bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphological and Functional Changes of the Tibialis Anterior Muscle After Combined Mirror Visual Feedback and Electromyographic Biofeedback in Poststroke Patients
Authors: Liu Meikuai , Xu Leyi , Li Haiyan , Chen Shunping , Chen Bin 
Published: October 2020

Objective
The aim of the study was to investigate the morphological and functional changes of the tibialis anterior muscle after mirror visual feedback combined with electromyographic biofeedback in poststroke patients.

Design
A total of 46 poststroke patients were randomly divided into three groups: a mirror visual feedback + electromyographic biofeedback group, a mirror visual feedback group, and a control group. The mirror visual feedback + electromyographic biofeedback group was treated with both mirror visual feedback and electromyographic biofeedback, and the mirror visual feedback group was treated with mirror visual feedback alone. The morphological parameters, including the pennation angle, muscle thickness, and fascicle length, were assessed.

Results
After 4 wks of treatment, the pennation angle and muscle thickness values were significantly increased in the mirror visual feedback + electromyographic biofeedback and mirror visual feedback groups (P < 0.05). The increase of these values in the mirror visual feedback + electromyographic biofeedback group was significantly greater than that in both metrics in the mirror visual feedback and control groups (P < 0.05), and those in the mirror visual feedback group were greater than those in the control group (P < 0.05). There was no significant difference in the fascicle length value among the three groups as a result of the treatment. After the treatment, the neurological functions were all increased in three groups (P < 0.05).

Conclusions
A combination of mirror visual feedback and electromyographic biofeedback seems to be an effective therapy for improving the motor function of the tibialis anterior muscle in poststroke patients.

Clinical trial registration number: ChiCTR1800017050.
Covert Subclinical Neurocognitive Sequelae During the Rehabilitation Course of Severe Coronavirus Disease 2019
Authors: Tay Matthew Rong Jie , Low Yee Hong , Lim Choie Cheio Tchoyoson , Umapathi Thirugnanam , Thio Jocelyn Mei Lin , Lui Wen Li , Chan Wai Lim William , Chua Karen Sui Geok 
Published: October 2020

Abstract
Apart from respiratory symptoms, encephalopathy and a range of central nervous system complications have been described in coronavirus disease 2019. However, there is a lack of published literature on the rehabilitative course and functional outcomes of severe coronavirus disease 2019 with encephalopathy. In addition, the presence of subclinical neurocognitive sequelae during postacute rehabilitation has not been described and may be underrecognized by rehabilitation providers. We report the rehabilitative course of a middle-aged male patient with severe coronavirus disease 2019 who required intensive care and mechanical ventilation. During postacute inpatient rehabilitation for severe intensive care unit–related weakness, an abnormal cognitive screen prompted brain magnetic resonance imaging, which revealed destructive leukoencephalopathy. Subsequently, detailed psychometric evaluation revealed significant impairments in the domains of processing speed and executive function. After 40 days of intensive inpatient rehabilitation, he was discharged home with independent function. This report highlights the need for an increased awareness of covert subclinical neurocognitive sequelae, the role of comprehensive rehabilitation, and value of routine cognitive screening therein and describes the neurocognitive features in severe COVID-19.
Increasing Primary Care Follow-up after Preparticipation Physical Evaluations
Authors: Kennedy Melanie , Comer Frances , Young Julie A. , Valasek Amy E. 
Published: October 2020

Background:
Preparticipation physical evaluations (PPEs) strive to prevent injuries and sudden death in athletes. Ideally, the medical home is the best setting for completion. However, many school systems request large PPE screenings for their student-athletes. This quality-improvement project aimed to increase primary care provider (PCP) follow-up for athletes “cleared with recommendation” (CR) or “disqualified” (DQ) during our mass PPEs.

Methods:
Our team evaluated prior PPE data for athlete clearance and PCP follow-up for CR or DQ athletes. The prominent gaps in our PPEs were resident education, PCP or medical home identification, and communication. Our team implemented interventions during the 2018 PPEs to increase both CR and DQ athlete follow-up at the medical home.

Results:
Retrospective baseline data revealed that physicians categorized 11% (67/582) of athletes at our PPEs as CR or DQ. Of these athletes, the PCP and specialist follow-up rate was 13% (9/67). Our process changed to enhance athlete follow-up, but the rate only increased slightly to 15% (18/120). Medical home identification improved. Successful interventions included resident education, medical home identification, and increased communication.

Conclusions:
Despite our interventions, this quality-improvement initiative was unsuccessful in reaching the aim. This project found small achievements in educational opportunities, improved documentation, medial home identification for student-athletes, and lead to local changes in our standard operating procedures. Although our aim was ambitious, 100% athlete follow-up with the PCP or medical home ensures athletic safety and decreases liability for all.
Application of Appropriate Use Criteria for Echocardiography in Pediatric Patients with Palpitations and Arrhythmias
Authors: Dasgupta Soham , Kelleman Michael , Sachdeva Ritu 
Published: October 2020

Background:
Before the integration of the pediatric appropriate use criteria (AUC) for initial transthoracic echocardiography (TTE) in the outpatient setting with our electronic medical record (EMR), there was a high proportion of “rarely appropriate” TTEs (17.2%) ordered for palpitations/arrhythmias. We studied appropriateness ratings and applicability of pediatric AUC on the initial outpatient evaluation of children with palpitations/arrhythmias after EMR integration and the yield of abnormal TTEs for these indications.

Methods:
We obtained data after the EMR integration of the AUC at our institution. The TTE ordering physician assigned the AUC indication and the corresponding appropriateness ratings autopopulated as: appropriate (A), may be appropriate (M), and rarely appropriate (R). We recorded the abnormal TTE findings.

Results:
A total of 463 TTEs were ordered for palpitations/arrhythmias. Overall, 142 (30.7%) were for A, 263 (56.8%) for M, 41 (8.8%) for R, and 17 (3.7%) for “unclassifiable” indications. Only 14 (3.0%) had abnormal TTE findings, of which none were for indications rated R. A TTE ordered for premature ventricular contractions in a 17-year-old revealed a significant abnormality (moderate atrial septal defect).

Conclusions:
The integration of AUC with the EMR significantly improved the appropriate utilization of TTE for palpitations and arrhythmias with a decrease in the proportion of TTEs for R indications (17.2%–8.8%). Although the yield of abnormal findings on TTE performed for palpitations/arrhythmias is quite low, the AUC ratings successfully stratified the indication with no abnormalities for indications rated R. These findings can guide future revisions of AUC indications and ratings to optimize resource utilization.
Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care
Authors: Hoehn Erin F. , Dean Preston , Lautz Andrew J. , Frey Mary , Cabrera-Thurman Mary K. , Geis Gary L. , Stalets Erika , Zackoff Matthew , Pham Tena , Maxwell Andrea , Vukovic Adam , Kerrey Benjamin T. 
Published: October 2020

Introduction:
Patients with physiologic disorders, such as hypoxemia or hypotension, are at high risk of peri-intubation cardiac arrest. Standardization improves emergency tracheal intubation safety, but no published reports describe initiatives to reduce the risk of cardiac arrest. This initiative aims to improve the care of children at risk of peri-intubation cardiac arrest in a pediatric emergency department (PED). We specifically aimed to increase the number of patients between those with peri-intubation cardiac arrest by 50%, from a baseline of 11–16, over 12-months.

Methods:
Our multidisciplinary team outlined a theory of improvement and designed interventions aimed at key drivers. The primary intervention was creating a PICU-ED Team (PET) and a checklist to guide the assessment and mitigation of risk for peri-intubation arrest and rapid consultation of the pediatric intensivists. The PET was iteratively refined, and we collected data by a video review of tracheal intubations.

Results:
Fifty-one patients with risk factors for peri-intubation arrest underwent tracheal -intubation in the PED from January 2016 to March 2020: 14 with PET activation since PET go-live in April 2019. None of the 14 PET patients had a peri-intubation cardiac arrest. Ninety-three percent (13/14) of PET patients were intubated in the PED, and 78% (10/13) of these patients had the first intubation attempt completed by PED physicians (balancing measures).

Conclusion:
We successfully developed the PET to mitigate the risk of peri-intubation cardiac arrest without significantly reducing key procedural opportunities for the PED. Initial data are promising, but further refinement is needed.
Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia: A Latent Class Analysis
Authors: Mody Aaloke , Sikombe Kombatende , Beres Laura K. , Simbeza Sandra , Mukamba Njekwa , Eshun-Wilson Ingrid , Schwartz Sheree , Pry Jake , Padian Nancy , Holmes Charles B. , Bolton-Moore Carolyn , Sikazwe Izukanji , Geng Elvin H. 
Published: October 2020

Background:
Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles.

Methods:
We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site).

Results:
Among 547 patients, we identified 5 profiles of care disruptions: (1) “Livelihood and Mobility” (30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) “Clinic Accessibility” (28.9%) reported challenges with attending clinic; (3) “Mobility and Family” (21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) “Doubting Need for HIV care” (10.2%) reported uncertainty around HIV status or need for clinical care, and (5) “Multidimensional Barriers to Care” (8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The “Doubting Need for HIV Care” class were mostly disengaged (97.9%), followed by the “Multidimensional Barriers to Care” (62.8%), “Clinic Accessibility” (62.4%), “Livelihood and Mobility” (43.6%), and “Mobility and Family” (23.5%) classes.

Conclusion:
There are distinct HIV care disruption profiles that are strongly associated with patients' current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes.
Reduction in Stigma Drivers Partially Mediates the Effect of a Stigma Reduction Intervention Among Nursing Students in India: The DriSti Cluster Randomized Controlled Trial
Authors: Srinivasan Krishnamachari , Heylen Elsa , Raj Tony , Nyblade Laura , Devadass Dhinagaran , Pereira Matilda , Ekstrand Maria L. 
Published: October 2020

Background:
HIV stigma in health care settings acts as a significant barrier to health care. Stigma drivers among health professionals include transmission fears and misconceptions and pre-existing negative attitudes toward marginalized groups vulnerable to HIV. The DriSti intervention, consisted of 2 sessions with videos and interactive exercises on a computer tablet and one interactive face-to-face group session, mostly tablet administered, was designed to target key stigma drivers that included instrumental stigma, symbolic stigma, transmission misconceptions and blame to reduce HIV stigma, and discrimination among nursing students (NS) and ward staff and tested in a cluster randomized trial.

Setting:
This report focuses on second and third year NS recruited from a range of nursing schools that included private, nonprofit, and government-run nursing schools in south India.

Results:
Six hundred seventy-nine NS received intervention and 813 NS were in the wait-list control group. Twelve months outcome analyses showed significant reduction among intervention participants in endorsement of coercive policies (P < 0.001) and in the number of situations in which NS intended to discriminate against PLWH (P < 0.001). Mediation analysis revealed that the effects of intervention on endorsement of coercive policies and intent to discriminate against PLWH were partially mediated by reductions in key stigma drivers.

Conclusions:
This brief scalable stigma reduction intervention targeting key stigma drivers fills a critical gap in identifying the mechanistic pathways that aid in stigma reduction among health professionals.
Development of a Mathematical Model to Estimate the Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program
Authors: Goyal Ravi , Hu Cindy , Klein Pamela W. , Hotchkiss John , Morris Eric , Mandsager Paul , Cohen Stacy M. , Luca Dara , Gao Jessica , Jones Andrew , Addison West , O'Brien-Strain Margaret , Cheever Laura W. , Gilman Boyd 
Published: October 2020

Background:
The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program.

Methods:
We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks.

Results:
The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52–3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks.

Conclusions:
The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.
IgG4-Related Disease
Authors: Duggal Lalit , Singh Bhandari Gurbir , Patel Jeet , Gupta Mayank , Grover Ashok K. , Jain Neeraj 
Published: October 2020

Aim
Immunoglobulin G4–related disease (IgG4-RD) is often an unrecognized, rare fibroinflammatory condition that can involve various organ systems. This study aimed to identify the different clinical patterns of this disease in a single center in North India.

Methods
Patients were diagnosed on the basis of published diagnostic criteria for IgG4-RD. Patients' presenting complaints; epidemiologic profiles; and laboratory, radiologic, and histologic findings along with the treatment and outcomes were collected and analyzed.

Results
In total, 70 patients were diagnosed with the disease. The female-to-male ratio was 0.94:1, and it increased with multiorgan involvement. The mean age of patients was 41.4 years, and the majority of the patients (65.7%) were younger than 50 years. Patients were diagnosed as possible (38.57%), probable (32.85%), and definite (28.57%) IgG4-RD. The incidence of the involvement of orbital and periorbital tissues was the highest (52.9%); however, 13% of the patients had multiple organ involvement. Patients with involvement of the retroperitoneal tissues and the lymph nodes were 8.5% and 5.7%, respectively. Increased serum IgG4 levels were found in 74.3% of the patients with single-organ involvement, whereas all patients with multiorgan involvement had increased IgG4 levels. The majority of patients (94.3%) required immunosuppressive medications along with corticosteroids. Azathioprine was the most commonly used (72.8%) immunosuppressive medication. Rituximab was used in 17.1% of the patients, of whom only one had multisystem involvement.

Conclusions
This study depicts the most common patterns of organ involvement, along with the epidemiologic, laboratory, histologic, and radiologic data and response to treatment, in IgG4-RD, with a definite ophthalmology referral bias.
Novel approaches to prediction in severe brain injury
Authors: Fidali Brian C. , Stevens Robert D. , Claassen Jan 
Published: October 2020

Purpose of review
Recovery after severe brain injury is variable and challenging to accurately predict at the individual patient level. This review highlights new developments in clinical prognostication with a special focus on the prediction of consciousness and increasing reliance on methods from data science.

Recent findings
Recent research has leveraged serum biomarkers, quantitative electroencephalography, MRI, and physiological time-series to build models for recovery prediction. The analysis of high-resolution data and the integration of features from different modalities can be approached with efficient computational techniques.

Summary
Advances in neurophysiology and neuroimaging, in combination with computational methods, represent a novel paradigm for prediction of consciousness and functional recovery after severe brain injury. Research is needed to produce reliable, patient-level predictions that could meaningfully impact clinical decision making.
Magnetic Resonance Angiogram Findings of Internal Carotid Artery Narrowing and Anterior Cerebral Artery Hypoplasia Associated With Optic Atrophy After Neonatal Extracorporeal Membrane Oxygenation
Authors: Pogrebniak Alexander E. , Marcus Matthew A. 
Published: October 2020

Abstract:
We use MRA to elucidate a potential association of unilateral optic atrophy in infancy, ipsilateral internal carotid artery narrowing after extracorporeal membrane oxygenation, and ipsilateral hypoplasia of the A1 segment of the anterior cerebral artery.
Eye Movements in Fragile X-Associated Tremor/Ataxia Syndrome
Authors: Hall Deborah A. , Leehey Maureen A. , Hagerman Randi J. , Pelak Victoria S. 
Published: October 2020

Background:
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder characterized by ataxia, tremor, and parkinsonism. Eye motility abnormalities on the clinical examination of FXTAS patients have not been formally studied.

Methods:
A case–control study with fragile X gene mutation carriers with and without FXTAS and normal controls was conducted and included a videotaping of ocular items of the International Cooperative Ataxia Rating Scale (ICARS). A neuro-ophthalmologist blinded to gene status rated nystagmus, ocular pursuit, and saccades.

Results:
Forty-four cases and controls were recruited, with an average age of 55.2 years (±7.4) and 57% women. Gaze-evoked nystagmus was increased in fragile X gene carriers (odds ratio 1.44, 95% confidence interval: 0.33–7.36) but was not statistically significant. There was no difference in ocular pursuit nor saccade dysmetria between cases and controls.

Conclusion:
The results show that clinical examination findings of ocular abnormalities, using the ICARS oculomotor disorders movement subscale, are not more common in FXTAS or FMR1 premutation carriers than normal controls on examination in the clinic. Examining a larger cohort of patients with FXTAS would be an ideal next step.
Optic Disc Edema and Posterior Globe Flattening Secondary to Ocular Hypotony: Case Report and Discussion Regarding Pathophysiology and Clinical Findings
Authors: Albano de Guimarães Juliana , Teixeira Gabriela Carneiro , Silva Taiane Kelly Lima da , Moura Frederico Castelo 
Published: October 2020

Abstract:
We describe a case of a young female patient presenting with ocular hypotension (4 mm Hg) secondary to cyclodialysis, and optic disc edema (ODE) after a blunt trauma in the right eye (right eye). MRI showed posterior globe flattening of the right eye, drawing our attention to the pathophysiology behind these findings. The combination of ODE and posterior globe flattening, as observed in the present case of ocular hypotony, is known from other conditions such as intracranial hypertension and space-flight neuro-ocular syndrome, pointing to a common pathophysiological mechanism, possibly resulting from axoplasmic stasis at the level of the lamina cribrosa due to a high translaminar pressure difference.
Structure prediction of crystals, surfaces and nanoparticles
Authors: Woodley Scott M. , Day Graeme M. , Catlow R. 
Published: October 2020

We review the current techniques used in the prediction of crystal structures and their surfaces and of the structures of nanoparticles. The main classes of search algorithm and energy function are summarized, and we discuss the growing role of methods based on machine learning. We illustrate the current status of the field with examples taken from metallic, inorganic and organic systems.This article is part of a discussion meeting issue ‘Dynamicin situmicroscopy relating structure and function’.