bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Stakeholders’ Perspectives on Introducing Human Papillomavirus Vaccination and Biobanking Evidence-Based Programs Within Medically Underserved Communities: A Community-Engaged Approach
Authors: Galbraith-Gyan Kayoll V. , Ramanadhan Shoba , Viswanath Kasisomayajula 
Published: July 2020

Purpose We explored the perspectives of program coordinators and community leaders from Community-based-organizations (CBOs) and Faith-based-organizations (FBOs) to determine how information on human papillomavirus (HPV) vaccination and biobanking is understood and supported within medically underserved communities, and identified strategies for introducing evidence-based programs (EBP) on HPV vaccination and biobanking within underserved communities. Methods The EPIS framework guided discussions in four focus groups with program coordinators ( n = 27) and one-on-one interviews with community leaders ( n = 15) from CBOs and FBOs. Results Participants reported that community members were aware of HPV vaccination but did not know of the link between HPV infection and cancers. Awareness for biobanking was low. HPV vaccination and biobanking were not priority health concerns among community members due to other health issues. However, HPV vaccination and biobanking were considered sensitive health topics. For HPV vaccination, sensitivity was due to concerns that HPV vaccination promoted sex among adolescents, while for biobanking, sensitivity was due to historical abuses of people of color by the medical community. Participants reported that program coordinators’ awareness of HPV vaccination and biobanking depended on their organizations’ mission. Neither were considered a priority health concern due to lack of funding. Few EBP were available on HPV vaccination and biobanking. Recommendations on culturally-appropriate strategies for engaging community members on HPV vaccination and biobanking EBP are discussed. Conclusion Given the promise of HPV vaccination and the Precision Medicine Initiative to reduce cancer disparities, findings elucidate factors to be considered when implementing EBP on HPV vaccination and biobanking into medically underserved communities.
Challenges to Federalism and Intergovernmental Relations and Takeaways Amid the COVID-19 Experience
Authors: Benton J. Edwin 
Published: July 2020

The American democratic system of government is being put to its greatest test since the Great Depression of the 1920s and 1930s, as the country endeavors to cope with the fallout from the COVID-19 pandemic. That is, considerable pressure continues to build up at the fault lines of governance inherent in the country’s unique federal form of government which explicitly and implicitly expects national, state, and local levels to work together while they also may function as separate, autonomous entities to promote and provide for the general welfare. These fault lines exist where governance and service provision matters necessitate the collective attention and action of two or more levels of government. Both cooperation and conflict are possible interactive outcomes in these situations. This article provides an early assessment of how national, state, and local governments have worked together since the onset of the COVID-19 pandemic and subsequently a “report card” of sorts on the functioning of intergovernmental relations in the U.S. at the present time. More specifically, the article will examine the current condition of interstate, interlocal, state-local, and national-state relations. While the findings and observations reported here are certainly enlightening, they should be viewed as preliminary. Followed up research should be conducted to determine if there have been any policy learning has occurred and if such information has been used in improve the quality of governance in keeping with citizen expectations of American federalism.
The diagnostic value of postcontrast susceptibility-weighted imaging in the assessment of intracranial brain neoplasm at 3T
Authors: Kang Hyunkoo , Jang Sungwon 
Published: July 2020

Background Susceptibility-weighted imaging (SWI) is occasionally performed with intravenous gadolinium (Gd). It was reported that SWI can be performed after Gd injection without information loss or signal change. Purpose To investigate the diagnostic value of contrast-enhanced SWI (CE-SWI) in the assessment of intracranial brain neoplasm. Material and Methods After obtaining the approval of the local ethics committee, 35 brain neoplasm patients (24 with metastasis and 11 with glioblastoma multiforme [GBM]) were enrolled. In order to investigate the value of using CE-SWI, two neuroradiologists performed an evaluation of the frequency of the intratumoral susceptibility signals (ITSS) in SWI and CE-SWI with visual assessment using 5-grade scales. We evaluated the visibility of the tumor margins and the internal architecture of tumors on T1-weighted imaging (T1WI), contrast-enhanced T1 (CE-T1), SWI, and CE-SWI. Results The contrast-enhanced scans (CE-T1 and CE-SWI) showed statistically significant higher scores compared to non-enhanced scans (T1WI and SWI) for the analysis of the tumor margin in GBM and metastasis ( P < 0.05, Wilcoxon signed rank test). Statistically significant higher scores are noted in GBMs compared to metastases in the visibility of the internal architecture of tumors on CE-SWI and the visibility of the tumor margin on CE-T1 ( P < 0.05, Mann–Whitney test). Conclusion Based on our results, SWI can be performed after gadolinium injection without information loss or signal change. CE-SWI is useful in evaluating intracranial neoplasm due to its ability to simultaneously demonstrate both ITSS that are not visible with conventional magnetic resonance sequences and contrast enhancement.
Shoulder-Pacemaker Treatment Concept for Posterior Positional Functional Shoulder Instability: A Prospective Clinical Trial
Authors: Moroder Philipp , Plachel Fabian , Van-Vliet Heiko , Adamczewski Christiane , Danzinger Victor 
Published: July 2020

Background: Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful. Purpose: The shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt. Study Design: Case series; Level of evidence, 4. Methods: A negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation–based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention. Results: WOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up ( P < .001). Young age ( P = .005), low weight ( P = .019), shoulder activity level ( P = .003), unilateral affliction ( P = .046), and higher baseline WOSI score ( P = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed. Conclusion: The shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.
Care Delivery for Children With Epilepsy During the COVID-19 Pandemic: An International Survey of Clinicians
Authors: Wirrell Elaine C. , Grinspan Zachary M. , Knupp Kelly G. , Jiang Yuwu , Hammeed Biju , Mytinger John R. , Patel Anup D. , Nabbout Rima , Specchio Nicola , Cross J. Helen , Shellhaas Renée A. 
Published: July 2020

Objective: To evaluate the effect of the COVID-19 pandemic on global access to care and practice patterns for children with epilepsy. Methods: We conducted a cross-sectional, online survey of pediatric neurologists across the world affiliated with the International Child Neurology Association, the Chinese Child Neurology Society, the Child Neurology Society, and the Pediatric Epilepsy Research Consortium. Results were analyzed in relation to regional burden of COVID-19 disease. Results: From April 10 to 24, 2020, a sample of 212 respondents from 49 countries indicated that the COVID-19 pandemic has dramatically changed many aspects of pediatric epilepsy care, with 91.5% reporting changes to outpatient care, 90.6% with reduced access to electroencephalography (EEG), 37.4% with altered management of infantile spasms, 92.3% with restrictions in ketogenic diet initiation, 93.4% with closed or severely limited epilepsy monitoring units, and 91.3% with canceled or limited epilepsy surgery. Telehealth use had increased, with 24.7% seeing patients exclusively via telehealth. Changes in practice were related both to COVID-19 burden and location. Conclusions: In response to COVID-19, pediatric epilepsy programs have implemented crisis standards of care that include increased telemedicine, decreased EEG use, changes in treatments of infantile spasms, and cessation of epilepsy surgery. The long-term impact of these abrupt changes merit careful study.
Endotracheal intubation in a ramped versus supine position in the emergency department: A randomised crossover manikin study
Authors: Hung Carolyn Cheuk Lam , Wong Anthony 
Published: July 2020

Background:Performing endotracheal intubation by placing patients in a ramped position has been shown to improve the ease of intubation and to reduce complications. The above findings, however, were only established in the operation theatre and intensive care settings.Objective:In order to establish the findings in the setting of the emergency department, we attempt to compare the ramped versus supine positions in normal and difficult airway scenarios.Methods:Medical doctors practicing at a local Accident and Emergency Department were recruited into a crossover randomised study. They were asked to perform intubations on a manikin in four scenarios. The manikin was put in a ramp or supine position. In addition, the manikin settings were adjusted to normal and difficult airways.Results:A total of 39 Accident and Emergency Department doctors were recruited. There was no statistically significant difference in the first-attempt success rates using the ramped position compared to supine position in either airway scenario (100% vs. 97.4%, P = 1 in normal airway, 79.5% vs. 74.4%, P = 0.789 in difficult airway). The mean intubation time in difficult airway setting was shorter when the manikin was put into ramped position (28.3 s vs. 38.4 s, P = 0.134). The ramped position improved the glottic view in the difficult airway setting ( P = 0.017). More intubators preferred to place the manikin into a ramped position during difficult airway setting (67%, P = 0.007). Experienced male intubators performed better in normal airway scenarios, whereas Accident and Emergency Department fellows performed better in difficult airway scenarios.Conclusion:The ramped position improves glottic view and operator ease when intubating a simulated difficult airway.
The Metabolomics of Chronic Pain Conditions: A Systematic Review
Authors: Aroke Edwin N. , Powell-Roach Keesha L. 
Published: July 2020

Background: Chronic pain is a significant public health problem in the United States, affecting approximately 100 million people. Yet there is a lack of robust biomarkers for clinical use in chronic pain conditions. Downstream effects of environmental, genomic, and proteomic variations in individuals with chronic pain conditions can be identified and quantified using a metabolomic approach. Aim/Design: The purpose of this systematic review was to examine the literature for reports of potential metabolomic signatures associated with chronic pain conditions. Methods: We searched relevant electronic databases for published studies that used various metabolomic approaches to investigate chronic pain conditions among subjects of all ages. Results: Our search identified a total of 586 articles, 18 of which are included in this review. The reviewed studies used metabolomics to investigate fibromyalgia ( n = 5), osteoarthritis ( n = 4), migraine ( n = 3), musculoskeletal pain ( n = 2), and other chronic pain conditions ( n = 1/condition). Results show that several known and newly identified metabolites differ in individuals with chronic pain conditions compared to those without these conditions. These include amino acids (e.g., glutamine, serine, and phenylalanine) and intermediate products (e.g., succinate, citrate, acetylcarnitine, and N-acetylornithine) of pathways that metabolize various macromolecules. Conclusion: Though more high-quality research is needed, this review provides insights into potential biomarkers for future metabolomics studies in people with chronic pain conditions.
Factors Associated With Medication Adherence in Vascular Surgery Patients
Authors: Minami Hataka R. , Zemela Mark S. , Ring Adam C. , Williams Michael S. , Smeds Matthew R. 
Published: July 2020

Introduction: Patients with vascular disease have higher mortality rates than age-matched peers and medical management of coexisting diseases may alter these outcomes. We sought to understand factors associated with medication nonadherence in vascular surgery patients at a single University vascular surgery clinic over a 3-month period. Materials and Methods: Consecutive vascular surgery patients were surveyed from June to August 2019. The survey included demographic questions, the validated Morisky Medication Adherence Scale, the 4-item Patient Health Questionnaire for Anxiety and Depression scales, and other medication-related questions. Medical and surgical histories were retrospectively collected from charts. Univariate and multivariate analyses were used to compare among high, intermediate, and low adherence. Results: A total of 128 (74%) of 174 patients met study inclusion criteria. On univariate analysis, lower medication adherence was associated with younger age ( P = .004), anxiety and depression ( P = .001), higher daily pain ( P < .001), and patients who believed their medications were less important for treating their vascular disease ( P < .001). Adherence was not associated with symptomatic vascular disease, gender, education level, marital status, employment, insurance, or the use of medication usage reminders. Multivariate analysis significantly predicted high adherence relative to low adherence with 5-year increase in age (odds ratio [OR] = 1.252, P = .021) and low adherence relative to high adherence with greater perceived pain (OR = 0.839, P = .016). Conclusions: Younger age and high level of pain were associated with lower medication adherence. Informing patients of the importance of prescribed medication and addressing anxiety or depression symptoms may improve adherence.
The antireflux mechanism – Angiographic anatomy and clinical implications
Authors: Gailloud Philippe 
Published: July 2020

Background Early anatomists suspected that the radiculomedullary veins draining the spinal cord had valves preventing their retrograde filling with anatomical casting material. Modern investigations have discarded the presence of true valves and introduced instead the notion of a pseudo-valvular configuration for which the term antireflux mechanism was coined in the 1970s. The angiographic anatomy of the antireflux mechanism has not been well documented so far. Methods This article discusses anatomical and clinical features of the antireflux mechanism with a series of 12 angiographic observations documenting the antireflux mechanism under normal and pathological circumstances. Results The antireflux mechanism divides radiculomedullary veins into intradural and extradural segments. While the structure of the antireflux mechanism is not yet fully clarified, it includes at least a tight narrowing of the radiculomedullary vein at its point of passage through the thecal sac, which is angiographically detectable and likely protects the intradural venous system from transient or persistent surges in venous pressure (e.g. sneezing, pregnancy). This tight narrowing of the antireflux mechanism likely also represents an obstacle to normal anterograde flow, potentially leading to venous stagnation and thrombosis. Conclusions The antireflux mechanism includes at least a tight narrowing of the radiculomedullary vein, which likely influences the development and clinical expression of low-flow spinal arteriovenous fistulas and might impact the spinal venous drainage even in the absence of arteriovenous shunts.
Obesity and pituitary gland volume – a correlation study using three-dimensional magnetic resonance imaging
Authors: Fehrenbach Uli , Jadan Anas , Auer Timo A , Kreutz Katharina , Geisel Dominik , Ziagaki Athanasia , Bobbert Thomas , Wiener Edzard 
Published: July 2020

Purpose Obesity has become a major health problem and is associated with endocrine disorders and a disturbed hypothalamic-pituitary axis. The purpose of this study was to correlate pituitary gland volume determined by routine magnetic resonance imaging with patient characteristics, in particular body mass index and obesity. Material and methods A total of 144 ‘healthy’ patients with normal findings in cerebral magnetic resonance imaging were retrospectively included. Pituitary gland volume was measured in postcontrast three-dimensional T1-weighted sequences. A polygonal three-dimensional region of interest covering the whole pituitary gland was assessed manually. Physical characteristics (gender, age, body height and body mass index) were correlated with pituitary gland volume. Multiple subgroup and regression analyses were performed. Results Pituitary gland volumes were significantly larger in females than in males ( p<0.001) and young individuals (<35 years) versus middle-aged patients (35–47 years) ( p=0.042). Obese patients (body mass index ≥30) had significantly larger pituitary gland volumes than overweight (25<body mass index<30; p=0.011) and normal-weight (body mass index <25; p=0.005) patients. In males, pituitary gland volumes of body mass index subgroups showed significant differences ( p=0.038). Obese males had larger pituitary gland volumes than overweight patients ( p=0.066) and significantly larger volumes than normal-weight ( p=0.023) patients. Obese females also had larger pituitary gland volumes but without statistical significance ( p>0.05). Regression analysis showed that increased pituitary gland volume is associated with higher body mass index independent from gender, age and body height. Conclusion Pituitary gland volume is increased in obese individuals and a high body mass index can be seen as an independent predictor of increased pituitary gland volume. Therefore, gland enlargement might be an imaging indicator of dysfunction in the hypothalamus-pituitary axis. Besides gender and age, body mass index should be considered by radiologists when diagnosing abnormal changes in pituitary gland volume.
The new simplified MARIA score applies beyond clinical trials: A suitable clinical practice tool for Crohn’s disease that parallels a simple endoscopic index and fecal calprotectin
Authors: Roseira Joana , Ventosa Ana Rita , de Sousa Helena Tavares , Brito Jorge 
Published: July 2020

BackgroundA simplified magnetic resonance enterography (MRe) index (sMARIA) for Crohn’s disease (CD) was recently developed and validated.ObjectiveOur aims were (a) to assess sMARIA’s accuracy in a sample other than the validation cohort; (b) to evaluate its correlation with a simpler endoscopy index (SES‐CD) and fecal calprotectin (FC); and (c) to assess the need of an expert radiologist to reliably use sMARIA.MethodsPatients with CD who underwent MRe, ileocolonoscopy and FC within 2–4 weeks had their MRe retrospectively reviewed by two blinded raters. Disease activity was evaluated through sMARIA, SES‐CD and FC. sMARIA’s accuracy, indices correlation, and interrater reliability were assessed.ResultsIn total, 84 patients were included, comprising 420 intestinal segments evaluations. sMARIA ≥1 accurately identified segments with active disease (90% sensitivity, 98% specificity; area under the curve 0.94, 95% confidence interval (CI) 0.91–0.97; p  < 0.01). sMARIA correlated with endoscopy, both for ileal and colonic segments (R = 0.94 and R = 0.82; p  < 0.01). Per patient, there was a strong correlation between sMARIA, endoscopy (R = 0.95; p  < 0.01) and FC (R = 0.91; p  < 0.01). Interrater agreement was excellent (intraclass correlation coefficient 0.95; 95% CI 0.94–0.96; p  < 0.01).ConclusionsMARIA accurately measured CD activity using SES‐CD as standard of reference, and exhibited high correlation with a simple endoscopic index and a biomarker. The interrater reliability between a radiology resident and an expert was excellent.
Prevalence of groin pain in unicycle athletes: A nationwide questionnaire survey
Authors: Kobayashi Daigo , Kobayashi Naomi , Oishi Takayuki , Choe Hyonmin , Tezuka Taro , Higashihira Shota , Inaba Yutaka 
Published: July 2020

Background and purpose: This nationwide questionnaire survey was performed to clarify the prevalence of groin pain in unicycle athletes and to reveal the relationship between groin pain and factors such as age or athletic career. Patients and methods: To evaluate the prevalence of groin pain, the questionnaire was sent to 1304 unicyclists belonging to the Japan Unicycle Association. All subjects aged 6 years or older at the time they answered the questionnaire. Results: Overall, 17% of unicyclists complained of groin pain. Pain was more common in those aged 13–19 years and in those with a career lasting more than 6 years. Conclusion: The incidence of groin pain (17%) among unicyclists is higher than that among athletes participating in other sports. Unicyclists aged between 13 and 19 years old and those with an athletic career of more than 6 years often suffer from groin pain.