bluuebunny/crossref_metadata_2025_split huggingface dataset:
SWEAT2 Study: Effectiveness of Trunk Training on Gait and Trunk Kinematics After Stroke: A Randomized Controlled Trial
Authors: Van Criekinge Tamaya , Hallemans Ann , Herssens Nolan , Lafosse Christophe , Claes Dirk , De Hertogh Willem , Truijen Steven , Saeys Wim 
Published: June 2020

Abstract

Objective
Trunk training after stroke is an effective method for improving mobility, yet underlying associations leading to the observed mobility carryover effects are unknown. The purposes of this study were to investigate the effectiveness of trunk training for gait and trunk kinematics and to find explanatory variables for the mobility carryover effects.

Methods
This study was an assessor-masked, randomized controlled trial. Participants received either additional trunk training (n = 19) or cognitive training (n = 20) after subacute stroke. Outcome measures were the Tinetti Performance-Oriented Mobility Assessment (POMA), the Trunk Impairment Scale, spatiotemporal gait parameters, center-of-mass excursions, and trunk and lower limb kinematics during walking. Multivariate analysis with post hoc analysis was performed to observe treatment effects. Correlation and an exploratory regression analysis were used to examine associations with the mobility carryover effects.

Results
Significant improvements after trunk training, compared with the findings for the control group, were found for the Trunk Impairment Scale, Tinetti POMA, walking speed, step length, step width, horizontal/vertical center-of-mass excursions, and trunk kinematics. No significant differences were observed in lower limb kinematics. Anteroposterior excursions of the trunk were associated with 30% of the variability in the mobility carryover effects.

Conclusions
Carryover effects of trunk control were present during ambulation. Decreased anteroposterior movements of the thorax were the main variable explaining higher scores on the Tinetti POMA Gait subscale. However, the implementation and generalizability of this treatment approach in a clinical setting are laborious and limited, necessitating further research.

Impact
Trunk training is an effective strategy for improving mobility after stroke. Regaining trunk control should be considered an important treatment goal early after stroke to adequately prepare patients for walking.
The Relationship Between Residents’ Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction
Authors: Dyrbye Liselotte N. , Leep Hunderfund Andrea N. , Winters Richard C. , Moeschler Susan M. , Vaa Stelling Brianna E. , Dozois Eric J. , Satele Daniel V. , West Colin P. 
Published: June 2020

Purpose
To explore the relationship between residents’ perceptions of residency program leadership team behaviors and resident burnout and satisfaction.

Method
In February 2019, the authors surveyed all residents across the 77 graduate medical education training programs at Mayo Clinic’s multiple sites. Survey items measured residents’ perceptions of program director and associate program director behaviors (using a composite residency program leadership team score), resident burnout, and resident satisfaction with the program and organization. Multivariable logistic regression was performed to evaluate relationships between these variables at the individual resident (adjusting for age, sex, postgraduate training year, program location, and specialty) and program (including only programs with at least 5 respondents) levels.

Results
Of the 1,146 residents surveyed, 762 (66.5%) responded. At the individual resident level, higher composite leadership team scores were associated with lower emotional exhaustion and depersonalization and higher overall satisfaction with the residency program and organization (all P < .001). In adjusted logistic regression models, each 1-point gain in composite leadership team score was associated with 9% lower odds of burnout, 20% higher odds of program satisfaction, and 19% higher odds of satisfaction with the organization (all P < .001). At the residency program level, higher mean composite leadership team scores were associated with a lower rate of burnout (r = −0.35, P = .03) and higher program and organization satisfaction (r = 0.67 and 0.74, respectively, both P < .001).

Conclusions
The behaviors of residency program leadership teams influence residents’ burnout and satisfaction. Additional studies are needed to determine if leadership training results in improved resident well-being and satisfaction.
What Works? Processes of Change in a Transdiagnostic Exposure Treatment for Patients With Chronic Pain and Emotional Problems
Authors: Södermark Martin , Linton Steven J. , Hesser Hugo , Flink Ida , Gerdle Björn , Boersma Katja 
Published: June 2020

Objectives:
We recently developed a transdiagnostic exposure treatment (the hybrid treatment) for chronic pain patients with concurrent emotional difficulties. This paper investigates the hypothesized treatment processes, specifically: (1) if changes on pain-related dysregulation (catastrophizing, fear-avoidance, and nonacceptance of pain) and general emotion dysregulation (difficulties to regulate a broad spectrum of emotional responses) mediate effects on outcomes; and (2) if mediation is more pronounced for patients who score higher on these processes pretreatment.

Materials and Methods:
Structural equation modeling for longitudinal data using the full intention-to-treat sample was used to test whether proposed variables mediated the effect of the hybrid treatment (n=58) compared with a guided internet-delivered pain management treatment based on cognitive-behavioral principles (n=57) on pain interference and depressive symptoms at the 9-month follow-up. To make full use of the multiple process measures collected in the trial, we modeled mediators as 2 continuous latent variables: pain-related dysregulation and general emotion dysregulation.

Results:
Reduced pain-related dysregulation mediated the effects of treatment on both outcomes, whereas reduced general emotion dysregulation mediated the effects on depressive symptoms only. In the hybrid treatment, the mediated effect was more pronounced for participants who scored higher on pain-related dysregulation pretreatment relative to those who scored lower.

Discussion:
Our findings provide initial support for the transdiagnostic theoretical underpinnings of the hybrid treatment model. Using a hybrid treatment approach that centers on teaching patients emotion-regulation skills before commencing broad exposure successfully influenced both pain-related dysregulation and general emotion dysregulation, which in turn was associated with better treatment outcomes. It appears central to address these processes in pain patients with comorbid emotional problems, especially among patients scoring high on measures of catastrophizing, fear-avoidance, and nonacceptance of pain.
Increase in Central Venous Pressure During Passive Leg Raising Cannot Detect Preload Unresponsiveness
Authors: Hamzaoui Olfa , Gouëzel Corentin , Jozwiak Mathieu , Millereux Maude , Sztrymf Benjamin , Prat Dominique , Jacobs Frederic , Monnet Xavier , Trouiller Pierre , Teboul Jean-Louis 
Published: June 2020

Objective:
By analogy with the classical central venous pressure rules to assess a fluid challenge, we hypothesized that an increase in central venous pressure greater than or equal to 5 cm H2O (i.e., 4 mm Hg) during passive leg raising can predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral of the left ventricular outflow tract greater than or equal to 10% during the test (negative passive leg raising test).

Design and Settings:
Velocity-time integral was measured by transthoracic echocardiography. Central venous pressure and velocity-time integral were measured before and during passive leg raising.

Patients:
Critically ill patients for whom the physician decided to test preload responsiveness by passive leg raising were prospectively included.

Measurement and Main Results:
Fifty-seven set of measurements were performed in 50 patients. Preload unresponsiveness (negative passive leg raising test) was observed in 32 cases. The changes in central venous pressure during passive leg raising did not differ between positive passive leg raising cases (positive passive leg raising test) and negative passive leg raising test cases (3 ± 2 vs 3 ± 2 mm Hg, respectively) and thus did not predict preload unresponsiveness (area under the receiver-operating characteristic curve of 0.59). An increase in central venous pressure greater than or equal to 4 mm Hg during passive leg raising was observed in 10 cases of positive passive leg raising test and in 11 cases of negative passive leg raising test. Taking an increase in central venous pressure greater than or equal to 3 or greater than or equal to 5 mm Hg rather than greater than or equal to 4 mm Hg during passive leg raising did not better allow one to identify negative passive leg raising test.

Conclusions:
Marked increase in central venous pressure during passive leg raising cannot identify negative passive leg raising test cases and thus preload unresponsiveness. Measurements of cardiac output (or its surrogates) during passive leg raising are, thus, mandatory to appropriately interpret this test.
Central Venous-to-Arterial Pco 2 Difference and Central Venous Oxygen Saturation in the Detection of Extubation Failure in Critically Ill Patients*
Authors: Mallat Jihad , Baghdadi Fawzi Ali , Mohammad Usman , Lemyze Malcolm , Temime Johanna , Tronchon Laurent , Thevenin Didier , Fischer Marc-Olivier 
Published: June 2020

Objectives:
To evaluate the ability of central venous-to-arterial carbon dioxide pressure difference, central venous oxygen saturation, and the combination of these two parameters to detect extubation failure in critically ill patients.

Design:
Multicentric, prospective, observational study.

Setting:
Three ICUs.

Patients:
All patients who received mechanical ventilation for more than 48 hours and tolerated spontaneous breathing trials with a T-piece for 60 minutes.

Interventions:
Extubation after successful spontaneous breathing trials. Extubation failure was defined as the need for mechanical ventilation within 48 hours.

Measurements and Main Results:
The oxygen delivery index, oxygen consumption index, central venous oxygen saturation, central venous-to-arterial carbon dioxide pressure difference, and oxygen extraction were measured immediately before spontaneous breathing trials and at 60 minutes after spontaneous breathing trials initiation. Seventy-five patients were enrolled, and extubation failure was noted in 18 (24%) patients. Oxygen consumption index increased significantly during spontaneous breathing trials in the failure group. Oxygen delivery index increased in both success and failure groups. Oxygen extraction increased in the failure group (p = 0.005) and decreased in the success group (p = 0.001). Central venous oxygen saturation decreased in the failure group and increased in the success group (p = 0.014). ΔPco2
value increased in the extubation failure group and decreased in the success group (p = 0.002). Changes in ΔPco2
(Δ – ΔPCO2) and central venous oxygen saturation (ΔScvO2) during spontaneous breathing trials were independently associated with extubation failure (odds ratio, 1.02; 95% CI, 1.01–1.05; p = 0.006, and odds ratio, 0.84; 95% CI, 0.70–0.95; p = 0.02, respectively). Δ – ΔPCO2 and central venous oxygen saturation could predict extubation failure with areas under the curve of 0.865 and 0.856, respectively; however, their combined areas under the curve was better at 0.940.

Conclusions:
We found that Δ – ΔPco
2 and central venous oxygen saturation, during spontaneous breathing trials, were independent predictors of weaning outcomes. Combination analysis of both parameters enhanced their diagnostic performance and provided excellent predictability in extubation failure detection in critically ill patients.
ACR-ACNM-ASTRO-SNMMI Practice Parameter for the Performance of Therapy With Radium-223
Authors: Hurwitz Mark , Buscombe John R. , Jacene Heather A. , Klitzke Alan K. , Lamonica Dominick , Lu Yang , Pryma Daniel A. , Rohren Eric M. , Speer Tod W. , Subramaniam Rathan M. , Thompson Holly M. , Tomblyn Michael B. , Wong William W. , Xiao Ying , Banks Kevin P. , Brown Richard K.J. 
Published: June 2020

Aim/Objectives/Background:
The goal of therapy with unsealed radiopharmaceutical sources is to provide either cure or significant prolongation of disease-specific survival, and effective reduction and/or prevention of adverse disease-related symptoms or untoward events while minimizing treatment-associated side effects and complications. Radium-223 dichloride (radium-223) is an alpha particle–emitting isotope used for targeted bone therapy. This practice parameter is intended to guide appropriately trained and licensed physicians performing therapy with radium-223. Such therapy requires close cooperation and communication between the physicians who are responsible for the clinical management of the patient and those who administer radiopharmaceutical therapy and manage the attendant side effects. Adherence to this parameter should help to maximize the efficacious use of radium-223, maintain safe conditions, and ensure compliance with applicable regulations.

Methods:
This practice parameter was developed according to the process described on the American College of Radiology (ACR) website (“The Process for Developing ACR Practice Parameters and Technical Standards,” www.acr.org/ClinicalResources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the American College of Nuclear Medicine (ACNM), the American Society for Radiation Oncology (ASTRO), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). All these societies contributed to the development of the practice parameter and approved the final document.

Results:
This practice parameter addresses the many factors which contribute to appropriate, safe, and effective clinical use of radium-223. Topics addressed include qualifications and responsibilities of personnel, specifications of patient examination and treatment; documentation, radiation safety, quality control/improvement, infection control, and patient education.

Conclusions:
This practice parameter is intended as a tool to guide clinical use of radium-223 with the goal of facilitating safe and effective medical care based on current knowledge, available resources and patient needs. The sole purpose of this document is to assist practitioners in achieving this objective.
Associations of pituitary-ovarian hormones and white matter hyperintensities in recently menopausal women using hormone therapy
Authors: Kling Juliana M. , Miller Virginia M. , Tosakulwong Nirubol , Lesnick Timothy , Kantarci Kejal 
Published: June 2020

Abstract

Objective:
Little is known about how menopausal hormone treatment (HT) may influence the development of white matter hyperintensities (WMHs) in the brain. This study evaluated the associations of changes in levels of pituitary-ovarian hormones during HT and changes in WMH.

Methods:
Women (n = 78 adherent to treatment) enrolled in the Kronos Early Estrogen Prevention Study underwent brain magnetic resonance imaging, and blood collection before and after 48 months of randomization to 0.45 mg/d oral conjugated equine estrogen (oCEE) daily, 50 μg/d transdermal 17β estradiol (tE2), or placebo pills and patches. Women in the active treatment groups also received oral 200 mg/d micronized progesterone the first 12 days of the month. Estradiol (E2), estrone (E1), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured in serum by high sensitivity liquid chromatography/mass spectrometry at baseline and following 48 months of HT. Longitudinal change in WMH volume was determined from fluid-attenuated inversion recovery magnetic resonance imaging using a semiautomated image segmentation algorithm.

Results:
Serum levels of FSH, LH, E1, or E2 did not associate with WMH volume at baseline. After 48 months of treatment, smaller increases in WMH associated with decreases in FSH from baseline in the tE2 group and increases in E1 in both tE2 and oCEE groups. Changes in LH did not associate with changes in WMH in any group.

Conclusions:
Circulating levels of pituitary-ovarian hormones associate with changes in WMH volume in recently menopausal women using HT. Whether these relationships would be influenced by different doses of tE2 or oCEE remains to be determined.

Video Summary:

http://links.lww.com/MENO/A590.
Effective Dose Coefficients for Intakes of Uranium Via Contaminated Wounds for Reference Adults
Authors: Zhang Bin , Sheng Wei , Feng Tian-Cheng , Xu Ming , Lei Jie-Ying , He Xin-Zhao , Yin Guo-Hui 
Published: June 2020

Abstract
Effective dose coefficients for intakes of uranium radionuclides via contaminated wounds have been calculated for reference adults following the procedures in the ICRP 103 series. The number of transformations in each source region for all members of the radioactive series from time of intake to 50 y post intake are calculated by coupling the NCRP 156 wound model to the ICRP 137 systemic models and ICRP 100 human alimentary tract model. Together with the ICRP 107 nuclear decay data for dosimetric calculations, the ICRP 133 specific absorbed fractions are implemented to calculate the radiation-weighted S coefficient deposited in each target organ or tissue from each transformation in each source region. Effective dose coefficients for different categories of intake materials via contaminated wounds are calculated for the three major uranium isotopes–238U, 235U, and 234U. Originating from the combined effects of the new absorbed fractions, biokinetic and dosimetric models, the new coefficients are generally reduced by a percentage of 23–28% as compared to the old ones. The new dose coefficients benefit the assessment of internal exposures for intakes of uranium via contaminated wounds in actual applications.
Demographics Predict Stage III/IV Colorectal Cancer in Individuals Under Age 50
Authors: Fass Ofer Z. , Poels Kamrine E. , Qian Yingzhi , Zhong Hua , Liang Peter S. 
Published: June 2020

Goals:
The goal of this study was to quantify the association between demographic factors and advanced colorectal cancer (CRC) in patients under age 50.

Background:
CRC incidence in the United States has declined in older individuals but increased in those under age 50 (early-onset). More than 60% of early-onset CRC patients present with advanced disease (stage III/IV), but predictors of stage in this population are poorly defined.

Study:
We analyzed CRC cases diagnosed between age 20 and 49 in the United States Surveillance, Epidemiology, and End Results (SEER) 18 database during 2004 to 2015. Logistic regression models were fit to assess the impact of age, sex, race, ethnicity, marital status, and cancer site on the probability of advanced disease.

Results:
The analysis included 37,044 cases. On multivariable regression, age was inversely associated with advanced disease. Relative to 45 to 49-year-olds, 40 to 44-year-olds had 8% greater odds of having advanced CRC, and 20 to 24-year-olds had 53% greater odds. Asians, blacks, and Pacific Islanders had 10%, 12%, and 45% greater odds of advanced disease compared with whites. Compared with nonpartnered individuals, those with partners had 11% lower odds of advanced CRC. Both right-sided and left-sided colon cancer were more likely to be diagnosed at stage IV compared with rectal cancer.

Conclusions:
Among individuals with early-onset CRC, younger age, Asian, black, or Pacific Islander race, and being nonpartnered were predictors of advanced disease at presentation. Colon cancer was more likely to be diagnosed at stage IV than rectal cancer. Patient characteristics associated with advanced CRC may indicate both differences in tumor biology and disparities in health care access.
Association of Gastric Acid Suppression and Sorafenib Efficacy in Advanced Hepatocellular Carcinoma
Authors: Razak Razwan A. , Fletcher Peter , Kunene Victoria , Ma Yuk Ting 
Published: June 2020

Background:
Recent studies have revealed that coadministration of gastric acid suppressants reduces the efficacy of the tyrosine kinase inhibitors erlotinib and sunitinib in patients with non–small cell lung cancer and renal cell carcinoma, respectively. The authors have therefore assessed if the concurrent use of gastric acid suppressants and sorafenib impairs outcomes in patients with advanced hepatocellular carcinoma (HCC).

Methods:
A retrospective analysis was conducted on all patients treated with sorafenib for advanced HCC at a single tertiary referral unit in the United Kingdom, between January 2008 and January 2014. A multivariate Cox proportional hazard model was used to assess the effect of the concomitant use of gastric acid suppression and sorafenib on progression-free survival (PFS) and overall survival (OS).

Results:
Data were collected from 197 patients, of which 182 could be assessed for this study; 77 (42%) were on concurrent gastric acid suppression therapy. After adjusting for imbalances between the groups, a Cox regression analysis gave an adjusted hazard ratio for the concurrent acid suppression group compared with the no acid suppression group of 5.4 (95% confidence interval, 3.6-7.9) for PFS and 1.85 (95% confidence interval, 1.3-2.6) for OS.

Conclusions:
This single-center experience shows that patients with advanced HCC taking sorafenib and concomitant gastric acid suppression therapy have significantly inferior PFS and OS. This is the first time that this negative interaction has been reported and further prospective validation is warranted.
Alcohol-associated Cirrhosis and Alcoholic Hepatitis Hospitalization Trends in the United States
Authors: Shirazi Farah , Singal Ashwani K. , Wong Robert J. 
Published: June 2020

Goals:
The goals of this study were to evaluate trends in hospitalizations and in-hospital mortality among US adults with alcohol-associated cirrhosis and alcoholic hepatitis.

Background:
Alcohol-associated liver disease contributes to significant liver-related morbidity in the United States, among which inpatient care is a major driver of clinical and economic burden.

Methods:
Using the 2007-2014 National Inpatient Sample, alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations were identified. Survey-weighted annual hospitalization trends were stratified by sex, race/ethnicity, and age and compared using χ2 and Student’s t-test methods. Adjusted multivariate logistic regression models evaluated predictors of in-hospital mortality.

Results:
Among 159,973 alcohol-associated liver disease hospitalizations, 83.7% had a primary diagnosis of alcohol-associated cirrhosis and 18.4% had a primary diagnosis of alcoholic hepatitis. Sex-specific differences in hospitalizations emerged, with significantly higher hospitalization rates seen in males versus females among both alcoholic hepatitis [incidence rate ratio=3.71, 95% confidence interval (CI): 3.47-4.01, P<0.01] and alcohol-associated cirrhosis (incidence rate ratio=2.68, 95% CI: 2.21-3.71, P<0.01). Differences in hospitalization and mortality by ethnicity were observed for both alcohol-associated cirrhosis and alcoholic hepatitis. African Americans with alcohol-associated cirrhosis had significantly higher in-hospital mortality compared with non-Hispanic whites [odds ratio (OR)=1.13, 95% CI: 1.04-1.24, P<0.01], whereas Native Americans (OR=1.88, 95% CI: 1.06-3.34, P=0.030) and Asian/Pacific Islanders (OR=2.02, 95% CI: 1.00-4.06, P=0.048) with alcoholic hepatitis had significantly higher in-hospital mortality compared with non-Hispanic whites.

Conclusions:
This study demonstrated increasing alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations in the United States. The highest rates were observed in men and among Native American and Hispanic ethnic minorities. Significant ethnicity-specific disparities in mortality were observed.