online health information. Methods Two focus groups were conducted with women from the general public, followed by interviews with 12 physicians practicing in Saudi Arabia. The data was analyzed by using a thematic analysis approach. Results Researchers of this study identified six topics of information that were need-related, ten that were enabling, and six inhibiting subthemes related to online information seeking about HPV and cervical cancer. Discussion and conclusion In accordance with the identified themes and sub-themes, we offer recommendations to optimize the health information-seeking task related to HPV and cervical cancer through eHealth educational solutions. User- and expert-based feedback can both strengthen and inform the design, development, and implementation of eHealth interventions.
Weight loss in a digital app-based diabetes prevention program powered by artificial intelligence
Authors: Graham Sarah A. , Pitter Viveka , Hori Jonathan H. , Stein Natalie , Branch OraLee H. 
Published: October 2022

ObjectiveThe National Diabetes Prevention Program (DPP) reduces diabetes incidence and associated medical costs but is typically staffing-intensive, limiting scalability. We evaluated an alternative delivery method with 3933 members of a program powered by conversational Artificial Intelligence (AI) called Lark DPP that has full recognition from the Centers for Disease Control and Prevention (CDC).MethodsWe compared weight loss maintenance at 12 months between two groups: 1) CDC qualifiers who completed ≥4 educational lessons over 9 months (n  =  191) and 2) non-qualifiers who did not complete the required CDC lessons but provided weigh-ins at 12 months (n  =  223). For a secondary aim, we removed the requirement for a 12-month weight and used logistic regression to investigate predictors of weight nadir in 3148 members.ResultsCDC qualifiers maintained greater weight loss at 12 months than non-qualifiers (M  =  5.3%, SE  =  .8 vs. M  =  3.3%, SE  =  .8; p  =  .015), with 40% achieving ≥5%. The weight nadir of 3148 members was 4.2% (SE  =  .1), with 35% achieving ≥5%. Male sex ( β = .11; P  =  .009), weeks with ≥2 weigh-ins ( β = .68; P < .0001), and days with an AI-powered coaching exchange ( β = .43; P < .0001) were associated with a greater likelihood of achieving ≥5% weight loss.ConclusionsAn AI-powered DPP facilitated weight loss and maintenance commensurate with outcomes of other digital and in-person programs not powered by AI. Beyond CDC lesson completion, engaging with AI coaching and frequent weighing increased the likelihood of achieving ≥5% weight loss. An AI-powered program is an effective method to deliver the DPP in a scalable, resource-efficient manner to keep pace with the prediabetes epidemic.
The role of phone-based triage nurses in supporting older adults with multimorbidity to digitally self-manage – Findings from the ProACT proof-of-concept study
Authors: Doyle Julie , McAleer Patricia , van Leeuwen Cora , Smith Suzanne , Murphy Emma , Sillevis Smitt Myriam , Galvin Mary , Jacobs An , Tompkins Lorraine , Sheerin James , Dinsmore John 
Published: October 2022

Background Achieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management. Methods The aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts. Results Themes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants. Discussion This work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.'s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.
An Exploratory Study on the Mediating Effect of Clinical Competence in the Relationship Between Grit and Field Adaptation in Newly Graduated Nurses
Authors: Shin Eunhee 
Published: October 2022

Introduction Even under difficult situations, individuals with psychological resources such as positive psychological capital and resilience are less likely to consider turnover. Grit is a psychological factor that predicts success at work in other industries, but little is known about its impact on newly graduated nurses. Objectives The study’s purpose is to investigate newly graduated nurses’ grit, clinical competence, and field adaptation as well as the mediating effect of clinical competence in the relationship between grit and field adaptation. Methods A total of 102 nurses from university hospitals located in W city took part in this investigation. Data were collected using a self-questionnaire and were analyzed using descriptive statistics, Pearson’s correlation coefficient, multiple regression, and mediation analysis with the SPSS/26.0 program. Results Grit was remarkably related to clinical competence (r = .53, p < .001) and field adaptation (r = .30, p = .003). Clinical competence was significantly related to field adaptation (r = .24 p = .02). However, the role of clinical competence as a mediating factor in the relationship between grit and field adaptation was not found to be significant (β = .11, p = .32). Conclusion Grit boosted clinical competence and had a direct effect on field adaptation. In order for newly graduated nurses to retain a consistent level of enthusiasm in their work, it is necessary to develop a program or strategies to improve their grit.
A Descriptive Exploratory Study of the Causes and Effects of Hypertension Among Ghanaian Soldiers and Their Families
Authors: Dartey Anita Fafa , Lasidji Berlinda Narh , Baku Elizabeth , Worna Lotse Comfort , Kuug Anthony Kolsabilik , Dzansi Gladys 
Published: October 2022

Introduction The quality of life of any soldier can be affected by a simple diagnosis of Hypertension. Hypertension has not been directly linked to a single cause; however, knowing the associated risks and early diagnosis can help with its management. This study aimed to explore and describe the causes of hypertension among soldiers and its effects on their families. Objective(s) To explore and describe the causes of hypertension and its effects on soldiers and their families. Methods A qualitative technique and an exploratory descriptive design were used in this study. At saturation, a total of 10 soldiers were face-to-face interviewed and gathered data simultaneously transcribed and subjected to a content analytic method of analysis. Participants approved being audio recorded on tape with an audio recording device. Results Effects of hypertension on personal lives of soldiers, effects of hypertension on family life, and effects of hypertension on social life were identified as the causes and risk factors of hypertension among the soldiers. These themes are further expanded by their subthemes in the areas of decreased physical activity including sex life, decrease interaction with family, and isolation from friends. Conclusion This study revealed that hypertension does have effects on one's personal life, family life, and social life. Hence, it is recommended that frequent health education on hypertension and its effects should be organized in the various Garrisons by the public health department for all soldiers and their families. Screening programs should be organized for early hypertension detection. Soldiers should be educated on appropriate eating habits, weight and financial management, and reduction in tobacco and alcohol.