bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, Mortality, and Treatment Patterns of Synchronous Lower Genital Tract Squamous Cell Carcinoma
Authors: Wang Stephanie , Sparks Andrew D. , Rao Yuan J. , Long Beverly 
Published: April 2022

Objective
The aim of the study was to define the incidence, prognosis, and treatment patterns associated with synchronous lower genital tract squamous cell carcinoma (LGTSCC) among women diagnosed with any LGTSCC.

Materials and Methods
Surveillance, Epidemiology, and End Results (SEER) database patients diagnosed with synchronous cervical, vaginal, vulvar, and/or anal SCC from 2000 to 2016 were included. Incidence and mortality were evaluated using Kaplan-Meier curves. Multivariable Cox proportional hazards regression was used to identify treatment patterns, risk factors, and mortality associated with LGTSCC.

Results
Among 15,424 women with LGTSCC, 138 had synchronous LGTSCC (0.89%). Vulvar and vaginal SCC was the most common combination (49.3%), and cervical with anal SCC was the least common (1.4%). Only one patient had 3 or more primary LGTSCC. Synchronous LGTSCC was independently associated with higher mortality compared with single-site LGTSCC (adjusted hazards ratio [aHR] = 1.67; p < .001). Synchronous LGTSCC was significantly associated with older age (63 vs. 58 years, p < .001) and lower stage (adjusted odds ratio [aOR] = 0.38; p < .001) and grade of disease (aOR = 0.32; p < .001). Patients with synchronous LGTSCC were more likely to receive radiation (aOR = 1.74; p = .005) and were more likely to receive adjuvant radiation after primary surgical resection compared with single-site LGTSCC (aOR = 1.88; p = .007). Receipt of any treatment including radiation (aHR = 0.85; p < .001), chemotherapy (aHR = 0.50; p < .001), and surgery (aHR = 0.70; p < .001) was independently associated with decreased mortality hazard.

Conclusions
Synchronous LGTSCC is rare but is associated with increased mortality and higher rates of adjuvant radiation compared with single-site LGTSCC despite lower stage and grade at diagnosis. More research is needed to define optimal therapy for these patients.
The association between orthostatic blood pressure changes and arterial stiffness
Authors: Wu Pingping , Xu Guoyan , Pan Min , Lin Li , Cai Wenqin 
Published: April 2022

Objective
Although orthostatic hypotension (OH) and orthostatic hypertension (OHT) can independently predict cardiovascular events, the underlying mechanisms remain controversial. Our study aimed to examine the relationships between orthostatic blood pressure (BP) changes and arterial stiffness.

Methods
In this cross-sectional analysis, 1820 participants were divided into three groups according to BP changes within 3 min of orthostatism: the OH group had a decrease of >20 mmHg in SBP or >10 mmHg in DBP, the OHT group had an increase of ≥20 mmHg in SBP, and the orthostatic normotensive (ONT) group had normal changes. Arterial stiffness was assessed by measuring the carotid-femoral pulse wave velocity (cfPWV).

Results
OH and OHT were observed in 257 (14.1%) and 62 (3.4%) participants, respectively. Subjects in the OH group were significantly older, were more likely to have hypertension and diabetes, and had higher cfPWV than those in the ONT group (P < 0.05); however, no differences were found between the ONT and OHT groups. Stepwise multiple regression analysis of the subgroups stratified by hypertension and diabetes revealed that age was related to increased cfPWV in all stratifications, and the change in SBP was significantly positively correlated with cfPWV in hypertensive subjects; however, this association was not observed in nonhypertensive subjects.

Conclusion
We found that arterial stiffness was closely related to OH but not to OHT. In addition to expanding current knowledge of the relationship between orthostatic BP changes and arterial stiffness, our study underlines the importance of age, SBP changes, and hypertension in evaluating arterial stiffness.
Sampling rate influences measures of blood pressure variability in ambulatory blood pressure monitoring
Authors: Goel Arun , Goyal Manish , Bhattacharya Sandeep , Tiwari Sunita , Verma Narsingh 
Published: April 2022

Background
Ambulatory blood pressure monitoring (ABPM) is a valuable tool in the diagnosis and management of hypertension and it is a good predictor of future cardiovascular events. Lack of normal threshold values of ABPM parameters and inconsistency in the sampling rate of recording are hurdles in its wider usage. The aim of the present investigation was to study the influence of sampling rate on ABPM.

Methods
ABPM was performed in 47 healthy subjects and the effect of different sampling rates was studied on ABPM parameters.

Results
When data were down-sampled, there was a trend towards decreased concordance and increased dispersion with less frequent recordings. Percent dispersion of MESOR, 24-h average, 24 h standard deviation (SD), awake hours average and sleep hours average of systolic BP (SBP) were around 10% for a sampling interval of 1 h. While average real variability (ARV), morning surge and percent dip in SBP exhibited more than 30% dispersion at a sampling interval of 30 min.

Conclusion
24-h average blood pressure (BP) is less sensitive to sampling rate whereas BP variability parameters such as ARV, morning surge and percent dip in SBP are highly sensitive. We suggest that for improving the accuracy of BP variability parameters, a higher sampling rate is desirable around the time of awakening (~2 h before and after the expected time of awakening). At other times, a lower sampling rate may be used for maximizing patient comfort without compromising measurement accuracy.
Improving Lung Cancer Screening Rates Through an Evidence-Based Electronic Health Record Smoking History
Authors: Russell Cynthia K. , McNeill Margaret 
Published: April 2022

Background:
Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. In the United States, an estimated 131 880 lung cancer deaths are expected to occur in 2021, with most detected in later stages. Smokers are 15 to 30 times more likely to develop or die from lung cancer.

Local Problem:
Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate.

Intervention:
Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates.

Results:
Early-stage lung cancer detection increased 24%.

Conclusions:
Interprofessional teams used technology to adopt evidence-based practice and improve health outcomes in their communities.
CLABSI Rounding Team
Authors: Pate Kimberly , Brelewski Kiersten , Rutledge Sarah R. , Rankin Veronica , Layell Jessica 
Published: April 2022

Background:
Central line–associated bloodstream infections (CLABSIs) are an ongoing concern in health care, resulting in increased mortality, morbidity, length of stay, and additional costs to hospitals.

Local Problem:
Despite intermittent improvements in CLABSI rates within our facility, long-term sustainment has been challenging.

Methods:
This was a quality improvement project including a collaborative rounding approach supported by specialty nursing roles.

Interventions:
In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit.

Results:
High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits.

Conclusions:
Despite challenges correlated with COVID-19, a collaborative rounding team promotes and enhances awareness of prevention methods and a culture of safety.
Detection of altered pain facilitatory and inhibitory mechanisms in patients with knee osteoarthritis by using a simple bedside tool kit (QuantiPain)
Authors: Izumi Masashi , Hayashi Yoshihiro , Saito Ryota , Oda Shota , Petersen Kristian Kjær , Arendt-Nielsen Lars , Ikeuchi Masahiko 
Published: April 2022

Abstract

Purpose:
Altered pain facilitatory and inhibitory mechanisms have been recognized as an important manifestation in patients with chronic pain, and quantitative sensory testing (QST) can act as a proxy for this process. We have recently developed a simple bedside QST tool kit (QuantiPain) for more clinical use. The purpose of this study was to investigate its test–retest reliability and to evaluate its validity compared with the laboratory-based QST protocols in patients with knee osteoarthritis (OA).

Methods:

QuantiPain consists of 3 items: “pressure algometer” (for pressure pain thresholds [PPTs]), “pinprick” (for temporal summation of pain [TSP]), and “conditioning clamp” (for conditioned pain modulation [CPM]). In experiment-A, intrarater and interrater test–retest reliabilities were investigated in 21 young healthy subjects by using interclass correlation coefficient (ICC). In experiment-B, 40 unilateral painful patients with OA and 40 age-matched, healthy control subjects were included to compare the bedside tool kit against the computerized pressure algometry.

Results:
In experiment-A, excellent to moderate intrarater and interrater reliabilities were achieved in PPT and TSP (ICC: 0.60–0.92) while the agreements of CPM were good to poor (ICC: 0.37–0.80). In experiment-B, localized and widespread decrease of PPT, facilitated TSP, and impaired CPM was found by using the bedside tool kit in patients with OA compared with controls (P < 0.05). The data were significantly correlated with the established laboratory-based tools (R = 0.281–0.848, P < 0.05).

Conclusion:

QuantiPain demonstrated acceptable test–retest reliability and assessment validity with the sensitivity to separate patients with painful OA from controls, which has a potential to create more practical approach for quantifying altered pain mechanisms in clinical settings.
Total Plasma Protein S Is a Prothrombotic Marker in People Living With HIV
Authors: Sim Martha M. S. , Banerjee Meenakshi , Myint Thein , Garvy Beth A. , Whiteheart Sidney W. , Wood Jeremy P. 
Published: April 2022

Background:
HIV-1 infection is associated with multiple procoagulant changes and increased thrombotic risk. Possible mechanisms for this risk include heigthened expression of procoagulant tissue factor (TF) on circulating monocytes, extracellular vesicles, and viral particles and/or acquired deficiency of protein S (PS), a critical cofactor for the anticoagulant protein C (PC). PS deficiency occurs in up to 76% of people living with HIV-1 (PLWH). As increased ex vivo plasma thrombin generation is a strong predictor of mortality, we investigated whether PS and plasma TF are associated with plasma thrombin generation.

Methods:
We analyzed plasma samples from 9 healthy controls, 17 PLWH on first diagnosis (naive), and 13 PLWH on antiretroviral therapy (ART). Plasma thrombin generation, total and free PS, PC, C4b-binding protein, and TF activity were measured.

Results:
We determined that the plasma thrombin generation assay is insensitive to PS, because of a lack of PC activation, and developed a modified PS-sensitive assay. Total plasma PS was reduced in 58% of the naive and 38% of the ART-treated PLWH samples and correlated with increased thrombin generation in the modified assay. Conversely, plasma TF was not increased in our patient population, suggesting that it does not significantly contribute to ex vivo plasma thrombin generation.

Conclusion:
These data suggest that reduced total plasma PS contributes to the thrombotic risk associated with HIV-1 infection and can serve as a prothrombotic biomarker. In addition, our refined thrombin generation assay offers a more sensitive tool to assess the functional consequences of acquired PS deficiency in PLWH.
The Effects of Empowerment on Health Care Worker Performance During the COVID-19 Pandemic in Saudi Arabia
Authors: Alrige Mayda , Alshahrani Fatimah , Alharbi Amani , Aljuhani Nouf , Aldini Nuha 
Published: April 2022

Background and Objectives:
In this study, we assessed the potential impact of employee empowerment on health care workers' performance during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. In particular, we aimed to determine the empowerment practices that would have the greatest positive effect on employee performance. Understanding the relationship between performance and empowerment can help health care providers better manage worker stress during any global crisis. This understanding is crucial in guiding policies and interventions aimed at maintaining health care workers' psychological well-being and their overall performance.

Methods:
This cross-sectional study evaluated the relationship between employee empowerment and performance, determining the best empowerment practices for health care leaders to utilize. Frontline health care workers (n = 100) selected using convenience and snowball sampling completed the survey between March 15 and 31, 2020. This is the period when the pandemic just started to accelerate in Saudi Arabia. We conducted Pearson's correlation analysis to assess whether there was a relationship between performance and health care workers' empowerment practice, and stepwise linear regression analysis to investigate the impact each of these empowerment practices on health care workers' performance.

Results:
Our results indicate that health care workers' performance can be expected to increase the most through 2 empowerment practices: giving employees the discretion to change work processes and offering performance-based rewards (R
2 = 0.301, P < .05).

Conclusion:
Our findings suggest that health care leaders must invest in these 2 practices to better equip frontline health care workers. During a global crisis, additional discretion granted to employees helps reduce their anxiety and burnout and hence empowers them with the flexibility to adapt to unforeseen circumstances and improve the quality of their interactions with health service recipients.
Quantitative Patient-Reported Experience Measures Derived From Natural Language Processing Have a Normal Distribution and No Ceiling Effect
Authors: Rajagopalan Dayal , Thomas Jacob , Ring David , Fatehi Amirreza 
Published: April 2022

Background and Objectives:
Patient-reported experience measures have the potential to guide improvement in health care delivery. Many patient-reported experience measures are limited by the presence of strong ceiling effects that limit their analytical utility.

Methods:
We used natural language processing to develop 2 new methods of evaluating patient experience using text comments and associated ordinal and categorical ratings of willingness to recommend from 1390 patients receiving specialty or nonspecialty care at our offices. One method used multivariable analysis based on linguistic factors to derive a formula to estimate the ordinal likelihood to recommend. The other method used the meaning extraction method of thematic analysis to identify words associated with categorical ratings of likelihood to recommend with which we created an equation to compute an experience score. We measured normality of the 2 score distributions and ceiling effects.

Results:
Spearman rank-order correlation analysis identified 36 emotional and linguistic constructs associated with ordinal rating of likelihood to recommend, 9 of which were independently associated in multivariable analysis. The calculation derived from this model corresponded with the original ordinal rating with an accuracy within 0.06 units on a 0 to 10 scale. This score and the score developed from thematic analysis both had a relatively normal distribution and limited or no ceiling effect.

Conclusions:
Quantitative ratings of patient experience developed using natural language processing of text comments can have relatively normal distributions and no ceiling effect.
Medical Home Outcomes for School-Aged Children With Chronic Health Care Needs: A Mokken Analysis
Authors: Barnard-Brak Lucy , McGaha Valerie , Little Todd D. , Fearon-Drake Danielle 
Published: April 2022

Background and Objectives:
We examined the structure of the medical home construct as well as the association of having a medical home with school outcomes among children with chronic health conditions.

Methods:
The current study utilized a combination of structural equation modeling, item response theory, and Mokken scaling techniques to determine how components of a medical home may be prioritized. The components of an operationally defined medical home were the main measures along with number of missed school days and the degree of interference with a child's school.

Results:
Results of the current study provide a clear structure for the components of a medical home using Mokken scaling analyses. These components of a medical home are important as they were associated with fewer missed school days and a lower likelihood of a child's condition interfering with school as reported by parents.

Conclusion:
With the results of the current study, providers working with schools can quickly discriminate (1) whether a child has a medical home and (2) understand how to guide parents toward a comprehensive medical home by understanding the hierarchy of medical home components.
FDG PET/CT in a Case With Primary Poorly Differentiated Urothelial-Type Adenocarcinoma of the Prostate
Authors: Dong Aisheng , Zhu Yan , Zuo Changjing 
Published: April 2022

Abstract
Primary urothelial-type adenocarcinoma of the prostate is extremely rare. We describe FDG PET/CT findings in a case with primary poorly differentiated urothelial-type adenocarcinoma of the prostate with pelvic lymph node metastases. Both the prostate tumor and its metastatic lesions showed intense FDG uptake. The patient had normal serum prostate-specific antigen and elevated carcinoembryonic antigen levels, which may be helpful for the differential diagnosis.
18F-FDG PET/CT Demonstrating Crossed Cerebellar Diaschisis Due to Germ Cell Tumor of the Basal Ganglia
Authors: Dondi Francesco , Bertoli Mattia , Volpi Giulia , Bertagna Francesco , Giubbini Raffaele 
Published: April 2022

Abstract
Germ cell tumors of the basal ganglia are rare neoplasms that usually present with hemiparesis or other neurological symptoms. MR and PET/CT with different tracers have demonstrated their usefulness for the correct assessment of disease. Crossed cerebellar diaschisis refers to a depression in metabolism of a cerebellar hemisphere as a result of contralateral supratentorial lesions. We present a case in which MR and PET/CT were crucial for the assessment of left basal ganglia germ cell tumors with the presence of crossed cerebellar diaschisis.
18F-FDG PET/CT Metabolic Response With Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer Treated With Cyclin-Dependent 4/6 Kinase Inhibitors
Authors: Filizoglu Nuh , Ozguven Salih , Erdil Tanju Yusuf 
Published: April 2022

Abstract
Dysregulation of the cyclin D–CDK4/6–INK4–RB pathway, which leads to uncontrolled cell proliferation, is frequently observed in breast cancer. Recently, 3 CDK4/6 inhibitors have been FDA approved as first-line treatment for patients with hormone receptor–positive, human epidermal growth factor receptor 2–negative advanced breast cancer. Despite promising clinical results, the metabolic response to treatment with these new drugs has not been elaborately demonstrated yet. Herein, we presented a patient with hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer who demonstrated a complete metabolic response on 18F-FDG PET/CT to treatment with a CDK4/6 inhibitor (ribociclib).
Adamantinoma-Like Ewing Sarcoma of the Mandible Evaluated on 18F-FDG PET/CT
Authors: Huls Sean J. , Broski Stephen M. , Guo Ray Ruifeng , Binkovitz Larry A. 
Published: April 2022

Abstract
Ewing sarcoma is the second most common primary bone tumor in children. Typical Ewing sarcoma most frequently occurs in long bones and within the pelvis. ALES (adamantinoma-like Ewing sarcoma) is a rare subtype of Ewing sarcoma that is characterized by epithelial differentiation in addition to small round blue cells. Unlike typical Ewing sarcoma, ALES has been described in several cases in the head and neck. Herein, we describe a case of a 9-year-old boy with ALES of the mandible evaluated on 18F-FDG PET/CT with correlative MRI scans.
Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients
Authors: Mazuecos Auxiliadora , Villanego Florentino , Zarraga Sofía , López Verónica , Oppenheimer Federico , Llinàs-Mallol Laura , Hernández Ana M. , Rivas Alba , Ruiz-Fuentes María C. , Toapanta Néstor G. , Jiménez Carlos , Cabello Sheila , Beneyto Isabel , Aladrén María J. , Rodríguez-Benot Alberto , Canal Cristina , Molina María , Pérez-Flores Isabel , Saura Isabel M. , Gavela Eva , Franco Antonio , Lorenzo Inmaculada , Galeano Cristina , Tabernero Guadalupe , Pérez-Tamajón Lourdes , Martín-Moreno Paloma L. , Fernández-Girón Fernando , Siverio Orlando , Labrador Pedro J. , De Arriba Gabriel , Simal Fernando , Cruzado Leónidas , Moina Inigo , Alcalde Guillermo , Sánchez-Álvarez Emilio , Pascual Julio , Crespo Marta ,   for the Spanish Society of Nephrology COVID-19 Group
Published: April 2022

Background.
The clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination in kidney transplant (KT) recipients is lower than in the general population.

Methods.
From April to October 2021, 481 KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and vaccine type were collected, and outcomes of unvaccinated or partially vaccinated patients (n = 130) were compared with fully vaccinated patients (n = 351).

Results.
Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (P = 0.776). In multivariable analysis, age and pneumonia were independent risk factors for death, whereas vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination, as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (n = 213) showed a significantly lower mortality than those who received the BNT162b2 vaccine (n = 121) (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85; P = 0.010).

Conclusions.
COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of the mRNA vaccine. The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infections. Confirmation of these data will require further research taking into account the new variants and the administration of successive vaccine doses.