bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behavioral and psychological health inequities in income disparate perimenopausal women: a brief report
Authors: Dickins Kirsten A. , Looby Sara E. 
Published: September 2020

Abstract

Objective:
To assess differences in behavioral and psychological health characteristics in perimenopausal women delineated by income disparity.

Methods:
A hypothesis generating secondary data analysis was conducted in 33 women, using public health insurance enrollment as a proxy for income. Sociodemographic characteristics were assessed. Study outcomes included behavioral health characteristics: current cigarette smoking, substance abuse history, current exercise, obesity (BMI ≥30); psychological health characteristics, and sleep: depressed mood (Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and sleep (Insomnia Severity Index [ISI]). Group comparisons were assessed via the Student t test, Wilcoxon Rank-Sum test or Chi-square test, and multivariable models.

Results:
Forty-two percent (n = 14) were designated as income disparate, and sociodemographic characteristics were similar between groups; nearly half were Black/African American. More income disparate women reported current cigarette smoking [71% (10) vs 21%(4), P = 0.004] and substance abuse history [79%(11) vs 5%(1), P < 0.0001]. Fewer income disparate women reported current exercise [57%(8) vs 89%(17), P = 0.03] and more were obese [BMI ≥30; 50%(7) vs 11%(2), P = 0.01]. Income disparate women experienced significantly higher CES-D scores [13.5 (11.75, 23.75) vs 6 (0, 9), P < 0.0001], GAD-7 scores [5.5 (2, 8.75) vs 2 (0, 4), P = 0.04], and ISI scores [11 (5.55) vs 5 (4.36), P = 0.004].

Conclusions:
Findings from this preliminary analysis evidence inequities in behavioral, psychological, and sleep characteristics in perimenopausal women. Awareness of how the social determinants of health impact outcomes among vulnerable perimenopausal women is critical to developing equitable aging opportunities, including customized preventive health screenings and interventions that engage income disparate perimenopausal women.

Video Summary:

http://links.lww.com/MENO/A642.
Comparison of performance and health indicators between perimenopausal and postmenopausal obese women: the effect of high-intensity interval training (HIIT)
Authors: Jabbour Georges , Iancu Horia D. 
Published: September 2020

Abstract

Objective:
This study examined the effects of 6 weeks of high-intensity interval training (HIIT) on performance and health indicators in obese perimenopausal (PERIM) women and similarly aged and older postmenopausal women (POSTM1 and POSTM2, respectively).

Methods:
Sixteen PERIM women (average age 49.6 y), 21 POSTM1 women (average age 50.6 y), and 19 POSTM2 women (average age 69.6 y) completed a 6-week HIIT intervention. Anthropometric parameters, mechanical efficiency (ME in %), lipid oxidation (LO in %), and low and high spectral frequencies (LF[ms2] and HF[ms2]) were computed pre- and postintervention.

Results:
PERIM women showed a significantly higher VO2max preintervention compared to POSTM1 and 2 (P < 0.01). Moreover, HF, LF, and the LF/HF ratio differed significantly in PERIM women preintervention compared to POSTM1 and 2 (P < 0.01, respectively). After 6 weeks, a significant decrease in anthropometric variables was observed for all groups (P < 0.01). The VO2max in mL/kg/min increased for all groups (P < 0.01). Multiple linear regression analysis demonstrated that age contributed significantly to differences in VO2max values between groups preintervention (r = 0.72). This model accounted for 34% (r2 = 0.34) of the variation. On the other hand, menopause status was an independent predictor of LO, accounting for 38% of the variation, as well as of HF (33%), LF (29%), and the LF/HF ratio (24%). After HIIT, no age or menopause effect was detected for these independent variables.

Conclusions:
Maximal oxygen consumption, HF, LF, and the LF/HF ratio differ among women according to the menopausal status and age. A 6-week HIIT intervention improved many health and performance parameters and reduced the effects of menopause and age.
Pharmacologic therapy for pulmonary artery hypertension
Authors: Nair Ajith 
Published: September 2020

Purpose of review
Pulmonary arterial hypertension (PAH) is a disease that carries a significant mortality left untreated. This article aims to review pharmacotherapeutics for PAH.

Recent findings
PAH-specific therapies have evolved over the last three decades and have expanded from one therapy in the 1990s to 14 FDA-approved medications. Current therapies are directed at restoring the imbalance of vasoactive mediators that include nitric oxide, endothelin and prostacyclin. Although these agents are effective as monotherapy, recent trials have promulgated the strategy of upfront combination therapy. The availability of oral prostacyclin agonists has also allowed for expanded treatment options. Risk assessment is vital in guiding therapy for PAH patients. There is ongoing focus on targeting pathological mechanisms of the disease via novel therapies and repurposing existing drugs.

Summary
There is an array of medications available for the treatment of PAH. Prudent combination of therapies to maximize treatment effect can improve morbidity and mortality. This article reviews the data supporting these therapies and attempts to outline an approach to patient management.
Low blood pressure and adverse outcomes in acute stroke: HeadPoST study explanations
Authors: Ouyang Menglu , Muñoz-Venturelli Paula , Billot Laurent , Wang Xia , Song Lili , Arima Hisatomi , Lavados Pablo M. , Hackett Maree L. , Olavarría Verónica V. , Brunser Alejandro , Middleton Sandy , Pontes-Neto Octavio M. , Lee Tsong-Hai , Watkins Caroline L. , Robinson Thompson , Anderson Craig S. 
Published: September 2020

Objective:
As uncertainties exist over underlying causes, we aimed to define the characteristics and prognostic significance of low blood pressure (BP) early after the onset of acute stroke.

Methods:
Post hoc analyzes of the international Head Positioning in acute Stroke Trial (HeadPoST), a pragmatic cluster-crossover randomized trial of lying flat versus sitting up in stroke patients from nine countries during 2015–2016. Associations of baseline BP and death or dependency [modified Rankin scale (mRS) scores 3–6] and serious adverse events (SAEs) at 90 days were assessed in generalized linear mixed models with adjustment for multiple confounders. SBP and DBP was analysed as continuous measures fitted with a cubic spline, and as categorical measures with low (<10th percentile) and high (≥140 and ≥90 mmHg, respectively) levels compared with a normal range (≥10th percentile; 120–139 and 70–89 mmHg, respectively).

Results:
Among 11 083 patients (mean age 68 years, 39.9% women) with baseline BP values, 7.2 and 11.7% had low SBP (<120 mmHg) and DBP (<70 mmHg), respectively. Patients with low SBP were more likely to have preexisting cardiac and ischemic stroke and functional impairment, and to present earlier with more severe neurological impairment than other patients. Nonlinear ‘J-shaped’ relationships of BP and poor outcome were apparent: compared with normal SBP, those with low SBP had worse functional outcome (adjusted odds ratio 1.27, 95% confidence interval 1.02–1.58) and more SAEs, particularly cardiac events, with adjustment for potential confounders to minimize reverse causation. The findings were consistent for DBP and were stronger for ischemic rather than hemorrhagic stroke.

Conclusion:
The prognostic significance of low BP on poor outcomes in acute stroke was not explained by reverse causality from preexisting cardiovascular disease, and propensity towards greater neurological deficits and cardiac events. These findings provide support for the hypothesis that low BP exacerbates cardiac and cerebral ischemia in acute ischemic stroke.
Guidance Needed for Continued Employment of Long-term Contaminated Individuals
Authors: Paciello Lara R. , Owoc Julian J. 
Published: September 2020

Abstract
Operational practices in nuclear power utilities often restrict job assignments for workers with internal contamination due to the difficulty of monitoring for new intakes and strict radioactive material controls. However, restriction of job assignments for an extended period (i.e., months to years) may be too conservative. An industry consensus on guidance in these conditions would be helpful for Radiation Safety Officers (RSOs) to allow long term contaminated workers to have less work restrictions.
Attenuation of Gamma Radiation Using ClearView Radiation ShieldingTM in Nuclear Power Plants, Hospitals and Radiopharmacies
Authors: Bakshi Jayeesh , Chu Bae P. 
Published: September 2020

Abstract
Radiation protection materials, such as lead (Pb), water, concrete, steel, and aluminum, have been successfully used for decades. Although they are effective shields, these materials do have limitations. For example, lead is heavy and toxic, and water and concrete must be thick to provide significant shielding, all of which renders these materials prohibitive for certain applications. For example, the half-value layer for water to shield against 60Co is 30.48 cm (12”), which makes it an extremely bulky material. The development of ClearView Radiation Shielding™ addresses some of the limitations that are faced by traditional radiation protection shields. The product is a transparent liquid gamma radiation shield that can be fabricated in custom sizes and thicknesses. Here, we describe applications of ClearView Radiation Shielding in nuclear plants and hospitals. ClearView Radiation Shielding is used to shield nuclear power plant workers from 60Co in critical path and high dose in refueling outages to observe automated operations inside the containment, and operations such as cylindrical frisking stations and benchtop sampling. ClearView Radiation Shielding is designed as rolling shields and radionuclide containments in hospitals to protect staff and families during unsealed radionuclide treatment such as MIBG and Lutetium therapies. For successful implementation in hospitals, the product was tested against various radioisotopes, also described in this work. Operational uses of ClearView Radiation Shielding in commercial nuclear and medical industries allows staff working in radioactive environments visibility, better communication and similar levels of radiation protection compared with traditional shielding materials. The product helps improve workflows and reduced total dose received by workers. Additionally, attenuation measurements using ClearView Radiation Shielding against multiple isotopes was performed. With 1.25 cm (0.5”) ClearView Radiation Shielding thickness, the shield attenuated 1) 65% of the effective dose from 131I, 2) 35.15% of the effective dose from 137Cs, and 3) 22.5% of the effective dose from 60Co. Isotopes in the range of 35 keV to 1899 keV. 3.81 were attenuated greater than 90% with a ClearView Radiation Shielding shield thickness of 7.62 cm (3”). The half-value layer for 60Co with a ClearView Radiation Shielding thickness of 3.81 cm (1.5”) attenuated the effective dose of 18F gammas by 85.59%. With a density of 2.3 g cm−3, ClearView Radiation Shielding was measured to be half the weight of lead for equal shielding. ClearView Radiation Shielding is transparent, lightweight, and an alternative material to conventional radiation shields to reduce radiation exposure.
A Cyclotron Decommissioning Radiological Assessment Exercise Performed by Student Mentees Underrepresented in the Radiation Safety Profession
Authors: Zapata Jessie R. , Stewart Justice , Kelly Kalifa O. , Taylor Aaron R. , Martinez Erika I. , Amoako Kofi , Gutierrez Janet M. , Emery Robert J. , Cheng Sai Yan , Patlovich Scott J. , Harvey Mark C. 
Published: September 2020

Abstract
Cyclotrons used in nuclear medicine imaging accelerate protons, deuterons, and helium ions to bombard a target, which produces nuclear reactions that generate positron-emitting radionuclides. Secondary neutrons are nonuniformly emitted in these reactions and induce heterogeneous activation of the cyclotron components and concrete vault enclosure. This poses radioactive waste management complications when decommissioning a cyclotron facility, since the objective is to ensure that exposures are within regulatory limits and as low as reasonably achievable (ALARA). The McGovern Medical School in The University of Texas Health Science Center in Houston housed a Scanditronix MC40 cyclotron that produced short-lived radioisotopes for Positron Emission Tomography (PET) imaging from 1984 to 2001 until Tropical Storm Allison rendered it inoperable. The purpose of this study was to provide underrepresented Science, Technology, Engineering and Mathematics (STEM) students an ALARA experience with a practical problem encountered in the radiation safety profession. Gamma dose rate measurements were performed with both a Mirion InSpectorTM 1000 spectrometer and Fluke 451P survey meter in the vault at locations identified as hotspots based on preliminary scoping surveys with the Ludlum model 44-9 detector. However, gamma spectra were measured with the spectrometer exclusively at hotspots along the west wall. Results indicated the maximum gamma dose rate of 129 ± 31 nSv h−1 was about 2 times background near the central beam transport line of the now inoperable cyclotron. Furthermore, gamma emission peaks were identified in the spectra from trace amounts of 60Co and 152Eu in the vault’s concrete walls.
Exploring Perceived Interactions Between Consequences of Traumatic Brain Injury
Authors: van den Broek Brenda , Spauwen Peggy , Ponds Rudolf , van Heugten Caroline , Bus Boudewijn 
Published: September 2020

Objective:
To explore the perceived interactions between consequences of traumatic brain injury (TBI).

Participants:
Fifteen clinicians experienced in working with patients with TBI.

Methods:
Participating clinicians completed an online questionnaire in which they estimated the degree to which consequences of TBI (taken from the Brief ICF Core Set for Traumatic Brain Injury) causally relate to each other. Based on these perceived interactions, a visual network was constructed and centrality measures for this network were computed.

Results:
The resulting network demonstrates various strong perceived causal relations between the consequences of TBI. Impairments in consciousness were perceived to most strongly cause other TBI consequences in the network. Difficulties with acquiring, keeping, and terminating a job were perceived to be most strongly caused by other TBI consequences. Difficulties in partaking in complex interpersonal interactions were also perceived to play a central role in the network.

Conclusion:
In the perception of clinicians, consequences of TBI interact with each other and are thus not solely a direct result of the injury. While more research is needed to map the interactions between consequences of TBI, our results could have important implications for the way we understand and treat the problems patients are faced with after TBI.
Comparing the Westmead Posttraumatic Amnesia Scale, Galveston Orientation and Amnesia Test, and Confusion Assessment Protocol as Measures of Acute Recovery Following Traumatic Brain Injury
Authors: Spiteri Courtney , Ponsford Jennie , Jones Harvey , McKay Adam 
Published: September 2020

Background:
The duration of the acute period of recovery following traumatic brain injury (TBI) remains a widely used criterion for injury severity and clinical management. Consensus regarding its most appropriate definition and assessment method has yet to be established.

Objective:
The present study compared the trajectory of recovery using 3 measures: the Westmead Post-Traumatic Amnesia Scale (WPTAS), the Galveston Orientation and Amnesia Test (GOAT), and the Confusion Assessment Protocol (CAP). Patterns of symptom recovery using the CAP were explored.

Participants:
Eighty-two participants with moderate to severe TBI in posttraumatic amnesia (PTA) on admission to an inpatient rehabilitation hospital.

Design:
Prospective longitudinal study.

Outcome Measures:
Length of PTA (days), agreement between measures (%, κ coefficient), and pattern of symptom recovery.

Results:
Participants emerged from PTA earliest on the CAP followed the GOAT, and last on the WPTAS. There was good agreement between the CAP and the GOAT as to PTA status, but both tests had poor agreement with the WPTAS. Of patients considered out of PTA on the CAP, the majority exhibited signs of amnesia on the WPTAS and one-third had clinical levels of agitation.

Conclusion:
The WPTAS identifies a later stage of PTA recovery that requires specialized management due to ongoing amnesia and agitation. The CAP and the GOAT are less sensitive to this extended period of PTA.
De-implementing Prolonged Rest Advice for Concussion in Primary Care Settings: A Pilot Stepped Wedge Cluster Randomized Trial
Authors: Silverberg Noah D. , Otamendi Thalia , Panenka William J. , Archambault Patrick , Babul Shelina , MacLellan Anna , Li Linda C. 
Published: September 2020

Objective:
To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion.

Setting:
Community.

Participants:
Family physicians in community practice (n = 21 at 5 clinics).

Design:
Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits.

Main Measures:
The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements.

Results:
Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change.

Conclusions:
Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.
Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder
Authors: Stika Monica M. , Riordan Patrick , Aaronson Alexandra , Herrold Amy A. , Ellison Rachael L. , Kletzel Sandra , Drzewiecki Michelle , Evans Charlesnika T. , Mallinson Trudy , High Walter M. , Babcock-Parziale Judith , Urban Amanda , Pape Theresa Louise-Bender , Smith Bridget 
Published: September 2020

Background:
Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear.

Methods:
We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings.

Results:
Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms.

Conclusions:
In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.
The Use of Atypical Antipsychotics for Managing Agitation After Traumatic Brain Injury
Authors: McKay Adam , Trevena-Peters Jessica , Ponsford Jennie 
Published: September 2020

Objective:
This study examined the use of antipsychotics for managing agitation during posttraumatic amnesia (PTA) after traumatic brain injury (TBI) and its relationship with agitated behavior.

Design:
Observational prospective study with correlational design.

Setting:
Inpatient rehabilitation hospital for TBI.

Participants:
A total of 125 consecutive admissions who were in PTA and had moderate-severe TBI.

Measures:
Antipsychotic use was compared with agitation levels as measured by the total scores on the Agitated Behavior Scale (ABS).

Results:
Atypical antipsychotics were used in one-third of participants to manage agitation. Antipsychotic use was more common in participants with high levels of global agitation; however, there were many on antipsychotics who had mild or even no agitation according to the ABS. Uncontrolled observational data found no reduction in agitation after antipsychotic commencement or dose increase.

Conclusions:
Antipsychotics are commonly used to manage agitation after TBI despite limited evidence of efficacy. Agitation should be formally monitored in PTA to ensure antipsychotics are used to manage more severe agitation and for evaluating treatment response. Research is needed to understand why prescribers are using antipsychotics when agitation is mild or below clinical thresholds.
Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury
Authors: Hromas Gabrielle A. , Houck Zachary M. , Asken Breton M. , Svingos Adrian M. , Greif Sarah M. , Heaton Shelley C. , Jaffee Michael S. , Bauer Russell M. 
Published: September 2020

Objective:
To assess the relationship between subjective cognitive symptoms and objective cognitive test scores in patients after concussion. We additionally examined factors associated with subjective and objective cognitive dysfunction, as well as their discrepancy.

Participants:
Eighty-six individuals (65.1% female; 74.4% adult) from an interdisciplinary concussion clinic.

Methods:
Subjective and objective cognitive functioning was measured via the SCAT—Symptom Evaluation and the CNS Vital Signs Neurocognition Index (NCI), respectively. Cognitive discrepancy scores were derived by calculating standardized residuals (via linear regression) using subjective symptoms as the outcome and NCI score as the predictor. Hierarchical regression assessed predictors (age, education, time postinjury, attention-deficit/hyperactivity disorder, affective distress, and sleep disturbance) of cognitive discrepancy scores. Nonparametric analyses evaluated relationships between predictor variables, subjective symptoms, and NCI.

Results:
More severe affective and sleep symptoms (large and medium effects), less time postinjury (small effect), and older age (small effect) were associated with higher subjective cognitive symptoms. Higher levels of affective distress and less time since injury were associated with higher cognitive discrepancy scores (β = .723, P < .001; β = −.204, P < .05, respectively).

Conclusion:
Clinical interpretation of subjective cognitive dysfunction should consider these additional variables. Evaluation of affective distress is warranted in the context of higher subjective cognitive complaints than objective test performance.