bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Transportability to Understand Differences in Mediation Mechanisms Across Trial Sites of a Housing Voucher Experiment
Authors: Rudolph Kara E. , Levy Jonathan , Schmidt Nicole M. , Stuart Elizabeth A. , Ahern Jennifer 
Published: April 2020

Background:
Randomized trials may have different effects in different settings. Moving to Opportunity (MTO), a housing experiment, is one such example. Previously, we examined the extent to which MTO’s overall effects on adolescent substance use and mental health outcomes were transportable across the sites to disentangle the contributions of differences in population composition versus differences in contextual factors to site differences. However, to further understand reasons for different site effects, it may be beneficial to examine mediation mechanisms and the degree to which they too are transportable across sites.

Methods:
We used longitudinal data from MTO youth. We examined mediators summarizing aspects of the school environment over the 10–15 year follow-up. Outcomes of past-year substance use, mental health, and risk behavior were assessed at the final timepoint when participants were 10–20 years old. We used doubly robust and efficient substitution estimators to estimate (1) indirect effects by MTO site and (2) transported indirect effects from one site to another.

Results:
Differences in indirect effect estimates were most pronounced between Chicago and Los Angeles. Using transport estimators to account for differences in baseline covariates, likelihood of using the voucher to move, and mediator distributions partially to fully accounted for site differences in indirect effect estimates in 10 of the 12 pathways examined.

Conclusions:
Using transport estimators can provide an evidence-based approach for understanding the extent to which differences in compositional factors contribute to differences in indirect effect estimates across sites, and ultimately, to understanding why interventions may have different effects when applied to new populations.
Perceived Learning Needs of Patients With Heart Failure in Jordan: Perspectives of Patients, Caregivers, and Nurses
Authors: Ashour Ala , Al-Rawashdeh Sami , Alwidyan Mahmoud , Al-Smadi Ahmed , Alshraifeen Ali 
Published: April 2020

Background
Identifying learning needs is an important component of care among patients with heart failure (HF). There is a discrepancy in the level of importance of information as perceived by patients, caregivers, and nurses. No studies have been conducted to identify learning needs among patients with HF in Jordan.

Objective
The aim of this study was to identify the learning needs of patients with HF in Jordan from the perspective of patients, family caregivers, and their nurses.

Methods
A descriptive comparative design using a convenience sample of 67 patients with HF, 67 family caregivers, and 67 nurses was used. The Heart Failure Learning Needs Inventory was used to identify the learning needs. The mean scores were compared among the 3 groups and ranked by importance for each item to determine the most important areas of perceived needs for each group.

Results
All groups had high total Heart Failure Learning Needs mean scores: patients, 4.12 ± 0.92; caregivers, 4.14 ± 0.65; and nurses, 4.08 ± 0.54. The top priority learning need for both patients and caregivers was “the recommended daily salt intake,” whereas for nurses, it was “why I am taking each medication and its side effects”; nurses significantly perceived it as more important to learn than patients and caregivers did. Younger and employed patients requested more information than other patients.

Conclusions
Although some similarities exist, there are important differences among the 3 groups on perceived importance of information. Understanding these differences may be critical in developing a tailored educational program for patients and caregivers and improving nursing practice.
Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study
Authors: Kara Stephen , Crosswell Hannah , Forch Katherine , Cavadino Alana , McGeown Josh , Fulcher Mark 
Published: April 2020

Objective:To describe clinical recovery time and factors that might impact on recovery after a sports-related mild traumatic brain injury (SR-mTBI; concussion).Design:Prospective cohort study (level IV evidence).Setting:New Zealand Sports Concussion Clinic.Participants:Eight hundred twenty-two patients presenting within 14 days of a SR-mTBI/concussion over a 2-year period.Main Outcome Measures:Clinical recovery measured as number of days after injury.Interventions Methods:Participants were assessed and managed using a standardized protocol consisting of relative rest followed by controlled cognitive and physical loading. A reassessment was performed 14 days after injury with initiation of an active rehabilitation program consisting of a subsymptom threshold exercise program ± cervicovestibular rehabilitation (if required) for participants who remained symptomatic. Participants were then assessed every 2 weeks until clinical recovery.Results:A total of 594 participants were eligible for analysis (mean age 20.2 ± 8.7 years, 77% males) and were grouped into 3 age cohorts: children (≤12 years), adolescents (13-18 years), and adults (≥19 years). Forty-five percent of participants showed clinical recovery within 14 days of injury, 77% by 4 weeks after injury, and 96% by 8 weeks after injury. There was no significant difference in recovery time between age groups. Prolonged recovery was more common in females (P= 0.001), participants with “concussion modifiers” (P= 0.001), and with increased time between injury and the initial appointment (P= 0.003).Conclusions:This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate. Active rehabilitation results in high recovery rates after SR-mTBI.
Surgical Labyrinthectomy and Cochlear Implantation in Menière's Disease
Authors: Sykopetrites Vittoria , Giannuzzi Anna Lisa , Lauda Lorenzo , Di Rubbo Vittoria , Bassi Margherita , Sanna Mario 
Published: April 2020

Objective:The aim of this study was to analyze the results of labyrinthectomy and cochlear implantation (CI) on hearing, vertigo, and tinnitus and evaluate the adequacy of labyrinthectomy and CI for the treatment of end stage Menière's Disease (MD).Study Design:Retrospective case review.Setting:Tertiary referral center.Patients:Charts of 22 patients undergoing labyrinthectomy and CI in the same ear for intractable vertigo and hearing loss with both preoperatory and postoperatory documentation available, were reviewed.Intervention(s):Therapeutic.Main Outcome Measure(s):Auditory outcomes were assessed with pure tone and speech audiometry, and compared with the preoperatory audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the tinnitus handicap inventory (THI).Results:Post-CI pure tone average had a statistically significant improvement (p = 0.035, pairedttest). Speech audiometry resulted in a non-statistically significant speech discrimination score variation (p = 0.056, pairedttest). Postoperatory THI had a statistically significant variation (p = 0.0001, pairedttest). Sixty seven per cent of the patients had complete resolution of the vestibular symptoms in their operated ear, however, patients over 70 years old had significantly more failures as evinced by the postoperative DHI (p = 0.0109, Fisher's exact test).Conclusions:Patients affected by end stage MD or secondary MD, with vertigo and severe hearing loss can successfully undergo labyrinthectomy and CI. Caution should be reserved in elderly patients for a risk of persistent instability. The CI confers significant benefit in hearing rehabilitation and tinnitus suppression.
The Use of a Novel, Nonsurgical Bone Conduction Hearing Aid System for the Treatment of Conductive Hearing Loss
Authors: Kuthubutheen Jafri , Broadbent Chris , Marino Roberta , Távora-Vieira Dayse 
Published: April 2020

Objective:
Conventional bone conduction hearing aid solutions often require a cumbersome retention system such as a headband or cap. This study aims to determine if a novel, nonsurgical bone conduction aid utilizing an adhesive attachment over the mastoid is equivalent to the conventional bone conduction hearing aid (BCHA) for the management of conductive hearing loss.

Study Design:
Prospective, single-subject randomized, crossover trial.

Setting:
Tertiary referral center.

Patients:
Eleven adults and 1 child between 11 and 70 years of age with unilateral conductive hearing loss were enrolled.

Intervention:
Patients had their baseline hearing assessed and were randomized to receive either the novel device or BCHA headband system. Hearing loss etiologies were varied and included cholesteatoma, otosclerosis, chronic otitis media, and previous head and neck surgery. Patients had their baseline hearing assessed and trialled both the novel device or the BCHA headband system. Patients were randomly assigned one device which was worn for 2 weeks followed by a 2-week trial with the alternate device.

Main Outcome Measure:
Pure-tone thresholds and speech discrimination in quiet and noise were tested and patients also completed the short form of the Speech Spatial and Quality of Hearing (SSQ) questionnaire.

Results:
The mean unaided 4 frequency pure-tone average (PTA) air conduction threshold was 53.9 dB, bone conduction was 11.9 dB, and the mean air bone gap was 42 dB in the target ear. One patient with an adhesive skin reaction could not complete the protocol. Aided PTA and threshold testing between 250 Hz to 8000 Hz showed statistically equivalent results between both devices. The aided CNC word score, signal-to-noise ratio, and SSQ scores were also equivalent between both devices.

Conclusion:
The novel bone conduction aid demonstrates equivalent performance to the conventional BCHA headband solution. The novel device should be considered an alternative option where the cosmetic and comfort issues of a headband worn device are a concern.
Enhancing patient adherence to fecal microbiota transplantation maintains the long-term clinical effects in ulcerative colitis
Authors: Li Qianqian , Zhang Ting , Ding Xiao , Xiang Liyuan , Cui Bota , Buch Heena , Zhang Faming 
Published: April 2020

Objectives
The way to improve the long-term efficacy of fecal microbiota transplantation (FMT) in ulcerative colitis (UC) remains unclear. This study mainly dedicated to the UC patients’ satisfaction with FMT and the importance of patients’ adherence to repeated FMT for long-term clinical outcomes.

Methods
Patients with UC who underwent FMT at our center from November 2012 to September 2018 were included. We assessed patient satisfaction with efficacy, safety, and reliability of FMT, as well as adherence to the repeated FMT.

Results
One hundred and seventy-six patients were included in the analysis. The median follow-up duration of the study was 25.5 (interquartile range 13.0–46.5) months. The clinical response rate at 1 week, 1 month, 3 months, and 6 months after FMT was 48.9%, 69.3%, 49.4%, and 32.7%, respectively. 3.4% (6/176) of patients underwent colectomy after FMT during our long-term follow-up. Partial Mayo score at 1-month post-FMT (P < 0.001) was an independent factor of patients’ satisfaction. The laboratory preparation process was related to the incidence of adverse events (P < 0.05). 23.8% (29/122) of patients with a good adherence followed our recommendation to undergo the second course of FMT and achieved a longer clinical response compared with the patients with poor adherence (P < 0.001).

Conclusion
Patients’ good adherence to repeated FMT is important to maintain long-term clinical benefits achieved from FMT in UC. Registration number: NCT01790061.
Clinical phenotype and mortality in patients with idiopathic small bowel villous atrophy: a dual-centre international study
Authors: Schiepatti Annalisa , Sanders David S. , Aziz Imran , De Silvestri Annalisa , Goodwin John , Key Tim , Quaye Lydia , Giuffrida Paolo , Vanoli Alessandro , Paulli Marco , Cross Simon S. , Vergani Patricia , Betti Elena , Maiorano Gregorio , Ellis Richard , Snowden John A. , Di Sabatino Antonio , Corazza Gino R. , Biagi Federico 
Published: April 2020

Objective
Causes of small-bowel villous atrophy (VA) include coeliac disease (CD), its complications and other rare non-coeliac enteropathies. However, forms of VA of unknown aetiology may also exist. We defined them as idiopathic VA (IVA). To retrospectively classify the largest cohort of IVA patients and compare their natural history with CD.

Methods
Notes of 76 IVA patients attending two tertiary centres between January 2000 and March 2019 were retrospectively reviewed. CD, its complications and all the known causes of VA were excluded in all of them. Persistence of VA during follow-up and lymphoproliferative features were used to retrospectively classify IVA, as follows. Group 1: IVA with spontaneous histological recovery (50 patients). Group 2: persistent IVA without lymphoproliferative features (14 patients). Group 3: persistent IVA with lymphoproliferative features (12 patients). Survival was compared between IVA groups and 1114 coeliac patients. HLA was compared between IVA patients, coeliac patients and appropriate controls.

Results
Five-year survival was 96% in IVA group 1, 100% in IVA group 2, 27% in IVA group 3 and 97% in CD. On a multivariate analysis hypoalbuminemia (P = 0.002) and age at diagnosis (P = 0.04) predicted mortality in IVA. Group 2 showed association with HLA DQB1*0301 and DQB1*06.

Conclusion
IVA consists of three groups of enteropathies with distinct clinical phenotypes and prognoses. Mortality in IVA is higher than in CD and mainly due to lymphoproliferative conditions necessitating more aggressive therapies.
Acoustic radiation force impulse imaging of pancreas in patients with early onset idiopathic recurrent acute pancreatitis
Authors: Sanjeevi Rajesh , John Reetu Amrita , Kurien Reuben Thomas , Dutta Amit Kumar , Simon Ebby George , David Deepu , Joseph Anjilivelil Joseph , Chowdhury Sudipta Dhar 
Published: April 2020

Background and aims:
Patients with recurrent acute pancreatitis (RAP) may progress to chronic pancreatitis (CP). A critical step in this progression is the development of fibrosis. Elastography has been used to assess degree of fibrosis by measurement of shear wave velocity (SWV). The aim of this study was to measure the stiffness of pancreas as a surrogate for pancreatic fibrosis in patients with RAP and compare it with a group of individuals without any history of pancreatic disorders.

Material and methods:
Using acoustic radiation force impulse (ARFI) imaging SWV was calculated in 31 patients with idiopathic RAP having disease onset ≤30 years. A control group of 31 individuals with no history pancreatic disorder and no features of CP on endosonography was selected for comparison. ARFI imaging was done by a single radiologist who was blinded to the cases and controls

Results:
Mean age of patients with RAP was 24.8 (SD 9.86) years, disease duration was 3.45 (interquartile range 1–5) years, mean number of episodes 4.9 (SD 2.72). There was a significant difference in SWV between patients (1.27 ± 0.50 m/s) and controls (1.00 ± 0.17 m/s) (P = 0.001)). There was a positive correlation between SWV and number of pain episodes (P = 0.026) and negative correlation with BMI (P = 0.002).

Conclusion:
SWV was high in patients with RAP indicating a stiff pancreas. The stiffness increases with the number of episodes of pancreatitis.
Absence of hepatic activity in lymphoscintigraphy performed with Tc-99m-Nanoscan
Authors: Syed Adeel , Levart Danielle , Vadrucci Manuela , Gibson Victoria , Peters A. Michael 
Published: April 2020

Introduction
For assessment of lower extremity swelling using lymphoscintigraphy, several nuclear medicine departments in the UK have recently switched from 99mTc-Nanocoll to 99mTc-Nanoscan. The aim of the study was to compare quantitative and semiquantitative features of lymphoscintigraphy between these two tracers.

Methods
Twenty patients received 99mTc-Nanocoll and 20 received 99mTc-Nanoscan either side of the switch-over in our department. Tracers were compared with respect to visualisation of the liver, para-aortic lymph nodes and urine (all graded by consensus from 0 to 3; invisible-to-very prominent); and with respect to ilio-inguinal nodal quantification and ratio of liver-to-summed bilateral ilio-inguinal nodal activity at 120 min postinjection (L/N120). Scans were deemed abnormal when there was lymph diversion through skin or deep system, no activity in ilio-inguinal nodes at 60 min or negligible ilio-inguinal activity (<5%, left plus right) at 120 min.

Results
Liver was visualised in 18/20 99mTc-Nanocoll but only 3/20 99mTc-Nanoscan scans. Moreover, para-aortic activity was less prominent after 99mTc-Nanoscan. Urinary activity was more prominent after 99mTc-Nanocoll. There were 9/20 patients with stomach activity after 99mTc-Nanocoll compared with 1/20 after 99mTc-Nanoscan. Urinary and stomach activities correlated. There was an elevated L/N120, and therefore a suspicion of peripheral lympho-venous communication, in the single 99mTc-Nanoscan patient who displayed prominent hepatic activity.

Conclusion
Hepatic activity is the result of accumulation of colloidal degradation products generated in lymph nodes, rather than intact colloid. 99mTc-Nanoscan gives less hepatic activity than 99mTc-Nanocoll because it is more resistant to intranodal degradation. Peripheral lymphovenous communication remains a possible alternative route for activity to reach the liver.
Diagnostic classification of solitary pulmonary nodules using support vector machine model based on 2-[18F]fluoro-2-deoxy-D-glucose PET/computed tomography texture features
Authors: Zhang Jianping , Ma Guang , Cheng Jingyi , Song Shaoli , Zhang Yingjian , Shi L. Q. 
Published: April 2020

Purpose
This study aimed to evaluate the diagnostic value of a support vector machine (SVM) model built with texture features based on standard 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET in patients with solitary pulmonary nodules (SPNs) at a volume larger than 5 mL.

Patients and methods
The PET results of 82 patients diagnosed with SPNs between 2014 and 2018 were retrospectively analysed. The volumes of interest (VOIs) of the SPNs were automatically segmented using threshold techniques from the standard PET imaging. Then, a large number of texture features were extracted from the VOIs using texture-analysis software. Next, an optimized SVM machine-learning model that was trained on standard PET images using texture features was employed to identify the optimal discrimination between malignant and benign nodules. Diagnostic models based on the maximum standardized uptake value (SUVmax) and the metabolic tumour volume (MTV) were compared with the SVM model with regard to the SPN diagnostic power.

Results
Compared with the SUVmax and MTV models, the texture-based SVM model provided an improvement of approximately 20% in diagnostic accuracy, positive predictive value, negative predictive value and the area under the operating characteristic curve. The receiver operating characteristic curve of the SVM model showed a significant improvement compared with the MTV model (P = 0.0345 < 0.05) and the SUVmax model (P = 0.01 < 0.05).

Conclusions
Standard 18F-FDG PET imaging can increase the differentiation of benign and malignant SPNs with volumes larger than 5 mL using an SVM model based on texture features.
Varieties of Religious (Non)Affiliation
Authors: Saunders David , Norko Michael , Fallon Brian , Phillips James , Nields Jenifer , Majeed Salman , Merlino Joseph , El-Gabalawi Fayez 
Published: April 2020

Abstract
Given changing demographics of religiosity and spirituality, this article aims to help clinicians understand contemporary trends in patient religious and spiritual orientation. It first identifies and describes the evolving varieties of religio-spiritual orientation and affiliation, as identified in survey studies. Particular attention is given to the examination of those who identify as spiritual but not religious (SBNR) and None (i.e., no religious affiliation), which is important to mental health practice because many patients now identify as SBNR or None. Next, empirical data are considered, including what the literature reveals regarding mental health outcomes and SBNRs and Nones. We conclude with a summary of the main points and five recommendations that mental health practitioners and researchers need to consider regarding this increasingly large portion of the population.
Trauma and Suicide
Authors: Allen Adrienne Reid , Hagen Kathryn M. 
Published: April 2020

Abstract
This pilot study explored suicide risk in patients suffering from trauma and psychosis. Forty-seven participants diagnosed with schizophrenia spectrum disorders participated in the study. An archival design was used to identify the severity of suicide risk in participants with trauma and psychosis. Data included a chart review of documented trauma and responses to the Childhood Experience of Care and Abuse Questionnaire, Columbia–Suicide Severity Rating Scale, Beck Depression Inventory-II, and the Positive and Negative Syndrome Scale. Results of a linear regression indicated that chart-documented trauma and heightened depression scores were predictive of increased suicidality. Results suggest that, for patients with schizophrenia, depression severity and chart-documented trauma may be strong predictors of suicidality. Interestingly, data also revealed that, although depression and trauma were predictors of suicidality, psychosis was not. The implications of these results are discussed, in addition to suggestions for future research.
Rehabilitation After Critical Illness in People With COVID-19 Infection
Authors: Simpson Robert , Robinson Larry 
Published: April 2020

Abstract
The current COVID-19 pandemic will place enormous pressure on healthcare systems around the world. Large numbers of people are predicted to become critically ill with acute respiratory distress syndrome and will require management in intensive care units. High levels of physical, cognitive, and psychosocial impairments can be anticipated. Rehabilitation providers will serve as an important link in the continuum of care, helping move patients on from acute sites to eventual discharge to the community. Likely impairment patterns, considerations for healthcare practitioner resilience, and organization of services to meet demand are discussed. Innovative approaches to care, such as virtual rehabilitation, are likely to become common in this environment.