bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Rate of Gestational Diabetes Between Active Duty and Non-active Duty Beneficiaries at a Military Treatment Facility
Authors: Odedokun Tolulope , Weir Larissa F , Aden James K 
Published: December 2020

Abstract

Introduction
Gestational diabetes mellitus (GDM) affects approximately 1-14% of all pregnancies in the United States and has significant maternal and neonatal consequences. Developing GDM can increase a patient’s risk of developing overt diabetes in the future which may impact a soldier’s readiness. The purpose of this study is to compare the incidence of GDM in active duty females compared with civilian dependents.

Materials and Methods
This retrospective cohort analysis was performed at a military medical center with IRB approval. Active duty and dependent status women who delivered between June 1, 2014 and April 30, 2015 were identified along with incidence of GDM. Sample size calculation determined a need for 391 women in each group to observe a 5% difference in rate of GDM with a power of 80%. Chi-squared analysis was used to compare rates of GDM.

Results
Rates of GDM were similar between the two cohorts (active duty = 9.95%, dependent = 9.72%, P = .91). Age, gravidity, and prepregnancy BMI were also similar between groups. The rate of diet-controlled GDM were different between the two cohorts (active duty = 53.8%, dependent = 34.2%, P = .02).

Conclusions
This study highlights active duty females have similar rates of GDM as dependents. Gestational diabetes mellitus is known to affect short- and long-term maternal and neonatal outcomes and can impact a soldier’s readiness. Further research is required to determine the long-term impact of GDM in active duty females and best practices to decrease rates of GDM in the military population.
Deployment and Psychological Correlates of Suicide Ideation: A Prospective, Longitudinal Study of Risk and Resilience Among Combat Veterans
Authors: Yurgil Kate A , Barkauskas Donald A , Baker Dewleen G 
Published: December 2020

ABSTRACT

Introduction
Suicide rates among military personnel have risen in part due to war zone deployments. Yet, the degree to which deployment-related stressors, in combination with preexisting and co-occurring psychiatric symptoms and individual resilience factors, contribute to suicide ideation (SI) remains unclear. The current study leverages prospective, longitudinal data to examine both risk and protective factors associated with SI in deployed service members.

Materials and Methods
Participants were 1,805 active duty enlisted Marines and Navy service members assessed before and after a 7-month deployment for SI, preexisting and concurrent symptoms of depression, post-traumatic stress disorder (PTSD), alcohol consumption, as well as prior and deployment-related traumatic brain injury (TBI). Current self-reported psychological resilience and social support were analyzed as potential protective factors.

Results
Rates of SI were 7.3% and 3.9% before and after deployment, respectively. Of those with post-deployment SI, 68.6% were new-onset cases. Multivariate regression revealed that concurrent mild depression was the strongest risk factor (odds ratio [OR] = 10.03, 95% CI 5.28-19.07). Other significant risk factors included prior SI (OR = 3.36, 95% CI 1.60-7.05), prior subthreshold PTSD (OR = 2.10, 95% CI 1.10-3.99), and deployment TBI (OR = 1.84, 95% CI 1.03-3.28). Controlling for clinical symptoms and TBI, the risk of SI was reduced for those with moderate (OR = 0.50, 95% CI 0.27-0.93) and high psychological resilience scores (OR = 0.25, 95% CI 0.08-0.79) after deployment.

Conclusions
Results indicate that even mild symptoms of depression and PTSD may increase the risk of SI. Screening for subthreshold clinical symptoms and TBI while incorporating psychological resilience training would allow for a more multidimensional approach to suicide risk assessment.
Gamma-Irradiated Cornea in Combat-related Ocular Trauma
Authors: Davis Brian M , Clabeaux Carson , Vlasov Anton , Houghtaling Paul 
Published: December 2020

ABSTRACT
Corneal injury is a known risk for deployed troops worldwide. To the authors’ knowledge, there has been no reported use of gamma-irradiated corneas in the setting of severe corneal trauma. Our report highlights the case of a 36-year-old active duty solider who sustained bilateral penetrating ocular trauma from a nearby ordnance explosion. We propose that ocular surgeons should consider utilizing gamma-irradiated corneas in (1) a situation where the corneal tissue is so damaged that it would be challenging to accomplish an adequate repair while providing the opportunity for future visual rehabilitation and (2) remote and/or deployed environments where storage of fresh donor tissue is limited. The long shelf life of gamma-irradiated corneas reduces the need for specialized storage equipment and the need for continuous resupply, both potentially leading to significant cost savings for the Military Health System.
Methodology of the U.S. Army’s Suicide Prevention Leadership Tool Study: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4)
Authors: Curley Justin M , Duffy Farifteh F , Kim Paul Y , Clarke-Walper Kristina M , Nugent Katie L , Penix Elizabeth A , Elliman Toby D , Wilk Joshua E , Riviere Lyndon A 
Published: December 2020

ABSTRACT

Introduction
The Secretary of the U.S. Army issued two directives in late 2017 to directly combat the problem of suicide in the U.S. Army. The first was to develop an Army tool to assist commanders and first-line leaders in preventing suicide and improving behavioral health (BH) outcomes, which has been previously published as the BH Readiness and Risk Reduction Review (R4). The second was to conduct an evaluation study of the tool with Army units in the field. This study is the first to empirically examine the Army’s tool-based methods for identifying and caring for the health and welfare of soldiers at risk for suicide, and this article outlines the methodology employed to study the effectiveness of the R4 tools and accomplish the Secretary’s second directive.

Methods
The Walter Reed Army Institute of Research Institutional Review Board approved the R4 study. The study employed a repeated measurements in pre/post quasi-experimental design, including a nonequivalent but comparable business-as-usual control group. The R4 intervention consisted of the R4 tools, accompanying instructions, and an orientation. Samples were drawn from two geographically separated U.S. Army divisions in the continental United States, each composed of four comparable brigades. Study implementation consisted of three phases and three data collections over the course of 12 months. Soldiers completed anonymous survey instruments to assess a range of health factors, behaviors, characteristics, tool-related decision-making processes, and the frequency, type, and quality of interactions between soldiers and leaders.

Results
The R4 study commenced on May 6, 2019, and concluded on June 4, 2020. Sample size goals were achieved for both the divisions at all three data collection time points.

Conclusions
The methodology of the R4 study is critical for the U.S. Army from both a precedential and an outcome-based standpoint. Despite the use of many previous tools and programs for suicide prevention, this is the first time the Army has been able to empirically test the effectiveness of tool-supported decision-making among Army units in a rigorous fashion. The methodology of such a test is a critical marker for future interventional inquiries on the subject of suicide in the Army, and the results will allow for more informed decision-making by leaders when approaching these ongoing challenges.
COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States
Authors: da Silva Juliana F , Hernandez-Romieu Alfonso C , Browning Sean D , Bruce Beau B , Natarajan Pavithra , Morris Sapna B , Gold Jeremy A W , Neblett Fanfair Robyn , Rogers-Brown Jessica , Rossow John , Szablewski Christine M , Oosmanally Nadine , D’Angelo Melissa Tobin , Drenzek Cherie , Murphy David J , Hollberg Julie , Blum James M , Jansen Robert , Wright David W , Sewell William , Owens Jack , Lefkove Benjamin , Brown Frank W , Burton Deron C , Uyeki Timothy M , Patel Priti R , Jackson Brendan R , Wong Karen K 
Published: December 2020

AbstractBackgroundThe epidemiological features and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) have been described; however, the temporal progression and medical complications of disease among hospitalized patients require further study. Detailed descriptions of the natural history of COVID-19 among hospitalized patients are paramount to optimize health care resource utilization, and the detection of different clinical phenotypes may allow tailored clinical management strategies.MethodsThis was a retrospective cohort study of 305 adult patients hospitalized with COVID-19 in 8 academic and community hospitals. Patient characteristics included demographics, comorbidities, medication use, medical complications, intensive care utilization, and longitudinal vital sign and laboratory test values. We examined laboratory and vital sign trends by mortality status and length of stay. To identify clinical phenotypes, we calculated Gower’s dissimilarity matrix between each patient’s clinical characteristics and clustered similar patients using the partitioning around medoids algorithm.ResultsOne phenotype of 6 identified was characterized by high mortality (49%), older age, male sex, elevated inflammatory markers, high prevalence of cardiovascular disease, and shock. Patients with this severe phenotype had significantly elevated peak C-reactive protein creatinine, D-dimer, and white blood cell count and lower minimum lymphocyte count compared with other phenotypes (P &lt; .01, all comparisons).ConclusionsAmong a cohort of hospitalized adults, we identified a severe phenotype of COVID-19 based on the characteristics of its clinical course and poor prognosis. These findings need to be validated in other cohorts, as improved understanding of clinical phenotypes and risk factors for their development could help inform prognosis and tailored clinical management for COVID-19.
Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa
Authors: Shuldiner Scott R , Wong Lye-Yeng , Peterson Tess E , Wolfson Julian , Jermy S , Saad H , Lumbamba Mbalabu A J , Singh A , Shey M , Meintjes G , Ntusi N , Ntsekhe M , Baker J V 
Published: December 2020

Abstract

Background
Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa.

Methods
Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension.

Results
One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1–2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (&gt;125 pg/mL; odds ratio, 2.4; 95% CI, 1.0–6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3–5.5).

Conclusions
Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.
Osteosarcoma arising from acetabulum extended to femoral head through round ligament: a case report
Authors: Sasaki Toru , Gokita Tabu , Ae Keisuke , Tanizawa Taisuke , Hayakawa Keiko , Funauchi Yuki , Motoi Noriko , Matsumoto Seiichi 
Published: December 2020

ABSTRACTA skip metastasis was defined as a solitary separate focus of osteosarcoma occurring synchronously with a primary osteosarcoma in the absence of anatomic extension. The progression of skip metastasis is considered less likely because the articular cartilage acts as a barrier, so there have been few reports on progression of the extremity bone tumor across a joint. In our case report, the acetabular osteosarcoma progressed to the femoral head through the ligament of the femoral head. From the findings of magnetic resonance imaging and resected specimen and tissue specimen, we considered that the tumor progressed between ligament and synovial tissue covering the ligament, and not passing through the inside of the ligament. This case suggested a possibility that the tumor might progress through the synovium around the ligament of femoral head in the cases of osteosarcoma arising from the proximal femur and acetabulum.
Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting
Authors: Kalichman Seth C , Katner Harold , Eaton Lisa A , Banas Ellen , Hill Marnie , Kalichman Moira O 
Published: December 2020

Abstract
With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.
What the guide does not tell you: reflections on and lessons learned from applying the COM-B behavior model for designing real life interventions
Authors: Whittal Amanda , Atkins Lou , Herber Oliver Rudolf 
Published: December 2020

Abstract
Substantial inconsistency exists in the effectiveness of existing interventions to improve heart failure (HF) self-care, which can be partially explained by the fact that self-management interventions often lack theoretical models that underpin intervention development. The COM-B behavior model is a comprehensive theoretical framework that can be used to develop effective, theory-based interventions. The aim of this article is to highlight the challenges and practical solutions when applying the COM-B model to HF self-care, in order to provide useful support for researchers intending to use the model for designing behavior change interventions. “The Behaviour Change Wheel” handbook provides a step-by-step guide to understand and change behavior. When following the guide, some practical and methodological challenges were encountered. Lessons learnt to overcome these challenges are reported. Although the handbook is a comprehensive guide for designing behavior change interventions, a number of challenges arose. For example, the descriptions provided in the guide were not always sufficient to make solid judgments on how to categorize determinants; narrowing down intervention possibilities to a manageable number and prioritizing potential behavior change techniques over others involved a certain amount of subjectivity in an otherwise highly systematic and structured approach. For the encountered challenges, solutions are provided to illustrate how the model was applied practically to design theory-based behavior change interventions. This article provides a useful reference for researchers’ use of the COM-B behavior model, as it outlines challenges that may occur and potential solutions to overcome them.
Greater Trochanter Height: A Quantitative Predictor of Skeletal Maturity
Authors: Nelson Grant , Knapik Derrick M. , Janes Jessica L. , Liu Raymond W. 
Published: December 2020

Background:
The purpose of this investigation was to develop a quantitative and reproductible method for estimating skeletal maturity based on measurements of the height of the bony greater trochanter (GT) using timing to 90% of final height as a gold standard.

Methods:
Bony GT height was measured using serial anteroposterior pelvic radiographs in 76 healthy pediatric patients obtained from the Bolton-Brush (BB) Study with corresponding Greulich-Pyle (GP) bone ages. Chronologic age at 90% of final height was calculated. GT height was then measured in 300 contemporary patients aged 4 to 18 years, evenly divided based on sex and race. Bony GT height was compared between BB and contemporary patients, while linear mixed-effects models were used to examine for potential predictors of years to 90% final height using patient sex, GP bone age and bony GT height measurements.

Results:
Bony GT height was measured in 303 radiographs from the BB Collection (n=37 males; n=39 females) with corresponding GP bone ages, chronological ages, and heights to represent skeletal maturity. Mean age at 90% final height was 13.3±0.6 years for males and 11.4±0.8 years for females. When controlling for patient age and sex, multiple regression analysis revealed that contemporary patients possessed significantly greater bony GT height (mean difference: 1.15 mm; P=0.001) when compared with BB patients. Multivariate analysis showed that combining bony GT height, GP bone age, and sex significantly predicted years to 90% total growth (P<0.001) and explained ∼85% (95% confidence interval for R
2: 82%-87%) of the total variance in years using 90% of final height, with sex, GP bone age, and GT height all significant contributors.

Conclusions:
Including bony GT height provides more accurate prediction of 90% final height when combined with GP bone age and sex. GT height offers an efficient and accurate parameter that may be utilized in pediatric orthopedic conditions requiring a quantitative estimate of bone age in children with prior pelvis or hip imaging.

Level of Evidence:
Level II—diagnostic study.
Surgically Treated Pediatric Hand and Fingers Palmar Wounds Caused by Metal Fences: Analysis Over a 5-Year Period
Authors: Simon Anne-Laure , Savidan Pauline , Plomion Chloé , Mas Virginie , Ilharreborde Brice , Jehanno Pascal 
Published: December 2020

Background:
Hand wounds are frequent in children (31% of hand injuries) and one possible mechanism responsible for profound laceration is metal fences while climbing. These injuries usually require a surgical look to explore soft-tissue damages, but the literature is poor regarding surgical findings and outcomes after this kind of traumatism. The aim of the study was therefore to report a consecutive series of hand and finger wounds caused by metal fences in children, focusing on surgical findings and potential complications.

Methods:
All consecutive hand or finger deep wounds caused by metal fences treated between January 2013 and December 2018 were retrospectively reviewed. Inclusion criteria were age below 18 years and a minimum follow-up of 2 years. Complications and surgical revisions were analyzed.

Results:
A total of 1265 patients were operated for hand or finger deep wounds during the study period, among which 74 were caused by metal fences. The mean age at surgery was 11.3±0.4 years, and the majority of patients were men (80%). Associated injuries were found in 55.4% of the patients including nerves (n=29) or tendons sections/disinsertion (n=6), and sheath (n=16) and pulleys (n=6) tearing. At a mean follow-up of 2.6±0.2 years, 12% of the patients required revision surgery for an irreducible flexion contracture secondary to a contractile scar and consisted of complete scar excision and zigzag flap. Additional tenoarthrolysis was required during the procedure, for 6 patients because of a persisting flexion contracture after excision.

Conclusions:
Metal fences surgical palmar wounds in children are impressive lesions by their extended skin damages. Serious associated lesions (collateral pedicle or flexor tendons) were found in 1 case of 3. However, these injuries are not benign and should be carefully monitored clinically during the first postoperative month to look for potential contractile scars that can require revision.

Level of Evidence:
Level IV—retrospective cohort study.