bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographic and Functional Characteristics of National Veterans Wheelchair Games Participants: A Cross-sectional Study
Authors: Lee-Hauser Cecelia Rose , Schein Richard M , Schiappa Vince J , Pruziner Alison L , Tostenrude Dave , Goedhard Kristine E , Nelson Leif M , Schmeler Mark R 
Published: December 2020

Abstract

Introduction
Although many studies report the impact of adaptive sports and recreation on quality of life for people with disabilities across several age groups, few have focused on the Veteran population. The purpose of this study was to establish a baseline of common characteristics of the Veteran population that participated in the National Veterans Wheelchair Games (NVWG) in 2017 and 2018, including their perception on how their participation is associated with function and social factors.

Materials and methods
A cross-sectional study was implemented as part of a quality assurance collaboration between the University of Pittsburgh and the Veterans Administration National Veterans Sports Programs and Special Events. Demographic and quality-of-life data were collected through the Functional Mobility Assessment (FMA) and associated Uniform Dataset as well as the Sports Participation Outcome Research Tool and Comprehensive Uniform Survey (SPORTACUS). This report provides and discusses the descriptive analyses that were performed on the data and establishes a framework to assess the impact of sports and exercise for Veterans with disabilities.

Results
A sample of 426 Veterans, 87% who were male and an average population age of 56 years old, reported high FMA scores on each of 10 items (daily routine, comfort, health, operate, reach, transfer, personal care, indoor mobility, outdoor mobility, and transportation) along with SPORTACUS scores scoring above 5, based on a 1-6 scoring scale (1 being “completely disagree” and 6 being “completely agree”), on each domain indicating sports participation is associated with their ability to function and participate in the community.

Conclusion
Based on these results, it can be concluded for this military Veteran population that participation in a large, organized adaptive sports programs such as the NVWG has a positive association with daily function, quality of life, community participation, and use of higher quality assistive technology.
Unusual Case of Acute Decompensated Maple Syrup Urine Disease in the Emergency Department
Authors: Tobin Michael R , Grisham Justin , Brigg Andrew , Kinder Bradley 
Published: December 2020

ABSTRACT
A case report of an army soldier presenting to the emergency department with acute metabolic derangement resulting in encephalopathy, cerebral edema, and death is presented. The patient had no medical diagnoses before entering military service and was triaged in the emergency department with the common complaint of presyncope. However, as encephalopathy worsened, the patient experienced altered mental status, lethargy, emesis, and seizure. This patient ultimately died because of rapid decompensation. Maple syrup urine disease pathophysiology and treatment recommendations are reviewed.
Advancing Prehospital Combat Casualty Evacuation: Patients Amenable to Aeromedical Evacuation via Unmanned Aerial Vehicles
Authors: Maddry Joseph K , Arana Allyson A , Mora Alejandra G , Perez Crystal A , Cutright Julie E , Kester Braden M , Ng Patrick C , Schauer Steven G , Bebarta Vikhyat S 
Published: December 2020

ABSTRACT

Introduction
The U.S. military currently utilizes unmanned aerial vehicles (UAVs) for reconnaissance and attack missions; however, as combat environment technology advances, there is the increasing likelihood of UAV utilization in prehospital aeromedical evacuation. Although some combat casualties require life-saving interventions (LSIs) during medical evacuation, many do not. Our objective was to describe patients transported from the point of injury to the first level of care and characterize differences between patients who received LSIs en route and those who did not.

Materials and Methods
We conducted a retrospective review of the records of traumatically injured patients evacuated between January 2011 and March 2014. We compared patient characteristics, complications, and outcomes based on whether they had an LSI performed en route (LSI vs. No LSI). We also constructed logistic regression models to determine which characteristics predict uneventful flights (no en route LSI or complications).

Results
We examined 1,267 patient records; 47% received an LSI en route. Most patients (72%) sustained a blast injury and injuries to the extremities and head. Over 78% experienced complications en route; the LSI group had higher rates of complications compared to the No LSI group. Logistic regression showed that having a blunt injury or the highest abbreviated injury scale (AIS) severity score in the head/neck region are significant predictors of having an uneventful flight.

Conclusion
Approximately half of casualties evaluated in our study did not receive an LSI during transport and may have been transported safely by UAV. Having a blunt injury or the highest AIS severity score in the head/neck region significantly predicted an uneventful flight.
Forward Surgical Teams as a Model for Humanitarian Orthopedic Surgical Care: A Review of Current Literature
Authors: Recker Andrew J , Danelson Kerry , Coates Kevin E 
Published: December 2020

ABSTRACTIntroductionOrthopedic trauma is a significant portion of global burden of disease in low- and middle-income countries (LMICs). This has led the World Health Organization to advocate for increased surgical intervention in LMICs. The two largest barriers to orthopedic surgical care for LMICs are cost of procedure and geographic access to centers with appropriate surgical capabilities. There is no current consensus on how to structure surgical interventional teams. The overall objective of this study is to describe the composition of a forward surgical team (FST), including its abilities and limitations. It is hypothesized that an FST is an effective model for orthopedic surgical relief efforts in LMICs.MethodsA narrative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards published by the National Academies of Medicine. Studies were evaluated by structured review procedures to identify an FST’s capacity for orthopedic surgery, as well as applicability for humanitarian care. Articles detailing FST logistics, types of orthopedic treatment provided, and instances of humanitarian care while deployed in austere environments were included for review.ResultsThe FST is a military surgical unit operating with a small crew of surgeons and supporting staff who use tents or trailers that can be positioned near points of conflict, often in remote or austere environments. FSTs were designed to treat traumatic injuries, including orthopedic trauma from RTIs. If used as a sponsored humanitarian aid mission, FSTs can provide surgical care at free or greatly reduced costs. Because FSTs carry limited supplies and personnel, they are highly mobile surgical units that can be transported via truck.ConclusionFSTs are effective models for humanitarian orthopedic surgery in LMICs. FSTs were designed to treat orthopedic trauma, the largest burden of orthopedic care in LMICs. Efficient use of limited equipment allows FSTs to be cost effective for funding sources and highly mobile to reduce the geographic barrier to care. Further research is needed to determine the cost to operate an FST and ethical consideration for military intervention for foreign humanitarian aid.
A Rare Case of Rib Fractures During Centrifuge Training
Authors: Tu Min-Yu , Chu Hsin , Huang Yi-Jhih , Chiang Kwo-Tsao , Tong Pao-Tsung , Lai Chung-Yu 
Published: December 2020

ABSTRACT
There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum. We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G). This patient presented with progressive and localized pain in the right anterior chest and flank region. After conservative treatment with rest and pain management, he recovered from the rib fractures and completed all profile challenges in the advanced high-G training program. A review of the annual health examination of the pilot did not show any rib lesions or other related illnesses. He was qualified for flying class II and considered fit for flight training. His medication history was unremarkable, and he did not have a family history of malignancy, osteoporosis, or osteopenia. He also denied having previously experienced trauma of the rib cage or participated in any strenuous military training program or exercise before centrifuge training. The potential explanations for the multiple rib fractures are repetitive stress from the anti-G straining maneuver and anti-G suit compression of the abdominal bladder. To our knowledge, consecutive rib fractures related to high-G exposure have never been documented. This report may increase the awareness of flight surgeons and training units regarding the risk of chest wall injuries during high-G exposure and encourage them to use multiple diagnostic tools to determine the correct diagnosis.
Assessing Uncertainty in the Rooting of the SARS-CoV-2 Phylogeny
Authors: Pipes Lenore , Wang Hongru , Huelsenbeck John P , Nielsen Rasmus 
Published: December 2020

Abstract
The rooting of the SARS-CoV-2 phylogeny is important for understanding the origin and early spread of the virus. Previously published phylogenies have used different rootings that do not always provide consistent results. We investigate several different strategies for rooting the SARS-CoV-2 tree and provide measures of statistical uncertainty for all methods. We show that methods based on the molecular clock tend to place the root in the B clade, whereas methods based on outgroup rooting tend to place the root in the A clade. The results from the two approaches are statistically incompatible, possibly as a consequence of deviations from a molecular clock or excess back-mutations. We also show that none of the methods provide strong statistical support for the placement of the root in any particular edge of the tree. These results suggest that phylogenetic evidence alone is unlikely to identify the origin of the SARS-CoV-2 virus and we caution against strong inferences regarding the early spread of the virus based solely on such evidence.
Genetics-first approach improves diagnostics of ESKD patients &lt;50 years old
Authors: Snoek Rozemarijn , van Jaarsveld Richard H , Nguyen Tri Q , Peters Edith D J , Elferink Martin G , Ernst Robert F , Rookmaaker Maarten B , Lilien Marc R , Spierings Eric , Goldschmeding Roel , Knoers Nine V A M , van der Zwaag Bert , van Zuilen Arjan D , van Eerde Albertien M 
Published: December 2020

Abstract

Background
Often only chronic kidney disease (CKD) patients with high likelihood of genetic disease are offered genetic testing. Early genetic testing could obviate the need for kidney biopsies, allowing for adequate prognostication and treatment. To test the viability of a ‘genetics-first’ approach for CKD, we performed genetic testing in a group of kidney transplant recipients aged &lt;50 years, irrespective of cause of transplant.

Methods
From a cohort of 273 transplant patients, we selected 110 that were in care in the University Medical Center Utrecht, had DNA available and were without clear-cut non-genetic disease. Forty patients had been diagnosed with a genetic disease prior to enrollment; in 70 patients, we performed a whole-exome sequencing-based 379 gene panel analysis.

Results
Genetic analysis yielded a diagnosis in 51%. Extrapolated to the 273 patient cohort, who did not all fit the inclusion criteria, the diagnostic yield was still 21%. Retrospectively, in 43% of biopsied patients, the kidney biopsy would not have had added diagnostic value if genetic testing had been performed as a first-tier diagnostic.

Conclusions
The burden of monogenic disease in transplant patients with end-stage kidney disease (ESKD) of any cause prior to the age of 50 years is between 21% and 51%. Early genetic testing can provide a non-invasive diagnostic, impacting prognostication and treatment, and obviating the need for an invasive biopsy. We conclude that in patients who expect to develop ESKD prior to the age of 50 years, genetic testing should be considered as first mode of diagnostics.
The brain tumor not-for-profit and charity experience of COVID-19: reacting and adjusting to an unprecedented global pandemic in the 21st century
Authors: Amidei Christina , Arzbaecher Jean , Maher Mary Ellen , Mungoshi Christine , Cashman Rosemary , Farrimond Stuart , Kruchko Carol , Tse Chris , Daniels Maureen , Lamb Sharon , Granero Anita , Lovely Mary , Baker Jenifer , Payne Sally , Oliver Kathy 
Published: December 2020

Abstract

Background
The Coronavirus Disease 2019 (COVID-19) pandemic has affected individuals as well as disease-specific brain tumor organizations. These organizations around the world exist to address unmet needs for patients and caregivers they serve. The direct impact of the pandemic on these organizations constitutes significant collateral damage. In order to better understand the effects of the COVID-19 pandemic on brain tumor organizations, the International Brain Tumour Alliance (IBTA) carried out an international survey to identify organizational changes induced by the virus and approaches adopted to address challenges.

Methods
A 37-question online survey consisting of categorical and qualitative questions was developed and circulated to 130 brain tumor organizations across the world. Seventy-seven organizations from 22 countries completed the survey (59% return rate). Descriptive statistics and content analysis were used to present the results.

Results
Responses fell into the following 3 categories: (1) organizational characteristics, (2) impact of COVID-19 on services, and (3) COVID-19 impact on financial and human resources within organizations. Although organizational characteristics varied, common concerns reported were activity disruption which impacted organizations’ abilities to offer usual services and challenges to sustaining funding. Both financial and human resources were stressed, but integral adaptations were made by organizations to preserve resources during the pandemic.

Conclusions
Although brain tumor organizations have been impacted by the COVID-19 pandemic, organizations quickly adjusted to this unprecedented global healthcare crisis. Nimble reactions and flexibility have been vital to organization sustainability. Innovative approaches are required to ensure organizations remain viable so that needs of brain tumor community at large are met.
Multidisciplinary management of metastatic spine disease: initial symptom-directed management
Authors: Steinberger Jeremy M , Yuk Frank , Doshi Amish H , Green Sheryl , Germano Isabelle M 
Published: December 2020

Abstract
In the past 2 decades, a deeper understanding of the cancer molecular signature has resulted in longer longevity of cancer patients, hence a greater population, who potentially can develop metastatic disease. Spine metastases (SM) occur in up to 70% of cancer patients. Familiarizing ourselves with the key aspects of initial symptom-directed management is important to provide SM patients with the best patient-specific options. We will review key components of initial symptoms assessment such as pain, neurological symptoms, and spine stability. Radiographic evaluation of SM and its role in management will be reviewed. Nonsurgical treatment options are also presented and discussed, including percutaneous procedures, radiation, radiosurgery, and spine stereotactic body radiotherapy. The efforts of a multidisciplinary team will continue to ensure the best patient care as the landscape of cancer is constantly changing.
An overview of the tumors affecting the spine—inside to out
Authors: Kumar Naresh , Tan Wei Loong Barry , Wei Wei , Vellayappan Balamurugan A 
Published: December 2020

AbstractSpine tumors may arise within or surrounding the spinal cord and/or vertebral column. Spinal tumors can be benign or malignant. Based on their epicenter, they may be classified as intradural-intramedullary, intradural-extramedullary, or extradural. Of these, extradural lesions are the most common, and are typically metastatic. Primary bone tumors of the spinal column comprise 5% of all primary skeletal tumors. The majority of primary spinal column tumors are benign, with malignant tumors comprising only 20%. Overall, spine metastases are the most common malignant spine tumor, and these usually arise from primaries such as lung, breast, and prostate cancers. The advent of improved systemic therapies leading to improved survival and the frequent use of imaging has positioned metastatic spine disease as the new epidemic in oncology. For spine tumors, establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation. In this review, we will provide an overview of the epidemiology, radiological and histopathological features, and the natural history of key primary (benign and malignant) spinal cord and column tumors and metastatic spine tumors. Treatment principles for primary spinal cord or column tumors are aimed toward curative resection, whereas palliative resection forms the treatment principle for most metastatic tumors.
Reusable sanitary napkins—time to revisit
Authors: Mehta Sumita , Grover Anshul , Mittal Nalini , Nanda Pratibha , Khatuja Ritu , Naseem Azra 
Published: December 2020

AbstractBackgroundTo assess knowledge, attitude and practices (KAP) of women regarding menstrual hygiene and to evaluate the use of reusable sanitary napkins as an alternative to disposable sanitary napkins.MethodsA community-based cross-sectional study was done in two phases. In the first phase, 50 married women attending Gynecology OPD were asked to use reusable sanitary napkins for 2 months. A pre- and post-usage vaginal swab testing was done to rule out genital infection. This study was extended in the second phase to another 534 women after confirming that reusable sanitary napkins do not cause genital infection and are acceptable. KAP analysis regarding menstrual hygiene was done for all women.ResultsIn phase 1 of the study, the microbiological evaluation revealed no pathological organisms on vaginal swab culture after 2 months of usage. KAP analysis of 584 women revealed that only 26% women had awareness about menstruation before attaining menarche; in 51.88%, the primary source of information was their mother; 76.54% women in the study used disposable sanitary pads of which 15% were disposing of them unhygienically; 80.49% women found the reusable napkins comfortable and easy to use and 83.6% women confirmed recommending these napkins to others.ConclusionReusable sanitary pads are an effective, environment friendly, and cost-effective alternative to disposable napkins.
DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC HEAD COMPUTED TOMOGRAPHY IN MOROCCO: A NATIONWIDE SURVEY
Authors: Benmessaoud M , Dadouch A , Talbi M , Tahiri M , El-ouardi Y 
Published: December 2020

Abstract
The purpose of this study was to establish the diagnostic reference levels (DRLs) for paediatric head computed tomography (CT) in Morocco and to assess the effective doses received during head CT examinations. The data of 1007 patients were collected retrospectively from Moroccan university children’s hospitals. The sample was classified per age group:&lt;1, 1–5, 5–10 and 10–15 years. The proposed DRLs were defined as 75th percentile of the distributions, which were in terms of CT dose index of 26.98, 28.88, 34.00 and 38.20 mGy and dose length product of 461.64, 540.06, 627.20 and 705.98 mGy.cm, respectively. The effective doses estimated were 3.6, 2.9, 2 and 1.79 mSv, respectively. The DRLs reported in Morocco were compared with those of other countries, which were based on the same age grouping method, including Thailand, Switzerland, Japan and the international DRLs. Our initiative via the determination of the first Moroccan diagnostic reference levels for paediatric head CT must be a starting point to spread this investigation towards other examinations and imaging modalities.
Elderly hip fracture patients: surgical timing and factors to consider
Authors: Wenk Manuel , Frey Sönke 
Published: December 2020

Purpose of review
Hip fractures of the elderly population are a common trauma and numbers are increasing due to ageing societies. Although this is an ordinary low energy impact injury and surgical repair techniques show good results, the perioperative course is characterized by an unparalleled disproportionate perioperative morbidity and mortality.

Recent findings
Most studies focus on outcome-related data. Little is known on how to prevent and treat adverse sequelae, ranging from mild physical challenges to neurobiological disorders and death.

Summary
Although the contribution of the anaesthetic technique per se seems to be small, the role of the anaesthesiologist as a perioperative physician is undisputed. From focusing on comorbidities and initiating preoperative optimization to intraoperative and postoperative care, there is a huge area to be covered by our faculty to ensure a reasonable outcome defined as quality of postoperative life rather than merely in terms of a successful surgical repair. Protocol-driven perioperative approaches should be employed focusing on pre, intraoperative and postoperative optimization of the patient to facilitate early repair of the fracture that may then translate into better outcomes and hence alleviate the individual patient's burden as well as the socioeconomic load for society.
Follow-up Findings in Postconservative Treatment Surveillance for Women With Cervical Adenocarcinoma In Situ
Authors: Upadhyay Baskota Swikrity , Wang Tiannan , Zhao Chengquan 
Published: December 2020

Objectives
The risks of adenocarcinoma in situ (AIS) recurrence or progression after conservative treatment are uncertain. The aim of this study was to examine the role of high-risk human papillomavirus (hrHPV) and cytology in the posttreatment surveillance of AIS patients.

Materials and Methods
Follow-up results of hrHPV status, cytology results, and clinicopathological features of 207 patients were retrospectively analyzed, in whom AIS was initially treated by loop electrosurgical excision procedure (LEEP)/cone biopsy between September 2009 and June 2018.

Results
Among 207 patients diagnosed AIS on LEEP/cone biopsy, 30.9% (64/207) had positive margins. Persistent/recurrent AIS rate was substantially higher in the patients with positive margins than in those with negative margins (47.2% vs 9.3%, p < .001). Of 74 patients with hrHPV surveillance, 17 (17/74, 23.0%) were found to have positive hrHPV and 4 (4/17, 23.5%) had the persistent/recurrent AIS regardless of margin status. On the contrast, no AIS were found in negative surveillant hrHPV patients (23.5% vs 0%, p < .001). Lastly, 27.8% patients (22/79) were reported atypical glandular cells on surveillant cytology, and 9 persistent/recurrent AIS cases were further identified on second biopsy or hysterectomy with a positive detection rate of 40.9%.

Conclusions
In this study, we concluded the positive margin on LEEP/cone biopsy in AIS patients was associated with a significantly greater risk of disease persistence or recurrence. The posttreatment surveillance by cytology and adjunct hrHPV would be an ideal strategy in predicting AIS persistence and recurrence, which will warrant further treatments.