bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operational Virtual Health Modalities Increased Combat Power for 1st Squadron, 2nd Cavalry Regiment During the Enhanced Forward Presence Mission
Authors: Cornfeld Robert , Cranney Nathaniel , Rudy Elena 
Published: March 2020

Abstract

Introduction
Virtual Health (VH) is posited to be a force multiplier for Military Medicine, delivering digital healthcare to the point of need for the warfighter. To date, there are no studies on the impact of both synchronous and asynchronous VH modalities during a deployment. VH usage by the 1st Squadron, 2nd Cavalry Regiment (1/2 CR) during a 6 month deployment to rural Poland was evaluated prospectively to identify mission days saved for Commanders.

Materials and Methods
VH Europe staff trained 1/2 CR Garrison and Deployed Medical Staff on VH modalities. Workflows for communication to higher echelons of medical care were developed. Usage of VH was prospectively tracked to identify trends and outcomes.

Results
213 Soldier Mission Days during a 6 month deployment were saved through the use of VH versus in-person travel for care. The predominance of VH was for synchronous video VH for the Warfighter (VIEW) (90%), followed by asynchronous Health Experts onLine Portal (HELP) consultations (10%). Lost Soldier productivity of $87,330 was avoided.

Conclusion
Operational VH is a force multiplier that brings the resources of the Medical Center to the Warfighter at the point of need. The full spectrum of VH modalities offers the greatest benefit for deployed units. Expansion of these technologies throughout the Department of Defense will reduce medical evacuations, increase Active Duty Service Member time on mission, and reduce risks for Commanders.
Cosmic rays from the nearby starburst galaxy NGC 253: the effect of a low-luminosity active galactic nucleus
Authors: Gutiérrez E M , Romero G E , Vieyro F L 
Published: March 2020

ABSTRACT
NGC 253 is a nearby starburst galaxy in the Sculptor group located at a distance of ∼3.5 Mpc that has been suggested by some authors as a potential site for cosmic ray acceleration up to ultrahigh energies. Its nuclear region is heavily obscured by gas and dust, which prevents establishing whether or not the galaxy harbours a supermassive black hole coexisting with the starburst. Some sources have been proposed in the literature as candidates for an active nucleus. In this work, we aim at determining the implications that the presence of a supermassive black hole at the nucleus of NGC 253 might have on cosmic ray acceleration. With this aim, we model the accretion flow on to the putative active nucleus, and we evaluate the feasibility of particle acceleration by the black hole dynamo mechanism. As a by-product, we explore the potential contribution from non-thermal particles in the accretion flow to the high-energy emission of the galaxy. We found that in the three most plausible nucleus candidates, the emission of the accretion flow would inhibit the black hole dynamo mechanism. To rule out completely the influence that a putative nucleus in NGC 253 might have in cosmic ray acceleration, a better clarification concerning the true nature of the nucleus is needed.
A catalogue of intermediate-duration Type I X-ray bursts observed with the INTEGRAL satellite
Authors: Alizai K , Chenevez J , Brandt S , Lund N 
Published: March 2020

ABSTRACT
We present a catalogue of long-duration bursts observed with the Joint European X-ray Monitor and IBIS/ISGRI instruments onboard the INTEGRAL satellite. The 14 bursts have e-folding times ranging from 55 s to ≈17 min, and are therefore classified as intermediate-duration bursts, caused by the ignition of an unusually thick helium layer. Though seven events have already been reported in literature, we have systematically reanalysed the whole sample. We find three new photospheric radius expansion bursts, which are not reported in the literature, allowing us to provide a new estimate of the distances to these sources. We apply the enhanced persistent emission method (also known as the fa method) on sources with detectable persistent emission prior to a burst, in order to follow the evolution of the accretion rate during the burst. Although we do not get significantly better fits, the evolution of the fa factor shows an indicative behaviour, which we discuss.
The influence of a top-heavy integrated galactic IMF and dust on the chemical evolution of high-redshift starbursts
Authors: Palla M , Calura F , Matteucci F , Fan X L , Vincenzo F , Lacchin E 
Published: March 2020

ABSTRACT
We study the effects of the integrated galactic initial mass function (IGIMF) and dust evolution on the abundance patterns of high redshift starburst galaxies. In our chemical models, the rapid collapse of gas clouds triggers an intense and rapid star formation episode, which lasts until the onset of a galactic wind, powered by the thermal energy injected by stellar winds and supernova explosions. Our models follow the evolution of several chemical elements (C, N, α-elements, and Fe) both in the gas and dust phases. We test different values of β, the slope of the embedded cluster mass function for the IGIMF, where lower β values imply a more top-heavy initial mass function (IMF). The computed abundances are compared to high-quality abundance measurements obtained in lensed galaxies and from composite spectra in large samples of star-forming galaxies in the redshift range 2 ≲ z ≲ 3. The adoption of the IGIMF causes a sensible increase of the rate of star formation with respect to a standard Salpeter IMF, with a strong impact on chemical evolution. We find that in order to reproduce the observed abundance patterns in these galaxies, either we need a very top-heavy IGIMF (β &lt; 2) or large amounts of dust. In particular, if dust is important, the IGIMF should have β ≥ 2, which means an IMF slightly more top-heavy than the Salpeter one. The evolution of the dust mass with time for galaxies of different mass and IMF is also computed, highlighting that the dust amount increases with a top-heavier IGIMF.
Data Visualization Tools of Tobacco Product Use Patterns, Transitions and Sex Differences in the PATH Youth Data
Authors: Gueorguieva Ralitza , Buta Eugenia , Simon Patricia , Krishnan-Sarin Suchitra , O’Malley Stephanie S 
Published: March 2020

Abstract

Introduction
Evaluations of multiple tobacco product use and temporal changes in patterns of use are complicated by a large number of combinations and transitions. Visualization tools could easily identify most common patterns and transitions.

Methods
Set intersection bar plots describe ever use of five tobacco products among 12–17 years old youth in wave 1 of the Population Assessment of Tobacco and Health (PATH) study (N = 11 497). Heat maps visualize unweighted frequencies of transitions from ever use at wave 1 (2013–2014) to past 12-month use at wave 2 (2014–2015). Weighted calibrated heat maps assess differences in relative frequencies of transitions by pattern at wave 1 and identify differences in transitions by sex.

Results
The most common tobacco product ever use patterns in wave 1 were of cigarettes only, e-cigarettes only or hookah only, followed by ever use of both cigarettes and e-cigarettes. Initiation of use between waves was uncommon. The most frequent transition among those who reported use at wave 2 but not at wave 1 (N = 971) was to e-cigarette use (N = 301). However, among e-cigarette-only ever users at wave 1 (N = 260), about half did not report any product use at wave 2. Use of three or more products remained stable. Adolescent girls compared to boys appeared more likely to report hookah use at both waves.

Conclusion
Set intersection bar plots and heat maps are useful for visualizing tobacco product use patterns and transitions, especially for multiple products. Both techniques could identify common problematic tobacco use patterns across and within populations.

Implications
Given the growing complexity of the youth tobacco use landscape, approaches to efficiently communicate patterns of multiple tobacco product use should be used more often. This study introduces set intersection bar plots and modified versions of heat maps to the tobacco product literature and illustrates their use in the PATH youth sample. These techniques are useful for visualizing absolute and relative frequencies of multiple possible patterns and transitions. They also suggest targets for subsequent statistical inference such as sex differences in hookah use. The methods can be applied more generally for data visualization wherever large number of combinations occurs.
Uncommon causes of noncardiogenic pulmonary edema
Authors: Simko Lynn Coletta , Culleiton Alicia L. 
Published: March 2020

Abstract:
Although acute respiratory distress syndrome is the most common cause of noncardiogenic pulmonary edema, NPs also should be familiar with several other less common causes, including transfusion-related acute lung injury, neurogenic pulmonary edema, preeclampsia/eclampsia, opioid overdose, high-altitude pulmonary edema, and pulmonary embolism. This article addresses the pathophysiology, clinical presentation, diagnostics, treatment, and nursing considerations associated with each uncommon cause of noncardiogenic pulmonary edema.
High density all-pedicle screw technique in correction of high-degree (≥70 degrees) scoliosis with sequential derotation without osteotomies
Authors: Michael Fady , Zayan Ibrahim Mohammed , Fathy Ayman 
Published: March 2020

Background:
Pedicle screws have become the principal method for scoliosis correction by allowing secure segmental three-column fixation, with many advantages over other fixation methods. This prospective study was conducted in 23 patients to evaluate the efficacy and safety of high-density pedicle screws in the correction of high degrees (≥70 degrees) of adolescent idiopathic scoliosis with sequential derotation without osteotomies.

Methods:
The traditional posterior approach was done with pedicle-screw instrumentation at each level of the concave side unless the pedicle was hypoplastic or markedly deformed and could not support pedicle-screw purchase. For the convex side, the surgeons instrumented at least the three lower-most vertebrae, three upper-most vertebrae, and at least three apical vertebrae. The mean preoperative Cobb angle of the major curve was 82.34 degrees.

Results:
The Cobb angle had been corrected to 19.65 degrees postoperatively and to 20.69 degrees at latest follow-up. The percent of curve correction was 76.1%. The Scoliosis Research Society (SRS) 22 questionnaire score improved significantly from a mean of 2.3 preoperatively to 3 at latest follow-up. There was no metal failure or pseudarthrosis detected during the follow-up period. The high-density screw technique allows control of each vertebra in the curve. Using a tough rod with a rod derotation technique aligns the coronal position of each vertebra.

Conclusions:
A high-density pedicle-screw technique through a posterior-only approach is a safe, effective method for treatment of severe adolescent idiopathic scoliosis avoiding the anterior approach-related complications.

Level of Evidence:
Level IV.
Changes in Cervical Spinal Alignment After Thoracolumbar Corrective Surgery in Adult Patients With Adolescent Idiopathic Scoliosis
Authors: Nagoshi Narihito , Yagi Mitsuru , Daimon Kenshi , Suzuki Satoshi , Tsuji Osahiko , Okada Eijiro , Fujita Nobuyuki , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: March 2020

Study Design.
Case–control study.

Objective.
To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS)

Summary of Background Data.
Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported.

Methods.
We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2–C7 angle more than 20°, (2) C2–C7 SVA more than 40 mm, (3) and C2–C7 angle less than −10°. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed.

Results.
There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5 vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1° vs. 12.5°), and the C2–C7 angle was kyphotic (−16.1° vs. 3.0°). The average kyphotic angle at thoracic spine (T5–T12) was lower in the CD group preoperatively (12.5° vs. 19.5°) and postoperatively (15.2° vs. 20.8°). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2–C7 angle was lower than those who converted to non-CD following surgery (n = 16) (−17.0° vs. −10.3°).

Conclusion.
More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients.

Level of Evidence: 3
Postoperative Pain, Narcotics Consumption, and Patient-Reported Outcomes Based on PROMIS Physical Function Following a Single-Level Anterior Cervical Discectomy and Fusion
Authors: Parrish James M. , Jenkins Nathaniel W. , Narain Ankur S. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern 
Published: March 2020

Study Design.
Retrospective.

Objective.
To determine the association between preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scores with postoperative pain, narcotics use, and patient-reported outcomes (PRO) following a single-level anterior cervical discectomy and fusion (ACDF) procedure.

Summary of Background Data.
There is a scarcity of prior literature on the ability of baseline PROMIS scores to predict clinical outcomes for patients undergoing ACDF procedures.

Methods.
Patients who underwent a primary ACDF were retrospectively reviewed and stratified into low and high disability cohorts. Preoperative PROMIS PF cohorts were tested for association with demographic and perioperative characteristics using chi-square analysis and one-way analysis of variance. Cohorts were tested for association with inpatient pain scores and narcotics consumption, as well as postoperative improvements in PROMIS PF, neck disability index (NDI), and visual analog scale (VAS) neck and arm pain using linear regression.

Results.
Ninety one patients were included: 39 low disability and 52 high disability. Inpatient postoperative VAS pain scores and narcotic consumption are also compared between cohorts. Patients with greater disability reported higher VAS pain scores (P = 0.003). However, patients in both cohorts consumed comparable amounts of narcotics (P = 0.926). Patients with greater preoperative disability demonstrated lower PROMIS PF scores, greater NDI scores, and greater VAS Neck scores at the preoperative baseline. However, patients demonstrated similar improvement of VAS neck and arm pain, as well as NDI at all postoperative timepoints. Patients with low disability reported worsened physical function at the 6 weeks timepoint.

Conclusion.
Patients with worse preoperative disability as measured by PROMIS PF reported increased pain but comparable narcotics consumption in the immediate postoperative period following a single-level ACDF procedure. Furthermore, patients experienced similar long-term postoperative improvement of PROs regardless of preoperative physical function. PROMIS PF can efficiently quantify physical function before and after the ACDF procedure as self-evaluated by patients.

Level of Evidence: 3
Does Menses Affect the Risk of Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgeries?
Authors: Chiu Chee Kidd , Gani Siti Mariam Abd , Chung Weng Hong , Mihara Yuki , Hasan Mohd Shahnaz , Chan Chris Yin Wei , Kwan Mun Keong 
Published: March 2020

Study Design.
Retrospective propensity score matching study.

Objective.
To investigate whether menses affect intraoperative blood loss in female adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgeries.

Summary of Background Data.
There were concerns whether patients having menses will have higher intraoperative blood loss if surgery were to be done during this period.

Methods.
This study included 372 females who were operated between May 2016 to May 2019. Fifty-five patients had menses during surgery (Group 1, G1) and 317 patients did not have menses during surgery (Group 2, G2). Propensity score matching (PSM) analysis with one-to-one, nearest neighbor matching technique and with a match tolerance of 0.001 was used. The main outcome measures were intraoperative blood loss (IBL), volume of blood salvaged, transfusion rate, preoperative hemoglobin, preoperative platelet, preoperative prothrombin time, preoperative activated partial thromboplastin time (APTT), international normalized ratio (INR), and postoperative hemoglobin. Postoperative Cobb angle and correction rate were also documented.

Results.
At the end of PSM analysis, 46 patients from each group were matched and balanced. The average operation duration for G1 was 140.8 ± 43.0 minutes compared with 143.1 ± 48.3 minutes in G2 (P = 0.806). The intraoperative blood loss for G1 was 904.3 ± 496.3 mL and for G2 was 907.9 ± 482.8 mL (P = 0.972). There was no significant difference in terms of normalized blood loss (NBL), volume of blood salvaged during surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drift, estimated blood volume (EBV), IBL per EBV and IBL per level fused (P > 0.05). No postoperative complications were encountered in both groups. On average, the postoperative hospital stay was 3.5 ± 0.8 days for both groups (P = 0.143).

Conclusion.
Performing corrective surgery during the menstrual phase in female AIS patients is safe without risk of increased blood loss.

Level of Evidence: 4
A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy
Authors: Patel Bharat K. , Bapat Mihir R. , Upadhyay Arpit S. 
Published: March 2020

Study Design.
Case report.

Objective.
To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst.

Summary of Background Data.
Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1–C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression.

Methods.
A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst.

Result.
The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity.

Conclusion.
A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression.

Level of Evidence: 5
Keeping pace with the competition: His bundle versus biventricular pacing in heart failure
Authors: Upadhyay Gaurav A. , Tung Roderick 
Published: March 2020

Purpose of review
His bundle pacing (HBP) has emerged as a novel method to achieve electrical resynchronization in bundle branch block and as an alternative means to deliver cardiac resynchronization therapy (CRT). There are now data on HBP in CRT-eligible patients from cohort studies and a single pilot randomized controlled trial (RCT).

Recent findings
Early clinical data regarding HBP in heart failure have demonstrated echocardiographic and functional improvement similar to traditional biventricular pacing (BiV), mostly when utilized as a bailout to traditional BiV-CRT. A single pilot RCT, His-SYNC, showed a trend toward greater echocardiographic response in an on-treatment analysis, but was underpowered. No large RCTs have reported long-term clinical outcomes. In order to realize any benefit from HBP, output-dependent morphology changes must be demonstrated to ensure the conduction system capture is present. There may be a role for corrective HBP in patients with right bundle branch block and after atrioventricular node ablation, which is theoretically more desirable than traditional BiV. Importantly, however, HBP is likely not to benefit patients with nonspecific intraventricular conduction delay.

Summary
HBP is emerging as an alternative strategy for CRT and may have a role in patients in whom traditional BiV is not achievable or ineffective.