bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extrinsic and Behavioral Fall Risk Factors in People With Parkinson’s Disease: An Integrative Review
Authors: Kuljeerung Orawan , Lach Helen W. 
Published: April 2020

Abstract

Aim
The aim of the study was to explore extrinsic and behavioral risks for falls in older adults with Parkinson’s disease (PD).

Background
Falls that cause injury and disability in people with PD are common. Understanding the role of extrinsic and behavioral factors is important for fall prevention.

Design
Integrative literature review with search of CINAHL, MEDLINE, and SCOPUS and ancestry searching was performed.

Methods
The methodology of Whittemore and Knafl guided the review; ten studies were included.

Findings
Falls occur indoors and outdoors, commonly during daily activities in familiar home environments, but also when out in the community. Common challenges include uneven and unfamiliar environments and risky behavior like hurrying.

Conclusion
Extrinsic risk factors combined with behavioral and intrinsic factors contribute to falls in people with PD both at home and in the community.

Clinical Relevance
Rehabilitation of people with PD should include assessment of falls, function, extrinsic risk factors, and fit with their environment to develop fall prevention plans.
Impact of Facilitation of Early Mobilization on Postoperative Pulmonary Outcomes After Colorectal Surgery
Authors: Balvardi Saba , Pecorelli Nicolò , Castelino Tanya , Niculiseanu Petru , Alhashemi Mohsen , Liberman Alexander Sender , Charlebois Patrick , Stein Barry , Carli Franco , Mayo Nancy E. , Feldman Liane S. , Fiore Julio F. 
Published: April 2020

Objective:
To estimate the extent to which staff-directed facilitation of early mobilization impacts recovery of pulmonary function and 30-day postoperative pulmonary complications (PPCs) after colorectal surgery.

Summary Background Data:
Early mobilization after surgery is believed to improve pulmonary function and prevent PPCs; however, adherence is low. The value of allocating resources (eg, staff time) to increase early mobilization is unknown.

Methods:
This study involved the analysis of a priori secondary outcomes of a pragmatic, observer-blind, randomized trial. Consecutive patients undergoing colorectal surgery were randomized 1:1 to usual care (preoperative education) or facilitated mobilization (staff dedicated to assist transfers and walking during hospital stay). Forced vital capacity, forced expiratory volume in 1 second (FEV1), and peak cough flow were measured preoperatively and at 1, 2, 3 days and 4 weeks after surgery. PPCs were defined according to the European Perioperative Clinical Outcome Taskforce.

Results:
Ninety-nine patients (57% male, 80% laparoscopic, median age 63, and predicted FEV1 97%) were included in the intention-to-treat analysis (usual care 49, facilitated mobilization 50). There was no between-group difference in recovery of forced vital capacity [adjusted difference in slopes 0.002 L/d (95% CI −0.01 to 0.01)], FEV1 [−0.002 L/d (−0.01 to 0.01)] or peak cough flow [−0.002 L/min/d (−0.02 to 0.02)]. Thirty-day PPCs were also not different between groups [adjusted odds ratio 0.67 (0.23–1.99)].

Conclusions:
In this randomized controlled trial, staff-directed facilitation of early mobilization did not improve postoperative pulmonary function or reduce PPCs within an enhanced recovery pathway for colorectal surgery.

Trial Registration:
ClinicalTrials.gov Identifier: NCT02131844.
Pitfalls and novel experimental approaches to optimize microbial interventions for chemotherapy-induced gastrointestinal mucositis
Authors: da Silva Ferreira Ana R. , Wardill Hannah R. , Tissing Wim J.E. , Harmsen Hermie J.M. 
Published: April 2020

Purpose of reviewThere is a growing number of studies implicating gut dysbiosis in mucositis development. However, few studies have shed light on the causal relationship limiting translational potential. Here, we detail the key supportive evidence for microbial involvement, candidate mechanisms by which the microbiome may contribute to mucositis and emerging approaches to model host–microbe interactions with clinical relevance and translational potential.Recent findingsSynthesis of existing clinical data demonstrate that modulating the microbiome drastically alters the development and severity of mucositis, providing a strong rationale for its involvement. Review of the literature revealed potential microbiome-dependent mechanisms of mucosal injury including altered drug metabolism, bile acid synthesis and regulation of the intestinal barrier. Current studies are limited in their mechanistic insight due to cross-sectional and would benefit from longitudinal analyses and baseline phenotyping.SummaryThe causative role of the microbiome in mucositis development remains unclear. Future studies must adopt comprehensive microbial analyses with functional assessment, and utilize emerging ex-vivo models to interrogate host–microbe interactions in mucositis.
Sequence of Pelvic Examination Does Not Affect Patients With Baseline Vulvovaginal Syndromes: A Randomized Clinical Trial
Authors: Rinko Rebecca , Spector Chelsea , Cook Ellen , Mancenido Briana , Gracely Edward J. , Nyirjesy Paul 
Published: April 2020

Objective
The purpose of this study is to determine the optimal sequence in performing a pelvic examination to reduce discomfort in patients with baseline vaginal pain.

Methods
A randomized controlled trial of women presenting for a new appointment at the Drexel Vaginitis Center was conducted. Women were assigned to either group A, a Q-tip touch test, speculum examination, then bimanual examination, or group B, a Q-tip touch test, bimanual examination, then speculum examination. The primary outcome was visual analog scales to assess pain at baseline and after each portion of the examination. Secondary outcomes were responses to questionnaires for self-esteem, quality of life, and sexual function.

Results
Two hundred women were enrolled in the trial. For both group A and group B, each portion of the examination was similarly scored regardless of whether the speculum examination was performed before or after bimanual examination. Pain during the speculum examination was higher than pain during the other components of the examination, although not significant (P = 0.65).
When looking at reported pain outcomes, outcomes did not differ as a whole or between groups in relation to sexual activity, sexual orientation, and previous hysterectomy. The data were not significantly different between groups for self-esteem scores, sexual dysfunction, or quality of life scores.

Conclusion
In women with baseline vaginal pain, there was no difference in pain scores between the different components of the pelvic examination, nor is there a significant difference in pain during the examination compared with their baseline pain. Most patients reported minimal pain during each component.
Intra-abdominal Pressure and Pelvic Floor Health: Should We Be Thinking About This Relationship Differently?
Authors: Dietze-Hermosa Martin , Hitchcock Robert , Nygaard Ingrid E. , Shaw Janet M. 
Published: April 2020

Objectives
Intra-abdominal pressure (IAP) increases during physical activity. Activities with high IAP are often restricted for women because of potential pelvic floor overloading. Researchers categorize high IAP activities using absolute values (in centimeters of water). Although essential for descriptive purposes, absolute IAP may not be ideal for individualized exercise recommendations. For oxygen consumption, a well-established measure of fitness, exercise scientists use a percentage of the maximal value observed during exercise to create relative exercise intensity prescriptions for an individual. Relative exercise intensity correlates inversely to the maximal value observed. We explore whether this approach and response pattern extend to IAP observed during exercise.

Methods
Fifty-five women completed 16 exercises while wearing a vaginal sensor to measure IAP. The highest mean IAP occurred during seated Valsalva/strain (IAPSTRAIN). We calculated relative IAP (in percent) for each participant by dividing the maximal IAP during each exercise by IAPSTRAIN. We examined relationships between relative IAP and IAPSTRAIN for each activity using Pearson r correlations.

Results
Mean age was 30.4 ± 9.4 years, and body mass index was 22.4 ± 2.6 kg/m2. For most women, IAP was greater during strain than during exercises. Relative IAPs negatively correlated with IAPSTRAIN. Excluding one exercise because of small sample sizes, r for all others ranged from −0.35 to −0.80, all statistically significant.

Conclusions
The relative IAP responses to many exercises exhibit an inverse relationship to the highest IAP values during strain, consistent with other variables measured during exercise. Relative IAP may provide an alternative to absolute IAP in understanding IAP’s effect on pelvic floor health.
Pregnancy in Women With Prior Treatments for Pelvic Floor Disorders
Authors: Wieslander Cecilia K. , Weinstein Milena M. , Handa Victoria L. , Collins Sarah A. 
Published: April 2020

Abstract
Although the peak incidence of surgery for pelvic floor disorders does not occur until after menopause, an increasing number of younger women are seeking treatment for these problems. Whereas most surgeons would recommend delaying surgery until the completion of childbearing, published cases and case series address outcomes after subsequent pregnancies in women who have been treated for urinary incontinence and pelvic organ prolapse. This document synthesizes the available evidence on the impact of pregnancy on women with prior treatment for pelvic floor disorders and on the impact of these prior treatments on subsequent pregnancy. Pregnancy after the repair of obstetrical anal sphincter laceration is also discussed. Consensus recommendations are presented based on available literature review and expert involvement.
Streamlining Postoperative Void Trials: A Study Comparing Standard Backfill Versus Backfill in the Operating Room
Authors: Meekins A. Rebecca , Amundsen Cindy L. , Weidner Alison C. 
Published: April 2020

Objective
The standard backfill void trial (VT) performed after urogynecologic surgery is time-consuming. We adopted a new VT protocol in which the bladder is backfilled in the operating room (OR). We hypothesized that this protocol would result in (1) shorter postoperative care unit (PACU) stay and (2) lower rates of postoperative catheterization compared with standard VT.

Methods
We performed a retrospective cohort study of women who underwent same-day urogynecologic surgery between August 2018 and March 2019. Basic demographic and procedure information was collected. Patients were divided into 2 groups based on VT performed. Continuous and categorical variables were compared using Student t tests and χ2 tests, respectively. A linear regression model for PACU length of stay was used to control for confounders.

Results
Two hundred twenty-five women were included. One hundred eleven (49.3%) had the OR backfill VT and 114 (50.7%) had the standard VT. There were no statistically significant between-group differences in demographics or procedures performed. The average time in PACU was 15 minutes shorter in the OR backfill compared with the standard VT group (154.8 ± 60.6 vs 169.8 ± 83.2, P = 0.12). After adjusting for confounders, having the OR backfill VT resulted in a 23-minute reduction in PACU time (β = −23.7; 95% confidence interval, −41.3 to −6.1; P = 0.009). The overall VT failure rate was 21.3% and was not significantly different between groups (24.3% vs 18.4%, P = 0.28).

Conclusions
The OR backfill VT resulted in a shorter stay in PACU without increasing the incidence of postoperative catheterization. With the transition to enhanced recovery after surgery protocols, streamlining PACU activities is a priority.
Extracorporeal membrane oxygenation use in Trauma Quality Improvement Program centers: Temporal trends and future directions
Authors: Guttman Matthew P. , Tillmann Bourke W. , Pannell Dylan , Vallelonga Mark , Nathens Avery B. , Haas Barbara 
Published: April 2020

BACKGROUND
Increased clinical experience and the decreased need for systemic anticoagulation have renewed interest in the use of extracorporeal membrane oxygenation (ECMO) for posttraumatic respiratory and cardiopulmonary failure. The objectives of this study were to describe the incidence and temporal trends of ECMO use at trauma centers, the outcomes of trauma patients undergoing ECMO, and the characteristics of trauma centers providing ECMO.

METHODS
Data were derived from the American College of Surgeons Trauma Quality Improvement Program data set. We included adults with at least one severe injury admitted to a level I or II trauma center between 2012 and 2016 who received at least 1 day of mechanical ventilation. Patients were categorized based on whether or not they received ECMO during their admission. The primary outcome was change in the incidence of ECMO across study years. We also evaluated patient outcomes and variation in ECMO volumes across centers.

RESULTS
Of 194,314 severely injured patients undergoing mechanical ventilation across 450 centers, 269 (0.14%) received ECMO. Extracorporeal membrane oxygenation patients had significantly higher mortality than non-ECMO patients (32% vs. 19%). The standardized rate of ECMO from 2012 to 2016 increased significantly from 75.2 to 179.0 cases per 100,000 severely injured patients undergoing mechanical ventilation. The average annual growth rate was 24%. Of the 82 centers(18%) reporting at least 1 ECMO trauma case, 34 (41%) reported only a single case.

CONCLUSION
The use of ECMO for trauma, although rare, is rapidly increasing. Two thirds of patients who receive ECMO following traumatic injury survive their hospitalization. These data suggest that ECMO represents a potential treatment strategy for trauma patients with respiratory or cardiopulmonary failure. However, given the rarity of the procedure, there exists an opportunity to develop practice guidelines regarding the indications for, and approach to, ECMO in the setting of trauma.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
The Validity and Reliability of the Six-Spot Step Test (SSST) in Older Adults
Authors: Kondori Rana Ebrahimi , Cetin Sebahat Yaprak , Erel Suat 
Published: April 2020

Objective:
To investigate the validity and reliability of the Six-Spot Step Test (SSST) in older adults.

Methods:
The study included 100 adults (60 males and 40 females) with a mean age of 68.91 years. The cognitive level of the older adults was evaluated with the Standardized Mini Mental Examination. Intraclass correlation coefficient (ICC) was used for reliability of the SSST. For the convergent validity of the SSST, the Timed Up and Go Test (TUG), the 10-m walk test (10MWT), the Four-Square Step Test (FSST), and the Tinetti Balance and Gait test were used.

Results:
According to the results of the study, the ICC was 0.96 for the right foot and 0.93 for the left foot. This result shows that the ICC value for the right and left feet is excellent. The SSST, which was performed separately with right and left feet, was found to have excellent correlation with the TUG, high-level correlation with the 10MWT, moderate-level correlation with the FSST, moderate-level correlation with the Tinetti test, and high-level correlation with the gait test.

Conclusions:
According to these results, it was concluded that the SSST is a valid and reliable test for older adults.
Mechanisms underlying progression in multiple sclerosis
Authors: Absinta Martina , Lassmann Hans , Trapp Bruce D. 
Published: April 2020

Purpose of review
In multiple sclerosis, currently approved disease-modifying treatments are effective in modulating peripheral immunity, and coherently, in reducing clinical/radiological relapses, but still, they perform poorly in preventing disease progression and overall disability accrual. This review provides an up-to-date overview of the neuropathology of progressive multiple sclerosis, including a summary of the main mechanisms of disease progression.

Recent findings
Clinical progression in multiple sclerosis is likely related to the accumulation of neuro-axonal loss in a lifelong inflammatory CNS environment (both adaptive and innate) and relative un-balance between damage, repair and brain functional reserve. A critical driver appears to be the T-cell and B-cell-mediated compartmentalized inflammation within the leptomeninges and within the parenchyma. Recent perspective highlighted also the role of the glial response to such lifelong inflammatory injury as the critical player for both pathological and clinical outcomes.

Summary
The neuropathological and biological understanding of disease progression in multiple sclerosis have progressed in the last few years. As a consequence, new therapeutic approaches are emerging outside the modulation of T-cell activity and/or the depletion of B cells.
Neuromodulation in primary headaches: current evidence and integration into clinical practice
Authors: Rimmele Florian , Jürgens Tim P. 
Published: April 2020

Purpose of review
Neuromodulatory approaches add to our armamentarium of therapeutic tools for the treatment of primary headaches. This review provides a comprehensive overview of current controlled studies on the different neuromodulation techniques and recommendations for clinical practice.

Recent findings
Evidence for efficacy of transcutaneous vagal nerve stimulation (tVNS) is limited to acute use in migraine with ambiguous results and episodic cluster headache as well as chronic cluster headache if applied in addition to conventional treatment. Transcutaneous stimulation of the supraorbital and supratrochlear nerve was effective in both acute and preventive stimulation (the latter with ambiguous results) in episodic migraines. Thus, invasive procedures should be reserved for severe and refractory cases only. Occipital nerve stimulation for chronic refractory cluster headache is the only available invasive approach with a Conformité Européenne mark.

Summary
Neuromodulation can complement conventional therapy, with noninvasive procedures being used preferably. Given the limited number of studies for each modality and the lack of head-to-head studies, it is difficult to place neuromodulation techniques in a conventional treatment algorithm.
COVID-19. Transport of respiratory droplets in a microclimatologic urban scenario
Authors: Guerrero Nicolás , Brito José M. , Cornejo Pablo 
Published: April 2020

AbstractAlthough there are some recent studies which intent to address the spread of respiratory droplets through the air, these correspond to indoor conditions or outdoor situations which not take into account realistic scenario. Less attention has been paid to the spread of respiratory droplets in outdoor environments under microclimatologic turbulent wind and which is of growing importance given the current COVID-19 epidemic. We implement a computational model describing a sneezing person in an urban scenario under a medium intensity climatological wind. Turbulence was described with a wall-modeled Large Eddy Simulation model and the spread of respiratory droplets by using a lagrangian approach. Results show the spread of respiratory droplets is characterized by the dynamics of two groups of droplets of different sizes: larger droplets (400 – 900 μm) are spread between 2–5 m during 2.3 s while smaller (100 – 200 μm) droplets are transported a larger range between 8–11 m by the action of the turbulent wind in 14.1 s average. Given the uncertainty of potential contagion over this way and with this reach, these efforts are an intent to contribute to shine a light on the possibility of adopting stricter self-care and distancing measures.
Using wastewater-based epidemiology with local indicators of opioid and illicit drug use to overcome data gaps in Montana
Authors: Margetts Miranda , Keshaviah Aparna , Hu Xindi C. , Troeger Victoria , Sykes Jordan , Bishop Nicholas , Jones-Lepp Tammy , Henry Marisa , Keil Deborah E. 
Published: April 2020

AbstractOpioid misuse takes an enormous toll on the health and economy of the U.S., costing 130 lives per day, and an estimated 157 billion dollars per year. Mitigating the epidemic requires better information on the mix of drugs being used in a community and when and where drug use concentrates. Many widely used data sources, such as national population surveys, have a two-year lag before the data are available, and underestimate the prevalence of drug use because they rely on self-reported information about a stigmatized behavior. For rural populations, the data gap is compounded by privacy policies that suppress key information (for example, opioid-related death rates) in small populations. Municipal wastewater testing is an innovative approach to assessing community-level drug use that can provide near real-time, cost-effective, and unbiased measures of drug use. Importantly, wastewater-based data cannot reveal who is using a particular drug, mitigating privacy concerns. The methodology is routinely used across Europe and Australia as part of a holistic multi-indicator monitoring and alert system. When combined with geospatial mapping and advanced analytics, wastewater-based data can help locate geographic hotspots of use and provide an early warning for new substances entering into a community. We conducted a pilot study to compare temporal trends in estimates of per-capita drug use between wastewater-based data and other local data sources in two municipalities (one urban, one rural) in Montana. In the first phase of our study (Bishop et al, 2020, manuscript is in submission to Sci Total Environ), we optimized testing to estimate per-capita drug use in wastewater in an urban and rural municipality. Here, we report the value of these data for public health officials to predict rather than react to changes in drug use patterns. We also illustrate how rural populations can use the methodology to assess the impacts of local law enforcement efforts and evaluate the effectiveness of programs, such as the prescription take-back program, to improve public health and safety.