bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensor and Survey Measures Associated With Daily Fatigue in HIV: Findings From a Mixed-Method Study
Authors: Makic Mary Beth , Gilbert Danielle , Jankowski Catherine , Reeder Blaine , Al-Salmi Nasser , Starr Whitney , Cook Paul F. 
Published: December 2019

Abstract
Fatigue is the most common symptom among people living with HIV (PLWH), but may have many causes. This mixed-method study was designed to characterize PLWH's fatigue experiences and associated self-management behaviors, using Two Minds Theory. Fifty-five PLWH completed daily smartphone surveys on psychological states and fatigue at random times for 30 days and used a Fitbit Alta™ wristband. Within-person multilevel models were used to identify univariate correlates of fatigue. The first 25 participants also completed qualitative interviews about their experiences, and results were compared across methods. Participants had significant fatigue despite well-controlled HIV. Fatigue varied between persons and over time. Fatigue was associated with physical activity, sleep, daily psychological states, and barriers to self-care. PLWH reported new insights into fatigue from self-monitoring. There are potential opportunities for PLWH to improve sleep, activity, or stress management to alleviate fatigue. PLWH were interested in reducing fatigue and willing to use self-monitoring technology.
Renal artery wall 18F-NaF activity and glomerular filtration rate: an exploratory analysis in a high cardiovascular risk population
Authors: Oliveira-Santos Manuel , McMahon Gearoid , Castelo-Branco Miguel , Silva Rodolfo , Gomes Andreia , Chichorro Nuno , Abrunhosa Antero , Donato Paulo , de Lima João Pedroso , Pego Mariano , Gonçalves Lino , Ferreira Maria João 
Published: December 2019

Objectives
Atherosclerotic plaque molecular imaging with 18F-sodium fluoride (NaF) PET with computed tomography (PET-CT) may identify active unstable microcalcification. We sought to explore renal arteries calcification activity in a group of high cardiovascular (CV) risk subjects without manifest CV disease.

Methods
High CV risk hypertensive individuals from a single centre were prospectively scanned with 18F-NaF-PET-CT in major vascular territories. Renal arterial wall activity was retrospectively analysed and expressed as the ratio between maximum standard uptake value in the lesion and mean blood pool activity in the superior vena cava [tissue-to-background ratio (TBR)]. We explored renal artery wall 18F-NaF activity’s association to CV risk factors and renal function.

Results
Mean age was 64 ± 8.6 years, 56% male, 96% Caucasian and 24% had chronic kidney disease (CKD) (n = 25). Six individuals (24%) showed renal artery wall radiotracer uptake (TBR 1.4 ± 0.4); these subjects were heavier, had higher triglycerides, high-sensitivity C-reactive protein and predicted CV risk (SCORE) compared to the remaining cohort (P < 0.05 for all comparisons). There was a trend toward higher 18F-NaF uptake in other major vessels and increased thoracic fat volume in subjects with renal artery wall uptake. Glomerular filtration rate (GFR) was lower in subjects with positive renal plaques (93.0 ± 29.7 vs. 65.0 ± 19.7 ml/min, P = 0.04). Renal artery radiotracer uptake and eGFR were inversely correlated (r = −0.42, P = 0.04).

Conclusion
In a high CV risk group without manifest CV disease, higher renal artery wall 18F-NaF activity is associated with superior predicted CV risk and lower GFR.
A Quantitative Assessment of Gluten Cross‐contact in the School Environment for Children With Celiac Disease
Authors: Weisbrod Vanessa M. , Silvester Jocelyn A. , Raber Catherine , Suslovic William , Coburn Shayna S. , Raber Blair , McMahon Joyana , Damast Amy , Kramer Zachary , Kerzner Benny 
Published: December 2019

ABSTRACTObjectives:A gluten‐free (GF) diet is the primary treatment for celiac disease (CD). Gluten is used in schools, particularly in early childhood, art, and home‐economics classrooms. This study aimed to measure gluten transfer from school supplies to GF foods that a child with CD may eat. Also, to measure efficacy of washing techniques to remove gluten from hands and tables.Methods:Five experiments measured potential gluten cross‐contact in classrooms: Play‐Doh (n = 30); baking project (n = 30); paper mâché (n = 10); dry pasta in sensory table (n = 10); cooked pasta in sensory table (n = 10). Thirty participants ages 2 to 18 were enrolled. Following activities, gluten levels were measured on separate slices of GF bread rubbed on participant's hands and table surfaces. Participants were assigned 1 of 3 handwashing methods (soap and water, water alone, or wet wipe). Repeat gluten transfer measurements were taken from hands and tables. Gluten measurements made using R‐Biopharm R7001 R5‐ELISA Sandwich assay.Results:Paper mâché, cooked pasta in sensory tables, and baking project resulted in rates of gluten transfer far greater than the 20 ppm threshold set by Codex Alimentarius Commission. Play‐Doh and dry pasta, however, resulted in few gluten transfers to GF bread >20 ppm. Soap and water was consistently the most effective method for removing gluten, although other methods proved as effective in certain scenarios.Conclusions:The potential for gluten exposure at school is high for some materials and low for others. For high‐risk materials, schools should provide GF supplies and have a robust strategy to prevent gluten cross‐contact with food.
Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound
Authors: Payne Karlie , Payne Justin , Larkin Theresa A. 
Published: December 2019

Objective
The aim of the study was to determine whether gluteus medius muscle thickness or activation differed between left and right sides and was associated with patellofemoral pain presence or severity.

Design
Males and females were recruited and screened by a physiotherapist for inclusion in the control or patellofemoral pain syndrome group. Bilateral measures were obtained for Q angle and gluteus medius muscle thickness at rest and on contraction via standing hip external rotation, using ultrasound. Muscle activation was calculated as the percentage change in muscle thickness on contraction relative to at rest. Patellofemoral pain syndrome participants completed the anterior knee pain scale and a visual analog pain scale.

Results
Gluteus medius muscle thickness at rest and on contraction, muscle activation, and Q angle were not different between control (n = 27, 63% female) and patellofemoral pain syndrome (n = 27, 59% female) groups. However, patellofemoral pain syndrome participants had a significantly larger left-right side imbalance in gluteus medius muscle activation than controls (15.9 ± 19.3% vs. 4.4 ± 21.9%, P < 0.05). Among patellofemoral pain syndrome participants, the magnitude of asymmetry of gluteus medius muscle activation was correlated with knee pain score (r = 0.425, P = 0.027).

Conclusions
Asymmetry of gluteus medius muscle activation was associated with patellofemoral pain syndrome and pain severity. This is clinically relevant for patellofemoral pain syndrome prevention and treatment, particularly because this was quantifiable using ultrasound.
Patient and Clinician Perspectives on Quality-of-Care Topics for Users of Custom Ankle-Foot Orthoses
Authors: Heinemann Allen W. , Deutsch Anne , Fatone Stefania , Soltys Nicole , McPherson Vari , Peterson Michelle , Slater Billie C. S. , LaVela Sherri L. 
Published: December 2019

Objective
As in all healthcare areas, there is a need to improve quality relevant to orthotic practice, but we lack information as to what aspects of healthcare quality are meaningful to measure. Thus, the objective was to identify issues that are important to the quality-of-care for people who use custom ankle-foot orthoses as identified by ankle-foot orthosis users, orthotists, and physical therapists.

Design
We conducted focus groups with custom ankle-foot orthosis users, orthotists, and physical therapists. A stenographer took verbatim notes and provided transcripts. Research staff members assessed the transcripts using thematic analysis.

Results
Participants included 5 ankle-foot orthosis users (1 focus group), 17 orthotists (2 focus groups), and 7 physical therapists (1 focus group). They discussed domains of quality-of-care relevant for people with ankle-foot orthoses. We identified 28 thematic codes addressing 10 broad themes of quality-of-care. Six of the broad themes (organizational characteristics, patient-clinician communication, care coordination, device fit and comfort, body function, activity, and participation) mapped to the National Quality Forum’s person- and family-centered care concepts. Environment of care, clinician competencies, and device characteristics and usage were important to orthotic practice but do not map to any National Quality Forum concept. Participants did not mention the National Quality Forum concept of shared decision-making.

Conclusions
The quality themes provide information as to what aspects of healthcare quality are meaningful to measure with respect to orthotic care, thus providing guidance on how to measure and improve ankle-foot orthosis service delivery.
Toward Better Reporting Standards of Patients’ Characteristics in Rehabilitation Trials
Authors: Meyer Thorsten , Selb Melissa , Kiekens Carlotte , Grubišić Frane , Arienti Chiara , Stucki Gerold , Negrini Stefano 
Published: December 2019

Background and Aim
The reporting of clinical studies in rehabilitation has been criticized in several aspects, including the reporting of patient characteristics. This article aims to contribute to the improvement of the reporting of patient characteristics in rehabilitation trials. Specifically, we want to determine the type of information that should be reported in rehabilitation trials that is specific to rehabilitation patients and how this information is captured by current reporting standards.

Methods
In the first step, we made a conceptual analysis of characteristics of rehabilitation patients by addressing the specifics of the field of medical rehabilitation, including the definition of rehabilitation and a description of its beneficiaries. In the second step, we compared this reference framework to the current reporting standards, especially the Consolidated Standards of Reporting Trials (CONSORT) statement and its extensions, as well as standards for the reporting of clinical guidelines (agree, right).

Results
Patients included in rehabilitation interventions should be distinguished by specific information. From a clinical perspective, patients dealt with in rehabilitation comprise broader diagnostic groups compared with other clinical settings. Information on comorbidities should be added in the description of the patients. In addition, a description of baseline characteristics of patients should always include functioning characteristics of the patients, including information on relevant context factors, ie, environmental and personal factors. The CONSORT statement aims to provide patient characteristic to enable transferability of results to users. It is represented in terms of selection (inclusion/exclusion) criteria and the description of the resulting samples. Extensions of the CONSORT statement specified that information on socioeconomic variables should be added, and the selection of patient characteristics to be reported at baseline should be based on the selection of outcome variables. In addition, all relevant prognostic variables should be reported. Only one CONSORT extension asks explicitly to include comorbid conditions. The reporting standards on guidelines demand a more comprehensive characterization of patients, specific to the rehabilitation area.

Conclusions
Present reporting standards can only partly address relevant issues pertinent to medical rehabilitation. The present analysis provides a conceptual and empirical framework for the development of reporting standards on patient characteristics in rehabilitation trials.
Patient-Related Risk Factors for Worsened Abdominal Well-Being after Autologous Breast Reconstruction
Authors: Stone Jill P. , Bello Ricardo J. , Siotos Charalampos , Meyer Meredith L. , Sebai Mohamad E. , Payne Rachael M. , Manahan Michele A. , Cooney Damon S. , Sacks Justin M. , Broderick Kristen P. , Cooney Carisa M. , Rosson Gedge D. 
Published: December 2019

Background:
Patient-reported lower satisfaction with the abdomen preoperatively is a strong predictor of undergoing DIEP flap surgery. The authors evaluated physical well-being of the abdomen before and after flap-based breast reconstruction to determine potential predictors for decreased postoperative abdominal well-being.

Methods:
The authors retrospectively analyzed an institutional breast reconstruction registry, selecting patients who underwent abdominally based autologous flap breast reconstruction from 2010 to 2015. The authors’ primary outcome was the Physical Well-being of the Abdomen domain from the BREAST-Q, measured preoperatively and at 6- and 12-month follow-up visits after final reconstruction. The authors classified two patient groups: those who experienced a clinically important worsening of Physical Well-being of the Abdomen score and those who did not. The authors used the chi-square test, t test, and Wilcoxon rank sum test, and multivariable logistic regression to identify potential predictors.

Results:
Of 142 women identified, 74 (52 percent) experienced clinically important worsening of physical well-being of the abdomen, whereas 68 (48 percent) did not. The first group experienced a 25-point (95 percent CI, 22 to 28) decrease and the latter an 8-point (95 percent CI, 5 to 10) decrease in score compared to baseline. Multivariable analysis showed an association between higher baseline score and race, with higher odds of decreased score at the 12-month follow-up. A higher baseline RAND-36 general health score, bilateral reconstruction, and a lower body mass index demonstrated a trend for clinically important worsening of physical well-being of the abdomen.

Conclusions:
More than half of flap-based breast reconstruction patients experienced clinically important worsening of abdominal well-being after final breast reconstruction. Clinicians may use these findings to identify patients at higher risk of worsened postoperative abdominal well-being.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Occurrence of Symptomatic Hypotension in Patients Undergoing Breast Free Flaps: Is Enhanced Recovery after Surgery to Blame?
Authors: Anolik Rachel A. , Sharif-Askary Banafsheh , Hompe Eliza , Hopkins Thomas J. , Broadwater Gloria , Hollenbeck Scott T. 
Published: December 2019

Background:
Enhanced recovery after surgery (ERAS) initiatives improve postoperative function and expedite recovery, leading to a decrease in length of stay. The authors noted a high rate of postoperative symptomatic hypotension in patients undergoing abdominal free flap breast reconstruction and wished to explore this observation.

Methods:
Subjects undergoing abdominal free flap breast reconstruction at the authors’ institution from 2013 to 2017 were identified. The ERAS protocol was initiated in 2015 at the authors’ hospital; thus, 99 patients underwent traditional management and 138 patients underwent ERAS management. Demographics and perioperative data were collected and analyzed. Postoperative symptomatic hypotension was defined as mean arterial pressure below 80 percent of baseline with symptoms requiring evaluation.

Results:
A significantly higher rate of postoperative symptomatic hypotension was observed in the ERAS cohort compared with the traditional management cohort (4 percent versus 22 percent; p < 0.0001). Patients in the ERAS cohort received significantly less intraoperative intravenous fluid (4467 ml versus 3505 ml; p < 0.0001) and had a significantly increased amount of intraoperative time spent with low blood pressure (22 percent versus 32 percent; p =0.002). Postoperatively, the ERAS cohort had significantly lower heart rate (77 beats per minute versus 88 beats per minute; p < 0.0001) and mean arterial pressure (71 mmHg versus 78 mmHg; p < 0.0001), with no difference in urine output or adverse events.

Conclusions:
The authors report that ERAS implementation in abdominal free flap breast reconstruction may result in a unique physiologic state with low mean arterial pressure, low heart rate, and normal urine output, resulting in postoperative symptomatic hypotension. Awareness of this early postoperative finding can help better direct fluid resuscitation and prevent episodes of symptomatic hypotension.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Pediatric Tissue Expansion: Predictors of Premature Expander Removal in a Single Surgeon’s Experience with 472 Expanders
Authors: Wang Howard D. , Ibrahim Zuhaib , Quan Amy , Bai Jennifer , Ostrander Benjamin T. , Redett Richard J. 
Published: December 2019

Background:
Tissue expansion is used for soft-tissue reconstruction in pediatric patients. The expansion process can be complicated by infection and extrusion, leading to premature expander removal. The aim of this study was to identify risk factors associated with premature expander removal caused by infection or extrusion in pediatric patients.

Methods:
A retrospective study of pediatric patients who underwent tissue expansion performed by the senior author (R.J.R.) over a 12-year period was performed. Predictor variables included age, sex, race, indication, anatomical location, number of expanders, serial expansion, and expander size. Bivariate and multivariate analyses were performed to identify risk factors for premature expander removal.

Results:
A total of 139 patients with 472 expanders were included in this study. Complications occurred with 78 expanders (16.5 percent). Premature expander removal caused by infection or exposure occurred with 51 expanders (10.8 percent). In terms of location, the highest rates of premature removal occurred in the lower extremity (20.0 percent) and scalp (16.3 percent). Multivariate analysis identified younger age (0 to 6 years compared with 13 to 17 years; OR, 3.98; 95 percent CI, 1.13 to 14.08; p = 0.03), greater number of expanders (OR, 1.45; 95 percent CI, 1.03 to 2.03; p = 0.03), and lower extremity location (OR, 4.27; 95 percent CI, 1.45 to 12.53; p = 0.008) were associated with an increased odds of premature expander removal.

Conclusions:
Expander removal occurred in approximately 10 percent of tissue expanders. Odds of premature removal is increased with younger age, greater number of expanders, and lower extremity location.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Three-Dimensional Topographic Surface Changes in Response to Volumization of the Lateral Suborbicularis Oculi Fat Compartment
Authors: Schreiber Jillian E. , Stern Carrie S. , Jelks Elizabeth B. , Jelks Glenn W. , Tepper Oren M. 
Published: December 2019

Background:
Autologous fat grafting is an increasingly preferred method for aesthetic facial rejuvenation. The authors’ group previously described the concept of “lipotopography” as topographic surface changes that occur with fat grafting to discrete facial fat compartments. The purpose of this study was to define the “augmentation zone” of the lateral suborbicularis oculi fat compartment to understand the topographical surface changes following augmentation.

Methods:
Nine cadaver hemifaces were injected with fat analogue at intervals from 1 to 4 cc. Three-dimensional photographs were taken at baseline and following each 1-cc incremental injection. The interval surface changes were calculated using three-dimensional software including perimeter, diameter, and projection.

Results:
The augmentation zone of the lateral suborbicularis oculi fat compartment was characterized by a consistent shape and boundary. The shape was an elongated oval bound superiorly by the lid-cheek junction and inferiorly at the level of the zygomaticocutaneous ligament. Vertical and horizontal diameter and perimeter showed initial increases between 1 and 2 cc and then a plateau between 2 and 3 cc. Projection changes demonstrated an initial slow increase from 1 to 2 cc injection followed by nearly linear growth from 2 to 4 cc.

Conclusions:
Three-dimensional photography and computer analysis provide tools to understand the surface anatomy change in response to fat grafting specific facial fat compartments. Targeted volumization of the lateral suborbicularis oculi fat compartment also results in a unique surface change with consistent shape and anatomical boundaries. The lid-cheek junction and zygomaticocutaneous ligament were observed to restrict the expansion of fat analogue for all injection volumes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Psychological Resilience and Vulnerability as Mediators Between Adverse Life Events and Fatigue, Motor Dysfunction, and Paresthesia in Multiple Sclerosis
Authors: Swanepoel Isabelle , van Staden Werdie , Fletcher Lizelle 
Published: December 2019

ABSTRACT

Objective
Adverse life events have been associated with exacerbating multiple sclerosis (MS) symptoms, but results have been variable, raising the question on the role of other psychological factors. This study examined the role of psychological resilience and vulnerability as mediators between adverse life events on MS symptoms.

Methods
Participants with MS (N = 1239) were aged 18 to 81 years (mean [SD] = 45.6 [10.4] years), and 84.5% were female. MS symptoms were measured by the modified Fatigue Severity Scale, modified Fatigue Assessment Scale, Motor Dysfunction Assessment Scale, Paraesthesiae Spell Duration Scale, and the Paraesthesiae Cumulative Duration Scale. Psychological measures included the Connor-Davidson Resilience Scale, Resilience Scale for Adults, Psychological Vulnerability Scale, the vulnerability section of the Defence Style Questionnaire, and the Adverse Life Events Assessment Scale. Regression analyses and structural equation modeling were performed.

Results
Adverse life events during the preceding 60 days were associated with fatigue, motor dysfunction, and paresthesia, but with small effect sizes (β from 0.07 to 0.15; p ≤ .014). A structural equation model by which resilience mediated less and vulnerability more MS symptoms after adverse life events during the preceding 60 days showed a statistically significant fit with the data of a moderate to good degree (p < .001; goodness-of-fit statistic = 0.725; root mean square error of approximation = 0.047). Vulnerability played a markedly larger role than did resilience.

Conclusion
The results suggest that psychological resilience and vulnerability play mediating roles in the relation between adverse life events and MS symptoms, but other psychological factors also need to be investigated.