bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elective Labor Induction at 39 Weeks of Gestation Compared With Expectant Management
Authors: El-Sayed Yasser Y. , Rice Madeline Murguia , Grobman William A. , Reddy Uma M. , Tita Alan T.N. , Silver Robert M. , Mallett Gail , Hill Kim , Thom Elizabeth A. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Chien Edward K. , Casey Brian M. , Gibbs Ronald S. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. , Macones George A. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*
Published: September 2020

OBJECTIVE:
To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management.

METHODS:
We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliveries before 39 weeks of gestation and those not adherent to study protocol or with fetal anomalies were excluded. A composite of adverse outcomes (perinatal death or severe neonatal complications), third- or fourth-degree lacerations, and postpartum hemorrhage were evaluated. Log binomial regression models estimated relative risks and 95% CIs for associations of outcomes with patient characteristics including randomly assigned treatment group. Interactions between patient characteristics and treatment group were tested.

RESULTS:
Of 6,096 women with outcome data, 5,007 (82.1%) met criteria for inclusion in this analysis. Frequency of the perinatal composite was 252 (5.0%), 166 (3.3%) for third- or fourth-degree perineal laceration, and 237 (4.7%) for postpartum hemorrhage. In multivariable analysis, intended labor induction at 39 weeks of gestation was associated with a reduced perinatal composite outcome (4.1% vs 6.0%; adjusted relative risk [aRR] 0.71; 95% CI 0.55–0.90), whereas increasing body mass index (BMI) was associated with an increased perinatal composite outcome (aRR 1.04/unit increase; 95% CI 1.02–1.05). Decreased risk of third- or fourth-degree perineal laceration was observed with increasing BMI (aRR 0.96/unit increase; 95% CI 0.93–0.98) and in Black women compared with White women (1.2% vs 3.9%; aRR 0.34; 95% CI 0.19–0.60). Increased risk of postpartum hemorrhage was observed in Hispanic women compared with White women (6.3% vs 4.0%; aRR 1.64; 95% CI 1.18–2.29). Patient characteristics associated with adverse outcomes were similar between treatment groups (P for interaction >.05).

CONCLUSION:
Compared with expectant management, intended induction at 39 weeks of gestation was associated with reduced risk of adverse perinatal outcome. Patient characteristics associated with adverse outcomes were few and similar between groups.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.
INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE
Authors: Rush Ryan B. , Del Valle Penella Agustin , Reinauer Robert M. , Rush Sloan W. , Bastar Pedro Gomez 
Published: September 2020

Purpose:
To evaluate the benefits of internal limiting membrane peeling in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the treatment of vitreous hemorrhage.

Methods:
Two hundred and fifty-eight proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage were enrolled into the trial. Patients were randomized into one of two cohorts: Group A patients underwent internal limiting membrane peeling, whereas Group B patients did not undergo internal limiting membrane peeling. The main outcome was best-corrected visual acuity at 6 months. Secondary outcomes were optical coherence tomography central macular thickness at 6 months, incidence of diabetic macular edema treatment during the postoperative trial period, and incidence of epiretinal membrane at 6 months.

Results:
Two hundred and seven patients were randomized and completed 6 months follow-up. Group A had better best-corrected visual acuity at 6 months than Group B (P < 0.01). Group A had a lower incidence of diabetic macular edema treatment during the postoperative trial period and a lower incidence of epiretinal membrane at 6 months than Group B (P = 0.02 and P < 0.001, respectively). There was a trend toward lower central macular thickness on optical coherence tomography in Group A than Group B (P = 0.09). There were no significant differences in baseline details or complications intraoperatively or postoperatively between cohorts.

Conclusion:
This trial demonstrated better vision, fewer postoperative diabetic macular edema treatments, and a lower incidence of epiretinal membrane at 6 months when internal limiting membrane peeling was performed. Internal limiting membrane peeling may be considered a vital maneuver to perform in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage.
SPONTANEOUS LAMELLAR MACULAR HOLES CLOSURE
Authors: Chehaibou Ismael , Manoharan Niranjan , Govetto Andrea , Tsui Irena , Hubschman Jean-Pierre 
Published: September 2020

Purpose:
To report two cases of spontaneous closure of lamellar macular holes with epiretinal proliferation (ERP).

Methods:
Observational cases report.

Results:
Two patients affected with lamellar macular hole showed progressive and spontaneous closure of the hole associated with ERP development. At presentation, both patients presented with irregular foveal contour, and foveal cavitation with apparent loss of retinal tissue. In both cases, ERP, also called “lamellar hole-associated epiretinal proliferation”, was present and increased in size over time. This proliferation progressively developed across the hole with apparent restoration of the foveal contour and preservation of visual acuity.

Conclusion:
This report describes two cases of lamellar macular hole in which ERP increased over time, resulting in lamellar macular hole closure. Such observations may suggest a spontaneous healing process driven by glial cell proliferation.
UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A PATIENT WITH HAND-FOOT-MOUTH DISEASE: A CASE REPORT
Authors: Falk Zachary E. , Malik Khurram J. 
Published: September 2020

Purpose:
To demonstrate a rare cause of acute, focal chorioretinitis.

Methods:
Review of slit-lamp fundoscopy, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography.

Results:
Slit-lamp examination revealed parafoveal microaneurysms, parafoveal intraretinal hemorrhages, and outer segment irregularity in the left eye. Fundus photographs demonstrated retinal hemorrhages and a greyish-whitish sheen in the central parafoveal area. Optical coherence tomography was notable for a small pocket of outer segment and retinal pigment epithelium disruption and irregularity in the central foveal area of the left eye. Fluorescein angiography revealed increased focal macular leakage within a larger central area of leakage and staining.

Conclusion:
Unilateral acute idiopathic maculopathy and, specifically, coxsackievirus-related chorioretinitis should be considered in the differential diagnosis of atypical maculopathy.
The Effects of Carbon and Plastic Ankle-Foot Orthoses on Gait, Balance, and Mobility in Persons with Multiple Sclerosis: A Pilot Study
Authors: Jackson Kurt , Bigelow Kimberly Edginton , Hollis Sarah 
Published: September 2020

ABSTRACT

Introduction
Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait in individuals with multiple sclerosis (MS). However, there is currently little research to support their use or guide clinicians in the prescription process in this population. The purpose of this pilot study was to compare the effects of carbon and plastic AFOs on measures of gait, balance, and mobility in persons with MS.

Materials and Methods
Ten individuals with MS who had not used an AFO previously had their gait, balance, mobility, and perception of benefit assessed under three different AFO conditions: no AFO, carbon AFO (C-AFO), and plastic AFO (P-AFO), on separate days. Gait was assessed using an instrumented 10-m walk, a 6-minute walk, the physiological cost index (PCI), and a visual analog fatigue rating scale. Static balance was assessed using posturography under different sensory conditions and dynamic balance using the limits of stability (LOS) test. Mobility was assessed using the timed up and go (TUG) test. The perceived benefit of using the AFO was measured with an eight-item Likert scale survey.

Results
No significant differences were identified between the C-AFO and P-AFO conditions for any of the gait, balance, and mobility measures. Both AFO types tended to improve static balance but negatively impacted dynamic balance and mobility when compared with no AFO. There was no significant difference in the perceived benefit between the AFO types. However, there were differences in the PCI and perception of benefit for individual subjects that could be clinically meaningful.

Conclusions
There were no differences in gait, balance, and mobility measures or perception of benefit between C-AFO and P-AFO in persons with MS. However, there were differences in individual performance that may warrant consideration when prescribing AFOs. Therefore, clinicians should consider using appropriate standardized assessment tools that measure various aspects of gait, balance, and mobility when evaluating individual responses to AFOs.
Myoelectric Elbow-Wrist-Hand Orthosis for an Adolescent with Hemiparesis: A Case Report
Authors: Constantino Christopher , May Elizabeth , Flanagan Ann , Altiok Haluk , Harris Gerald 
Published: September 2020

ABSTRACT

Introduction
Robot-assisted therapy is an innovative approach to upper-limb rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning. An example of upper-limb robot-assisted therapy is the myoelectric orthosis MyoPro (Myomo Inc, Cambridge, USA). It is a custom-fabricated myoelectric elbow-wrist-hand orthosis (MEWHO) with built-in surface sensors that detect the user's electromyographic (EMG) signals during muscle contraction. Studies on the MEWHO have focused mostly on elderly chronic stroke patients. None have discussed its use on the adolescent population and the considerations they face in wearing the orthosis.

Case Presentation
A 15-year-old male 10th grade student with a diagnosis of right spastic hemiplegia secondary to cerebral palsy was prescribed a MEWHO because of muscle weakness of his right upper extremity, decreased functional status, and fine motor skills deficits.

Results
After two occupational therapy cycles, the patient demonstrated improvements in functional strength and performance of physical activities. Despite these improvements, the patient only used the MEWHO during therapy and was less engaged with its use at home and school.

Discussion
This case report presents insights on why the patient was not as proficient and interested in using the orthosis at home and school. Recommendations to address these issues include peer modeling, community outings, early intervention, and the use of family-centered approaches. Future studies are also suggested to further understand MEWHO use and the considerations for successful orthotic management in this group of patients.
Suicide Clusters Among Top 10 High-Risk Occupations
Authors: Too Lay San , Spittal Matthew J. 
Published: September 2020

AbstractA number of studies have demonstrated elevated risk of suicide in certain occupational groups. We seek to understand a possible new risk factor: suicide contagion, as demonstrated through a suicide cluster analysis. National-level coronial data and census population data were used for the study. We calculated suicide rates to identify “risky” occupations. SaTScan v9.4.1 was used to perform Poisson discrete scan statistic. Suicides occurring in arts and media professionals, construction, manufacturing, and skilled animal and horticultural workers seemed to cluster in time and/or space. Those working in construction settings were at risk of being in both time and space clusters.
Pseudocarcinomatous Squamous Hyperplasia Involving Bone
Authors: Spasić Smiljana , Kryvenko Oleksandr N. , Kerr Darcy A. , Nielsen Gunnlaugur P. , Gomez-Fernandez Carmen , Rosenberg Andrew E. 
Published: September 2020

Background:
Pseudocarcinomatous squamous hyperplasia (PSH) within the bone is uncommon and closely mimics well-differentiated squamous cell carcinoma (SCC). It arises from cutaneous or mucosal surfaces and grows directly into the bone. This study analyzes a large series of PSH and discusses the clinicopathologic features that facilitate its distinction from SCC.

Design:
Cases were identified from the surgical pathology files between 1985 and 2020.

Results:
The 31 cases included 21 males, 9 females, 1 unknown sex; who were 20 to 87 years old (average: 59 y). Sites included mandible—17, maxilla—5, toes—4, and 1 case from finger, femur, tibia, ischium, and unknown. Fourteen patients had a history of SCC, 13 treated with resection and chemoradiation and developed infected osteoradionecrosis, 4—medication-related osteonecrosis, 3—peripheral vascular disease, and diabetes mellitus, 3—trauma, 3—osteomyelitis, 3—unknown, and 1—hematologic malignancy. All cases exhibited severe osteomyelitis and nests of reactive keratinizing squamous epithelium that matured towards the bone surface, lacked significant atypia, or mitotic activity but permeated the medullary cavity. Patients with previous SCC developed PSH after 2 months to 8 years (average: 4 y). Nineteen of 30 patients had follow-up (2 to 48 mo, average: 17 mo); 6 patients experienced repeated debridements over 2 months to 1 year; no patient developed SCC.

Conclusions:
PSH involving bone is infrequent, complicates severe osteomyelitis, and is often therapy related. The clinical findings are usually not concerning for malignancy, however, the histologic findings are an important diagnostic pitfall because they mimic SCC.
Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study
Authors: Eiding Helge , Røise Olav , Kongsgaard Ulf E. 
Published: September 2020

Objectives
The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated.

Methods
Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital’s electronic incident reporting system. One year later, the hospital’s reporting system was scrutinized to determine the number of incidents actually reported.

Results
A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital’s electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents.

Conclusions
This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital’s electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients.
Immunological and virological efficacy of different antiretroviral regimens initiated during acute/recent HIV infection
Authors: Ambrosioni Juan , Farrera Júlia , de Lazzari Elisa , Nicolás David , Manzardo Christian , Hernández-Meneses Marta M. , Mosquera María M. , Ligero Carmen , Marcos María A. , Sánchez-Palomino Sonsoles , Fernández Emma , Plana Montserrat , Miró José M. 
Published: September 2020

Objectives:
Antiretroviral treatment (ART) during acute/recent HIV infection decreases transmission and optimizes immune recovery but the optimal ART-regimen in this setting is unknown. The objectives were to analyze the virological efficacy, immunological reconstitution and tolerability of different ART-regimens at 3 years after starting ART during acute/recent HIV infection.

Design:
Retrospective cohort study of consecutive acutely/recently infected patients who started ART within 6 months postinfection.

Methods:
We compared regimens based on protease-inhibitors (N = 28), integrase-strand-transfer-inhibitors (InSTI, N = 87) and nonnucleoside-reverse-transcriptase-inhibitors (N = 22). Virological suppression (viral load <50 copies/ml), immune reconstitution (CD4+ T-cell count >900 cells/μl and CD4+/CD8+ ratio >1) and adverse events leading to ART discontinuation at 1 and 3 years were compared.

Results:
Baseline characteristics were comparable among groups. Overall viral suppression at 1 (96%) and 3 years (99%) was comparable in all ART regimens and, InSTI group, comparable for dolutegravir and elvitegravir within InSTIs. CD4+ T-cell counts at 1 year were comparable in all ART regimens. Overall proportion of patients reaching CD4+ cell count more than 900 cells/μl and CD4+/CD8+ ratio more than 1 was 36% and 40% and 46% and 63% at 1 and 3 years, respectively with no differences among ART regimens. Starting ART during the earliest Fiebig stages (I–V vs. VI) was associated with higher rates of CD4+ cell count more than 900 cells/μl at 3 years (P = 0.027). Discontinuation due to adverse events was more frequent with nonnucleoside-reverse-transcriptase-inhibitors compared with other ART classes.

Conclusion:
Viral suppression and immunological recovery were excellent, with no differences between ART regimens. Earlier ART initiation was associated with a higher proportion of long-term immunological recovery.
Development and Implementation of Augmented Reality Enhanced High-Fidelity Simulation for Recognition of Patient Decompensation
Authors: Zackoff Matthew W. , Cruse Bradley , Sahay Rashmi D. , Fei Lin , Saupe Jennifer , Schwartz Jerome , Klein Melissa , Geis Gary L. , Tegtmeyer Ken 
Published: September 2020

Introduction
Simulation is a core aspect of training and assessment; however, simulation laboratories are limited in their ability to visually represent mental, respiratory, and perfusion status. Augmented reality (AR) represents a potential adjunct to address this gap.

Methods
A prospective, observational pilot of interprofessional simulation assessing a decompensating patient was conducted from April to June 2019. Teams completed 2 simulations: (1) traditional training (TT) using a manikin (Laerdal SimJunior) and (2) AR-enhanced training (ART) using a manikin plus an AR patient. The primary outcome was self-assessed effectiveness at the assessment of patient decompensation. Secondary outcomes were attitudes toward and adverse effects during the AR training.

Results
Twenty-one simulation sessions included 84 participants in headsets. Participants reported improved ability to assess the patient's mental status, respiratory status, and perfusion status (all P < 0.0001) during ART in comparison to TT. Similar findings were noted for recognition of hypoxemia, shock, apnea, and decompensation (all P ≤ 0.0003) but not for recognition of cardiac arrest (P = 0.06). Most participants agreed or strongly agreed that ART accurately depicted a decompensating patient (89%), reinforced key components of the patient assessment (88%), and will impact how they care for patients (68%). Augmented reality–enhanced training was rated more effective than manikin training and standardized patients and equally as effective as bedside teaching.

Conclusions
This novel application of AR to enhance the realism of manikin simulation demonstrated improvement in self-assessed recognition of patient decompensation. Augmented reality may represent a viable modality for increasing the clinical impact of training.
A Simulation-Based Failure Mode Analysis of SARS-CoV-2 Infection Control and Prevention in Emergency Departments
Authors: Balmaks Reinis , Grāmatniece Alise , Vilde Aija , Ļuļļa Mārtiņš , Dumpis Uga , Gross Isabel Theresia , Šlēziņa Ieva 
Published: September 2020

Background
Severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19)] outbreak has been declared a global pandemic by the World Health Organization. The COVID-19 pandemic has highlighted problems of sustainable infection prevention and control measures worldwide, particularly the emerging issues with an insufficient supply of personal protective equipment. The aim of this study was to provide an action plan for mitigation of occupational hazards and nosocomial spread of SARS-CoV-2 through a failure mode analysis based on observations during in situ simulations.

Methods
A multicenter, cross-sectional, observational, simulation-based study was performed in Latvia from March 2 to 26, 2020. This study was conducted at 7 hospitals affiliated with Riga Stradiņš University. The presentation of a COVID-19 patient was simulated with an in situ simulations, followed by a structured debrief. Healthcare Failure Modes and Effects Analysis is a tool for conducting a systematic, proactive analysis of a process in which harm may occur. We used Healthcare Failure Modes and Effects Analysis to analyze performance gaps and systemic issues.

Results
A total of 67 healthcare workers from 7 hospitals participated in the study (range = 4–17). A total of 32 observed failure modes were rated using a risk matrix. Twenty-seven failure modes (84.4%) were classified as either medium or high risk or were single-point weaknesses, hence evaluated for action type and action; 11 (40.7%) were related to organizational, 11 (40.7%) to individual, and 5 (18.5%) to environmental factors.

Conclusions
Simulation-based failure mode analysis helped us identify the risks related to the preparedness of the healthcare workers and emergency departments for the COVID-19 pandemic in Latvia. We believe that this approach can be implemented to assess and maintain readiness for the outbreaks of emerging infectious diseases in the future.