bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pattern of Female Genital Mutilation among Adolescents Attending Secondary Schools’ in Enugu Metropolis
Authors: Chinawa Awoere T , Chinawa Josephat M , Ossai Edmund N , Aronu Ann E , Ozokoli Godwin E , Enebe Joseph 
Published: October 2020

Abstract

Background
Female genital mutilation (FGM) is a public health menace and it study among adolescents is not exhaustive.

Objectives
The aim is to study the prevalence, pattern, cultural values, health implications and consequences of FGM among adolescent females attending secondary schools in Enugu metropolis.

Methods
A descriptive study involving female adolescents aged 13–21 years recruited by multistage sampling in three Girls Secondary Schools in Enugu Metropolis.

Results
Four hundred and fifty (450) questionnaires were distributed and four hundred and fourteen (414) were retrieved. The parents with moderate value for culture and tradition had the highest circumcised respondents (7.8%) (p = 0.056). Majority of the respondents, 93.7% were aware of female circumcision. The major complications of female circumcision according to the respondents were painful urination and menstrual problems. The prevalence of female circumcision among the respondents was 9.4%. A minor proportion of the respondents, 5.8% were of the opinion that all females should be circumcised. Respondents whose fathers attained tertiary education were three times less likely to be circumcised when compared with those whose fathers attained secondary education and less (adjusted odds ratio  = 0.3; 95% CI: 0.3–1.5).

Conclusion
Prevalence of FGM among adolescents aged 13–21 years in Enugu metropolis was 9.4%. Majority of the respondents had good knowledge of FGM, and major complications noted were painful urination and menstrual problems. Fathers education level is a very strong reason for this high awareness of FGM among female adolescents.
Supination Adduction Ankle Fractures Are Associated With Arthritis and Poor Outcomes
Authors: Benedick Alex , Kavanagh Michael , Audet Megan , Simske Natasha M. , Vallier Heather A. 
Published: October 2020

Objective:
To compare complications and functional outcomes between supination adduction type II (SAD) injuries and torsional ankle injuries (TAI).

Design:
Retrospective cohort.

Setting:
Level 1 trauma center.

Patients and Methods:
Patients (n = 1531) treated for ankle fractures (OTA/AO 43B or 44) over 16 years were identified. The most recent 200 consecutive adult patients treated for TAI (OTA/AO 44, not SAD) served as controls.

Main Outcome Measures:
Complications, unplanned secondary procedures, and patient-reported functional outcome scores, as measured by the Foot Function Index and Short Musculoskeletal Function Assessment.

Results:
Sixty-five patients with SAD injuries (4.2%) were included. They were younger (43.2 vs. 47.7 years, P = 0.08) and more commonly involved in a motorized collision, (58.5% vs. 29.0%) and more often multiply injured: other orthopaedic injuries (66.2% vs. 31.0%) and other nonorthopaedic injuries (40.0% vs. 7.5%, all P < 0.001 vs. TAI). Overall complication and unplanned secondary procedure rates were not different between groups. Those with a SAD injury had more posttraumatic arthrosis (80.0% vs. 40.9%, P = 0.004), but no differences were noted in infection, wound healing, malunion, or nonunion. The mean functional outcome scores were worse for SAD patients over 6 years after injury among all the Foot Function Index and Short Musculoskeletal Function Assessment categories; however, these differences were not significant.

Conclusions:
SAD injuries represented 4.2% of all ankle fractures, occurring in younger patients through higher-energy mechanisms and more often associated with polytrauma. Despite 80% of SAD patients developing posttraumatic arthrosis, secondary procedures were not more common, and functional outcomes after a SAD injury were not different from TAI.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sleep Variables as Predictors of Treatment Effectiveness and Side Effects of Stimulant Medication in Newly Diagnosed Children with Attention-Deficit/Hyperactivity Disorder
Authors: Davidson Fiona , Rigney Gabrielle , Rusak Benjamin , Chambers Christine , Rajda Malgorzata , Corkum Penny 
Published: October 2020

ABSTRACT:

Objective:
There is a growing body of research on the impact of stimulant medication on sleep in children with attention-deficit/hyperactivity disorder (ADHD). Negative sleep side effects are a common reason for nonadherence or for discontinuing a course of treatment. However, there is no published evidence as to whether pretreatment sleep can predict responses to treatment and the emergence of side effects.

Method:
In this study, baseline sleep variables were used to predict therapeutic effect (i.e., reduction of ADHD symptoms) and side effects (both sleep and global side effects) in a sample of newly diagnosed, medication-naive children (n = 50).

Results:
The results of hierarchical regression analysis showed that parent-reported shorter sleep duration before medication treatment significantly predicted better response to treatment, independent of pretreatment ADHD symptoms. Baseline sleep features did not significantly predict global (nonsleep) side effects but did predict increased sleep side effects during treatment.

Conclusion:
These results indicate that baseline sleep variables may be helpful in predicting therapeutic response to medication and sleep disturbance as a side effect of stimulant medication.
Innovations in targeted therapies for triple negative breast cancer
Authors: McCann Kelly E. , Hurvitz Sara A. 
Published: October 2020

Purpose of review
Triple negative breast cancer (TNBC) is defined by a lack of targets, namely hormone receptor (HR) expression and human epidermal growth factor receptor 2 amplification. Cytotoxic chemotherapy remains the mainstay of treatment. Though TNBC constitutes approximately 10–15% of breast cancer, it is disproportionally lethal, but it is hoped that outcomes will improve as targetable oncogenic drivers are identified.

Recent findings
Translational work in TNBC has focused on subsets defined by defects in homologous recombination repair, immune cell infiltration, or programmed death ligand receptor 1 expression, an over-active phosphoinositide-3 kinase pathway, or expression of androgen receptors. Though not specific to TNBC, the novel cell surface antigen trophoblast antigen 2 has also been identified and successfully targeted. This work has led to Food and Drug Administration approvals for small molecule poly-ADP-ribosyl polymerase inhibitors in patients with deleterious germline mutations in BRCA1 or BRCA2, the combination of nab-paclitaxel with immune checkpoint inhibitor antibodies in the first-line metastatic setting for programmed death ligand receptor 1+ TNBC, and use of the antibody–drug conjugate sacituzumab govitecan in the later-line metastatic setting.

Summary
Identification of targetable oncogenic drivers in TNBC is an area of intense cancer biology research, hopefully translating to new therapies and improved outcomes.
The severity of vasomotor symptoms and number of menopausal symptoms in postmenopausal women and select clinical health outcomes in the Women's Health Initiative Calcium and Vitamin D randomized clinical trial
Authors: Nudy Matthew , Jiang Xuezhi , Aragaki Aaron K. , Manson JoAnn E. , Shadyab Aladdin H. , Foy Andrew J. , Buerger Jonathan , Kelsey Anita M. , LeBlanc Erin S. , Wild Robert A. , Wactawski-Wende Jean , Stefanick Marcia L. , Robbins John A. , Schnatz Peter F. 
Published: October 2020

Abstract

Objective:
This study evaluated whether vasomotor symptom (VMS) severity and number of moderate/severe menopausal symptoms (nMS) were associated with health outcomes, and whether calcium and vitamin D (CaD) modified the risks.

Methods:
The Women's Health Initiative CaD study was a double blind, randomized, placebo-controlled trial, which tested 400 IU of 25-hydroxyvitamin-D and 1,000 mg of calcium per day in women aged 50 to 79 years. This study included 20,050 women (median follow-up of 7 y). The outcomes included hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease, stroke, cardiovascular death, and total cardiovascular disease (CVD). MS included: hot flashes, night sweats, dizziness, heart racing, tremors, feeling restless, feeling tired, difficulty concentrating, forgetfulness, mood swings, vaginal dryness, breast tenderness, migraine, and waking up several times at night. Associations between VMS severity and nMS with outcomes were tested.

Results:
No association between VMS severity and any outcome were found. In contrast, nMS was associated with higher stroke (hazard ratio [HR] 1.40 95% confidence interval [CI] 1.04-1.89 for ≥ 2 MS vs none; HR 1.20 95% CI 0.89-1.63 for 1 MS vs none, P trend = 0.03) and total CVD (HR 1.35, 95% CI, 1.18-1.54 for ≥ 2 MS vs none; HR 0.99, 95% CI, 0.87-1.14 for 1 MS vs none P trend < 0.001). CaD did not modify any association.

Conclusion:
Severity of VMS was not associated with any outcome. Having ≥2 moderate or severe MS was associated with an increased risk for CVD. The number of moderate/severe MS may be a marker for higher CVD risk.

Video Summary:

http://links.lww.com/MENO/A669.
COMPARING VITRECTOMY, SILICONE OIL ENDOTAMPONADE WITH/WITHOUT CYCLOPEXY TO TREAT CYCLODIALYSIS CLEFTS WITH SEVERE OCULAR TRAUMA
Authors: Wang Anan , Zhao Zhenquan 
Published: October 2020

Purpose:
Comparing the anatomical and functional outcomes of vitrectomy, silicone oil endotamponade without cyclopexy (VEWOC) and with cyclopexy (VEWC) in patients with traumatic cyclodialysis clefts and severe ocular comorbidities.

Methods:
A total of 55 patients (55 eyes) with traumatic cyclodialysis clefts were divided into VEWOC and VEWC groups according to the surgery undergone. Besides the cyclodialysis clefts, all study eyes had one or more additional conditions caused by severe ocular trauma: cataract, lens dislocation, vitreous hemorrhage, retinal detachment, choroidal detachment, maculopathy, suprachoroidal hemorrhage, subretinal hemorrhage, or proliferative vitreoretinopathy. The minimum postoperative follow-up period for all patients was six months. The main measures of outcome were rate of successful anatomical repair, intraocular pressure, and best-corrected visual acuity.

Results:
Both the VEWOC group (33 eyes) and the VEWC group (22 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure at the final follow-up. The groups had no significant differences in terms of anatomical success rates (VEWOC 29/33 vs. VEWC 20/22, P = 1.000), final best-corrected visual acuity (VEWOC 1.60 ± 0.76 [median Snellen acuity: counting fingers, range: light perception to 20/20] vs. VEWC 1.46 ± 0.66 [median Snellen acuity: 20/800, range: light perception to 20/32], P = 0.485), and final intraocular pressure (VEWOC 13.40 [8.20–17.80] vs. VEWC 11.40 [6.65–14.00] mmHg, P = 0.311). However, the intraocular pressure on postoperative Day 1 was significantly different between the groups (VEWOC 10.40 [6.40–14.60] vs. VEWC 6.40 [4.70–7.98] mmHg, P = 0.002).

Conclusion:
This study showed that both surgical approaches were equally effective in treating cyclodialysis clefts secondary to severe ocular trauma. Therefore, it may be unnecessary to perform cyclopexy in addition to the vitrectomy procedure in such cases.
Calcium imaging in population of dorsal root ganglion neurons unravels novel mechanisms of visceral pain sensitization and referred somatic hypersensitivity
Authors: Gao Xinyan , Han Shu , Huang Qian , He Shao‐Qiu , Ford Neil C. , Zheng Qin , Chen Zhiyong , Yu Shaoyong , Dong Xinzhong , Guan Yun 
Published: October 2020

Abstract
Mechanisms of visceral pain sensitization and referred somatic hypersensitivity remain unclear. We conducted calcium imaging in Pirt-GCaMP6s mice to gauge responses of dorsal root ganglion (DRG) neurons to visceral and somatic stimulation in vivo. Intracolonic instillation of 2,4,6-trinitrobenzene sulfonic acid (TNBS) induced colonic inflammation and increased the percentage of L6 DRG neurons that responded to colorectal distension above that of controls at day 7. Colorectal distension did not activate L4 DRG neurons. TNBS-treated mice exhibited more Evans blue extravasation than did control mice and developed mechanical hypersensitivity in low-back skin and hind paws, which are innervated by L6 and L4 DRG neurons, respectively, suggesting that colonic inflammation induced mechanical hypersensitivity in both homosegmental and heterosegmental somatic regions. Importantly, the percentage of L4 DRG neurons activated by hind paw pinch and brush stimulation and calcium responses of L6 DRG neurons to low-back brush stimulation were higher at day 7 after TNBS than those in control mice. Visceral irritation from intracolonic capsaicin instillation also increased Evans blue extravasation in hind paws and low-back skin and acutely increased the percentage of L4 DRG neurons responding to hind paw pinch and the response of L6 DRG neurons to low-back brush stimulation. These findings suggest that TNBS-induced colitis and capsaicin-induced visceral irritation may sensitize L6 DRG neurons to colorectal and somatic inputs and also increase the excitability of L4 DRG neurons that do not receive colorectal inputs. These changes may represent a potential peripheral neuronal mechanism for visceral pain sensitization and referred somatic hypersensitivity.
The Parkinson disease pain classification system: results from an international mechanism-based classification approach
Authors: Mylius Veit , Perez Lloret Santiago , Cury Rubens G. , Teixeira Manoel J. , Barbosa Victor R. , Barbosa Egberto R. , Moreira Larissa I. , Listik Clarice , Fernandes Ana M. , de Lacerda Veiga Diogo , Barbour Julio , Hollenstein Nathalie , Oechsner Matthias , Walch Julia , Brugger Florian , Hägele-Link Stefan , Beer Serafin , Rizos Alexandra , Chaudhuri Kallol Ray , Bouhassira Didier , Lefaucheur Jean-Pascal , Timmermann Lars , Gonzenbach Roman , Kägi Georg , Möller Jens Carsten , Ciampi de Andrade Daniel 
Published: October 2020

Abstract
Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.
Photophobia in complex regional pain syndrome: visual discomfort is greater on the affected than unaffected side
Authors: Drummond Peter D. , Finch Philip M. 
Published: October 2020

Abstract
In complex regional pain syndrome (CRPS), hyperalgesia encompasses uninjured sites on the ipsilateral side of the body and may also include the special senses because auditory discomfort often is greater on the CRPS-affected side. To determine whether this hemilateral hyperalgesia involves the visual system, the discomfort threshold to a light-source that increased in intensity at 100 lux/second from 500 to 3600 lux was investigated for each eye, and the nasal and temporal half of each visual field, in 33 patients with CRPS and 21 pain-free controls. Recent headache history was reviewed and, in patients with CRPS, sensitivity to mechanical and thermal stimuli was assessed in all 4 limbs and on each side of the forehead. In addition, the pupils were photographed in dim and bright light. The visual discomfort threshold was lower in patients than controls and was lower on the CRPS-affected than unaffected side (P < 0.001), indicating photophobia. Visual discomfort was unrelated to pupil diameter. Headache frequency was greater in CRPS patients than controls, and unilateral headaches were more likely to be on the CRPS-affected than contralateral side. Similarly, mechanical and thermal hyperalgesia was greater in the CRPS-affected than contralateral limb and was greater ipsilateral than contralateral to CRPS in the forehead and nonsymptomatic limbs. Ipsilateral photophobia was associated with mechanical and thermal hyperalgesia in the ipsilateral forehead but not the CRPS-affected limb. Together, these findings suggest that aberrant processing of nociceptive input in the ipsilateral trigeminal-medullary region of the brainstem contributes to visual discomfort in CRPS.
Promoting a Culture of Civility in Nursing Learning Environments
Authors: Ackerman-Barger Kupiri , Dickinson Jane K. , Martin Louisa D. 
Published: October 2020

Background
Incivility in nursing education imperils the well-being of both faculty and students, is damaging to professional relationships, and hinders the exchange of knowledge in nursing learning environments. Because supportive, respectful learning environments foster students' ability to flourish and reach their highest potential, it is essential that open dialogue and relationship building in nursing education are as valued as content taught.

Purpose
This study explored strategies for promoting a culture of civility in nursing learning environments.

Method
A 9-item survey was used to gather insights from nurses (n = 441) about how incivility could be managed or prevented in order to promote a culture of civility.

Results
The data revealed 2 major themes: personal action, and organization action.

Conclusion
Nursing faculty, students, and schools/programs can promote civility in nursing learning environments through establishing a power balance, effective communication, self-reflection, setting clear expectations early, and instituting consequences for violating a culture of civility.
Using Debriefing for Meaningful Learning With Screen-Based Simulation
Authors: Dreifuerst Kristina T. , Bradley Cynthia S. , Johnson Brandon K. 
Published: October 2020

Background
COVID-19 has led to increased use of screen-based simulation. However, the importance of including a robust debriefing as a component of these simulations is often neglected.

Problem
Failing to include debriefing with screen-based simulation could negatively impact student learning outcomes.

Approach
Debriefing, including recollection, discussion to reveal understanding, feedback and reflection, is a process of helping learners make sense of learned content and knowledge as it is applied to the patient care experience. Debriefing for Meaningful Learning (DML) is an evidence-based method derived from theory, which can be easily incorporated into screen-based simulation to augment the clinical learning experience.

Conclusion
By guiding learners to consistently engage in DML, clinical decisions and actions taken during virtual simulations can be uncovered, discussed, challenged, corrected, and explored. Including a synchronous, structured debriefing like DML ensures that screen-based simulation results in meaningful learning in addition to performance feedback to foster safe and quality patient care.
Institutional differences in management of compartment syndrome at academic and community-based trauma centers: A survey of Orthopaedic Trauma Association (OTA) members
Authors: Klima Matthew 
Published: October 2020

Abstract

Objectives:
The purpose of this study was to compare management of compartment syndrome at academic and community trauma centers and to identify any institutional variables that influence the number of adverse events reported to the hospital's peer review process.

Design:
Web-based survey.

Setting:
N/A.

Participants:
Orthopedic Trauma Association (OTA) members.

Methods:
A link to a 9-item web-based questionnaire was sent to members of the OTA.

Results:
Two hundred twenty-four (21%) of 1031 OTA members completed the survey. Respondents indicated that residents were primarily responsible for checking compartments at academic trauma centers (91%), while community trauma centers reported higher utilization rates of ortho attendings (81%), trauma attendings (26%), and nurses (27%). Seventy-five percent of respondents at academic trauma centers relied on intra-compartmental pressure monitoring to make the diagnosis in intubated/obtunded patients as opposed to just 56% of respondents at community centers. Seventy percent of all respondents utilizing prophylactic fasciotomies practiced at community trauma centers. Forty-four percent indicated that they had submitted cases involving management of compartment syndrome to their hospital peer review process. While most submitted only 1 or 2 cases (75% of positive replies), 5% had submitted 5 or more cases for peer review. Use of a pressure monitor and orthopaedic surgeons performing all fasciotomies were associated with a lower number of cases submitted to peer review (P < .02 and P < .04, respectively).

Conclusion:
Academic and community trauma centers differ in their utilization of in-house staff for early assessment, in the diagnostic modalities employed in obtunded patients, and in their threshold for fasciotomy. Adverse events are regularly reported for peer review at both academic and community trauma centers. As there is great variability between institutions in terms of clinical practice as demonstrated by the responses to this survey, it is recommended that institutions devise their own written protocol based on the resources they have available to reduce adverse events.

Level of Evidence:
Therapeutic Level V.