bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Simulated Low Speed Vehicle Impacts and Posture on Passive Intervertebral Mechanics
Authors: Fewster Kayla M. , Barrett Jeff M. , Callaghan Jack P. 
Published: August 2021

Study Design.
An in vitro biomechanics investigation exposing porcine functional spinal units (FSUs) to sudden impact loading although in a flexed, neutral, or extended posture.

Objective.
To investigate the combined effect of impact severity and postural deviation on intervertebral joint mechanics.

Summary of Background Data.
To date, no in vitro studies have been conducted to explore lumbar tissue injury potential and altered mechanical properties from exposure to impact forces. Typically, after a motor vehicle collision, the cause of a reported acute onset of low back pain is difficult to identify, with potential soft tissue strain injury sites including the intervertebral disc, facet joint and highly innervated facet joint capsule ligament.

Methods.
Seventy-two porcine functional spinal units (36 C34, 36 C56), consisting of 2 adjacent vertebrae, ligaments, and the intervening intervertebral disc were included in the study. Each specimen was randomized to 1 of 3 experimental posture conditions (neutral, flexed, or extended) and assigned to 1 of 3 impact severities representing motor vehicle accident accelerations (4 g, 8 g, and 11 g). Before impact (pre) and after impact (post) flexion-extension and anterior-posterior shear neutral zone testing was completed.

Results.
A significant two-way interaction was observed between pre-post and impact severity for flexion-extension neutral zone length and stiffness and anterior-posterior shear neutral zone length and stiffness. This was a result of increased
neutral zone range and decreased neutral zone stiffness pre-post for the highest impact severity (11 g), regardless of posture.

Conclusion.
Functional spinal units exposed to the highest severity impact (11 g) had significant neutral zone changes, with increases in joint laxity in flexion-extension and anterior-posterior shear and decreased stiffness, suggesting that soft tissue injury may have occurred. Despite observed main effects of impact severity, no influence of posture was observed.

Level of Evidence: N/A
Pediatric brain tumors as a developmental disease
Authors: Bruschi Marco , Grill Jacques , Guerrini-Rousseau Léa 
Published: August 2021

Purpose of review
Brain tumors are the most frequent solid cancer in the pediatric population. Owing to the rarity of environmental clues about their origin, it is tempting to consider these neoplasms as developmental processes gone awry. Our review will explore the heuristic power of this hypothesis and the influence of these findings on the clinical management.

Recent finding
A more accurate description of cancer predisposition syndrome has shown their frequent association with developmental abnormalities. Several genes involved in pediatric brain tumor oncogenesis are involved in developmental processes. Modeling of several pediatric brain tumor in cerebral organoids, mimicking embryonal stage of brain development, indicates that early events during brain development create the conditions necessary for their oncogenesis.

Summary
The onset of multiple brain tumor types early in life suggests a functional relationship between brain development and oncogenesis. A growing body of evidence seems to support the hypothesis that some of the main developmental steps in the brain can be highjacked by the tumors during their initiation. Collaborations between neuroscientists and oncologists should provide room for improvement in the knowledge for these neoplasms.
Neutrophils in Fixed Drug Eruptions: Correction of a Mistaken Hypothesis
Authors: Li Aofei , Kazlouskaya Viktoryia 
Published: August 2021

Abstract:
Classical histopathological findings of fixed drug eruption (FDE) include a lichenoid/interface dermatitis and perivascular infiltrate in the upper and deep dermis composed of lymphocytes and eosinophils accompanied by pigment incontinence. The presence of neutrophils is also an established finding but is less investigated. Sporadic cases of “neutrophilic FDE” have been reported and suggested as a separate entity, a rare variant, or an early stage of the condition. In this article, we report 16 cases of FDE with quantitative analysis showing that neutrophils are relatively common in FDE (68.8%) and that cases with abundant neutrophils had a significantly shorter onset-to-biopsy interval (3.7 vs. 16.9 days, P < 0.023). Our findings support that neutrophilic FDE more likely represents the early phase of FDE rather than a different entity. The presence of neutrophils expands the histopathological differential diagnosis of FDE to include neutrophilic dermatosis, signifying the value of clinical correlation.
A Rare Case of Epstein-Barr Virus–Positive T-Cell Lymphoma in the Skin of an Immunocompromised Patient
Authors: van Eijk Larissa E. , Koldijk Marjolein J. , van Kester Marloes S. , Diepstra Arjan , Diercks Gilles F. H. 
Published: August 2021

Abstract:
Immunodeficiency-associated lymphoproliferative disorders are associated with latent infection by Epstein–Barr virus (EBV). Most cases of EBV-positive immunodeficiency-associated lymphoproliferative disorders arise from B cells, although some are of T-cell or natural killer origin. Cutaneous involvement is unusual and sporadically reported in the literature. We describe a rare case of an EBV-positive T-cell lymphoma presenting in the skin of a 32-year-old woman using adalimumab for neurosarcoidosis.
A Novel Application of Magnetic Resonance Imaging to Surgical Planning of Penile Inversion Vaginoplasty
Authors: Abu El Hawa Areeg A. , Orra Susan , Bekeny Jenna C. , Dekker Paige K. , Georges Nicholas P. , Del Corral Gabriel 
Published: August 2021

Summary:
Transfeminine patients undergoing vaginoplasty frequently require reoperation due to dissatisfaction with insufficient vaginal dimensions. The goal of this study was to evaluate the role of preoperative imaging with magnetic resonance imaging (MRI) in establishing appropriate patient expectations and surgical planning for vaginoplasty procedures. In this retrospective review, we identified all patients that received MRI before undergoing penile inversion vaginoplasty by a single surgeon from 2019 to 2020. Our findings suggest that MRI can provide valuable information that can be used to set realistic expectations with patients as well as for operative planning for vaginoplasty procedures. Unlike traditional planning, MRI eliminates subjectivity in its estimate of vaginal depth. Future studies should incorporate a larger patient population and objectively analyze the impact of preoperative imaging on patient satisfaction and other measures of operative outcomes.
Neuromodulating the SMAS for Natural Dynamic Results
Authors: Corduff Niamh 
Published: August 2021

Summary:
Physicians using neuromodulators need to develop an in-depth and holistic understanding of the facial musculature as a single, large, functional structure that does not work in isolation. In this Special Topic, I review the anatomy of the continuous fibromuscular layer of the face, discuss how certain age-related indications develop as a consequence of imbalances to this unified structure, and propose considerations for neuromodulator-based interventions of the upper, mid, and lower face. I provide evidence-supported recommendations on the most optimal applications of neuromodulators to help rebalance the musculoaponeurotic layer for more natural outcomes. Through outcomes of my patients, I show how the facial mimetic muscles can be modulated with careful placement of botulinum toxin, without causing unnatural facial expressions, to achieve an expressive, well-balanced face that reflects health, vitality and happiness.
Lymphatic Function in the Arms of Breast Cancer Patients—A Prospective Cohort Study
Authors: Alstrup Mathias , Johannessen Andreas L. , Mohanakumar Sheyanth , Offersen Birgitte V. , Hjortdal Vibeke E. 
Published: August 2021

Background:
Lymphedema is a highly feared complication of breast cancer treatment, but the underlying complex mechanisms are still unknown. Thus, we investigated the lymphatic morphology and contractility in the lymphatic vessels of arms of high-risk breast cancer patients treated for node-positive early breast cancer.

Methods:
In this prospective cohort study 32 women treated for unilateral node-positive breast cancer were enrolled and studied 36 ± 23 days after loco-regional radiotherapy. Near-infrared fluorescence imaging was used to assess morphology and function of the superficial lymphatic vessels. Strain-gauge plethysmography was performed to evaluate the capillary filtration of fluid.
Both arms were investigated, with the non-treated arm acting as control. The patients were questioned about the presence of lymphedema yearly and finally 574 ± 118 days after ended radiotherapy.

Results:
Morphologically, 25% of the treated arms expressed lymphatic vessel abnormalities compared to the control arms (p = 0.0048). No difference in functional parameters (maximal pumping pressure, p = 0.20; contraction frequency, p = 0.63; contraction velocity, p = 0.55) was found between the treated and control arms. Patients who later developed lymphedema had a difference in velocity compared to those who did not develop lymphedema (p = 0.02). The capillary filtration rate was similar between the two arms (p = 0.18).

Conclusions:
Peripheral lymphatic vessels were morphologically changed in the ipsilateral arm in 25% of the patients and patients who later developed lymphedema showed an early increase in velocity. Other functional parameters and capillary filtration were unchanged in this early phase. These discrete changes might be early indicators of later development of lymphedema.
Critical Access Hospital Leaders Beat Challenges to Support Their Communities and Staffs
Authors: Schou Patricia M. 
Published: August 2021

Summary
Critical access hospitals (CAHs) serve their rural communities as the main access points and communication centers for healthcare, typically with very limited financial, staffing, and support resources. Local residents rely on their CAHs as the only providers for many miles around. When the COVID-19 pandemic hit in early 2020, CAH leaders had to rethink operations and priorities, both internally with staffs and externally with community leaders and organizations. Few critical care beds were available when the need was greatest. Testing was problematic, and cultural barriers complicated care. Now, as virus variants strike where vaccination numbers are low, CAH leaders remain wary of financial hits to elective procedure income, limited resources, and added stress for their staffs. Working with community service organizations and larger regional healthcare centers is a crucial strategy for CAHs as they address care delivery issues and ensure that their caregivers can do their jobs now and in the future.
Behavioral Health in the Pandemic: Making the Shift from Mental Illness to Mental Well-Being
Authors: Merz Stephen M. 
Published: August 2021

SUMMARY
Fighting the global COVID-19 pandemic has shifted from immediate response efforts to recognition of the long-term effects on the mental health and well-being of the general population and healthcare workforce. Leaders need to understand the vital role of behavioral health services in a population-based, integrated healthcare framework and address the needs of the behavioral health workforce to successfully deploy services in their organizations and communities.
During the ongoing national response to COVID-19, three major trends have emerged: (1) a shift to telehealth and digital care, (2) greater awareness of the impact on the workforce of the shift to digital care, and (3) an open dialogue to counteract the stigma and discrimination related to mental illness and to emphasize mental well-being instead. When they address stigma and discrimination, healthcare leaders embrace a more holistic approach that welcomes behavioral health professionals as equal, vital members of the care team. They help their organizations advance the mental well-being of all.
The Characteristics of Nurses Who Care for Dying Infants and Their Families
Authors: Eckenrode Jessica , Zimmerman Kathryn , Rice Mary Eve , Wilson Debra Rose 
Published: August 2021

Abstract
The purpose of this research was to explore the characteristics of nurses who care for dying infants and their families to better understand their strengths in this specialty and seek to give guidance to the nurse in this role.

Introduction
Caring for an infant and family at the end-of-life for the infant requires a unique set of nursing skills and characteristics. Nurses who have that skill set can shed light on the role and the individual strengths needed for success.

Methods
A phenomenological approach was used to examine the perceived traits and skills needed for these nurses. Eight participants were interviewed about their experience of working with these families. Interviews were audio-taped, transcribed verbatim, and analyzed using codes and categories. Four themes emerged.

Results
The four themes identified were flexibility, making memories, compassion, and nonjudgment.

Discussion
Understanding some of the characteristics required for this unique role can help nurses self-reflect and continue to care for these families and themselves during this sacred time. The findings have value for all pediatric nurses who care for children who may die.
Low myocardial mechano-energetic efficiency is an independent predictor of prognosis in advanced chronic liver disease
Authors: Cesari Maurizio , Frigo Anna Chiara , Piano Salvatore , Angeli Paolo 
Published: August 2021

Objective
We aimed at investigating if a low myocardial mechano-energetic efficiency (MEE) with energy waste could be a feature of cirrhotic cardiomyopathy and predictive of poor prognosis.

Methods
We retrospectively interrogated a large data set of 115 cirrhotic patients followed up for 6 years and compared with 50 healthy controls. Echocardiographic and haemodynamic parameters were assessed at baseline according with current guidelines. MEE was estimated by echocardiographic stroke volume (z-derived)/(heart rate × 0.6).

Results
Cirrhotic patients presented low peripheral vascular resistance, a compensatory hyperdynamic syndrome with increased cardiac work, left atrial and left ventricular (LV) dimension and mass. Systolic parameters and MEE were similar between patients and controls. Patients with cirrhosis and refractory ascites showed significantly lower MEE compared with both patients with treatable ascites and patients without ascites (1.68 ± 0.47 vs. 1.98 ± 0.64 and 1.80 ± 0.37 ml/s; P < 0.05). Increased age and heart rate and reduced body weight, cardiac dimension and work significantly correlated with lower MEE, mostly when compared nonalcoholic with alcoholic cirrhosis (1.65 ± 0.42 vs. 1.95 ± 0.56 ml/s respectively; P = 0.002). Among the cardiovascular parameters left atrium enlargement and reduced MEE were independent predictors of death.

Conclusions
In advanced chronic liver disease left ventricular performance is blunted due to an energetically inefficient cardiac mechanical work which correlates with a poor prognosis. Therefore, the simple basal assessment of MEE can identify patients with a worst prognosis which requires a close follow-up.
Integrating Mental Health in Safety-net Primary Care
Authors: Leung Lucinda B. , Benitez Christopher T. , Dorsey Charmaine , Mahajan Anish P. , Hellemann Gerhard S. , Whelan Fiona , Park Nina J. , Braslow Joel T. 
Published: August 2021

Background:
Beginning in 2010, Los Angeles County Departments of Health Services and Mental Health collaborated to increase access to effective mental health care. The Mental Health Integration Program (MHIP) embedded behavioral health specialists in primary care clinics to deliver brief, problem-focused treatments, and psychiatric consultation support for primary care-prescribed psychotropic medications.

Objective:
The aim was to compare primary care visits associated with psychiatric diagnoses before and after MHIP implementation.

Methods:
This retrospective cohort study (2009–2014) examined 62,945 patients from 8 safety-net clinics that implemented MHIP in a staggered manner in Los Angeles. Patients’ primary care visits (n=695,354) were either associated or not with a previously identified or “new” (defined as having no diagnosis within the prior year) psychiatric diagnosis. Multilevel regression models used MHIP implementation to predict odds of visits being associated with psychiatric diagnoses, controlling for time, clinic, and patient characteristics.

Results:
9.4% of visits were associated with psychiatric diagnoses (6.4% depression, 3.1% anxiety, <1% alcohol, and substance use disorders). Odds of visits being associated with psychiatric diagnoses were 9% higher [95% confidence interval (CI)=1.05–1.13; P<0.0001], and 10% higher for diagnoses that were new (CI=1.04–1.16; P=0.002), after MHIP implementation than before. This appeared to be fueled by increased visits for depression post-MHIP (odds ratio=1.11; CI=1.06–1.15; P<0.0001).

Conclusions:
MHIP implementation was associated with more psychiatric diagnoses coded in safety-net primary care visits. Scaling up this effort will require greater attention to the notable differences across patient populations and languages, as well as the markedly low coding of alcohol and substance use services in primary care.
The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients
Authors: Reaume Michael , Batista Ricardo , Rhodes Emily , Knight Braden , Imsirovic Haris , Seale Emily , Riad Karine , Prud’homme Denis , Tanuseputro Peter 
Published: August 2021

Background:
Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents’ preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers.

Methods:
We used administrative databases to establish a retrospective cohort study of home care recipients (2015–2017) in Ontario, Canada, where the predominant language is English. Residents’ preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year.

Results:
Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10–1.39) longer when compared with Anglophones without dementia.

Conclusions:
Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.
Gastric intestinal metaplasia: when to treat? How to treat?
Authors: Abdelfattah Thaer , Shahab Omer , Shah Tilak U. 
Published: August 2021

Purpose of review
Gastric intestinal metaplasia (GIM) is an attractive target for surveillance and treatment as it can progress to gastric adenocarcinoma (GAC). Yet, GIM remains a challenging area for clinicians as most patients do not progress to cancer, and there are conflicting data regarding the benefits of surveillance and therapy. This review aims to summarize recently published GIM surveillance guidelines, to discuss, which patients with GIM may benefit from treatment, and to review pivotal and recent literature on GIM therapy.

Recent findings
Guidelines published by American, British, and European gastroenterology societies do not recommend universal surveillance, but do suggest endoscopic surveillance in patients with risk factors for progression to GAC. Although light examination for at least 7 min and mapping biopsies may increase yield for dysplasia and GAC. In randomized trials, Helicobacter pylori eradication reduced risk of dysplasia and cancer. In GIM with visible dysplasia and early-stage GAC, endoscopic resection improves quality of life without reducing survival compared with surgery. Endoscopic ablation therapies have shown promise for invisible or extensive dysplasia.

Summary
Endoscopic resection is appropriate for visible dysplasia and early-stage GAC without high-risk features that persists despite H. pylori eradication therapy. Prospective studies are needed to assess the utility of endoscopic ablation in GIM.
Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study
Authors: Yengo-Kahn Aaron M. , Hibshman Natalie , Bezzerides Michael , Feldman Michael J. , Vukovic Adam A. , Mummareddy Nishit , Zhao Shilin , Penrod Cody H. , Bonfield Christopher M. , Vance E. Haley 
Published: August 2021

Introduction:
Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion.

Methods:
A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5–19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline–based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and “complete” discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation.

Results:
More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively.

Conclusions:
A simple, low-cost intervention such as peer-to-peer education and consensus guideline–based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.