bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center
Authors: Stalder Sarah , Techau Aimee , Hamilton Jenny , Caballero Carlo , Weber Mary , Roberts Mia , Barton Amy J. 
Published: February 2021

INTRODUCTION: All patients of a nurse-led federally qualified health center and faculty practice interested in medication management were automatically referred to the psychiatric mental health nurse practitioner in the clinic. This approach was not sustainable to provide access to patients who needed both simple and complex medication management. Thus, a search for a new care model that also focused on the full-scope practice of a psychiatric RN was initiated. AIMS: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHODS: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.
Tears of biceps femoris, semimembranosus, and semitendinosus are not equal—a new individual muscle-tendon concept in athletes
Authors: Lempainen Lasse , Kosola Jussi , Pruna Ricard , Sinikumpu Juha-Jaakko , Valle Xavier , Heinonen Olli , Orava Sakari , Maffulli Nicola 
Published: February 2021

Objectives: Hamstring injuries are common and can now be accurately diagnosed. In addition, novel surgical indications have been introduced. However, evidence-based guidelines on the hamstring injuries in management of top-level athletes are missing. Methods: The management methods and outcomes of treatment are classically based on relatively small case series. We discuss a novel concept based on the fact that each tendon of the hamstrings muscle should be managed in an individual fashion. Furthermore, suitable indications for hamstring surgery in athletes are introduced. Results: The present study introduces modern treatment principles for hamstring injury management. Typical clinical and imagining findings as well as surgical treatment are presented based on a critical review of the available literature and personal experience. Conclusions: Hamstring injuries should not be considered to be all equal given the complexity of this anatomical region: The three separate tendons are different, and this impacts greatly on the decision-making process and outcomes in athletes.
The relationship between flourishing, injury status, and resilience in collegiate athletes
Authors: Martin Chelsea L , Shanley Ellen , Harnish Chris , Knab Amy , Christopher Shefali , Vallabhajosula Srikant , Bullock Garrett 
Published: February 2021

Background Flourishing is a multi-dimensional construct that encompasses physical, psychological and social well-being. A proposed positive attribute of flourishing is resilience, which is the ability to bounce back despite the presence of stressors. A common stressor among athletes is overuse injuries, which may negatively affect well-being. Objective To examine the relationships of resilience and overuse injury with flourishing in collegiate athletes. Materials and methods 253 college athletes participated. The Flourishing Scale, Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC), and Brief Resilience Scale (BRS) were administered via online questionnaire. For OSTRC scores, athletes were classified into injury and participation status groups. For BRS scores, athletes were classified into low resilience (LR), normal resilience (NR), and high resilience (HR) groups. Results Median flourishing score was 50.0 (46.5–53.5); mean BRS score was 21.6 (SD 4.3). Overuse injury and substantial overuse injury incidence proportion (IP) were 25.4 (95% CI: 20.3, 30.5) and 9.1 (95% CI: 7.0, 11.2). The IP for participants unable to play was 15.1 (95% CI: 12.9, 17.2). Significant differences were found in flourishing among resilience groups (p = 0.002) but not among overuse injury groups (p = 0.140) or participation variables (p = 0.205). Conclusion College athletes demonstrated high flourishing scores. Flourishing demonstrated a significant relationship with resilience across all groups but not among overuse injury or participation status. This finding indicates that college athlete well-being is strongly associated with resilience. Future longitudinal studies are needed to determine if resilience can be modified to positively influence athlete well-being.
Time in Range Does Not Associate With Carotid Artery Wall Thickness and Endothelial Function in Type 1 Diabetes
Authors: Cutruzzolà Antonio , Parise Martina , Scavelli Faustina B , Barone Milena , Gnasso Agostino , Irace Concetta 
Published: February 2021

Background: Patients with Type 1 diabetes (T1D) have an increased risk of developing atherosclerosis and complications as myocardial infarction and peripheral artery disease. The thickening of the carotid wall and the brachial artery dysfunction are early and preclinical manifestations of atherosclerosis. The standard marker of care for assessment of glycemic control, glycated hemoglobin, does not associate with early atherosclerosis. We have hypothesized that the emerging metric of glycemic control, as the time spent in the target range (TIR), might be associated with carotid thickening and endothelial dysfunction. According to the hypothesis, we have designed the present research with the aim to evaluate the association between TIR collected in the short and long term and the measures of arterial morphology and function in patients with T1D. Methods: In our study, 70 patients and 35 healthy controls underwent ultrasound vascular study to measure carotid artery intima-media thickness (IMT) and brachial artery endothelial function by the flow-mediated dilation (FMD) technique. TIR was collected by a continuous glucose monitoring system for 2 weeks, 3 months, and 6 months before the vascular study. Results: Patients with T1D showed a significantly higher carotid IMT (mean±SE, 644±19 vs. 568±29 µ; p= 0.04) and a significantly lower FMD (mean±SE, 7.6±0.4 vs. 9.8±0.6%; p=0.01) compared with control subjects. No significant relationship between IMT, FMD, and TIR collected in the short and long term emerged. Conclusions: Young patients with T1D have early vascular abnormalities. The percent of TIR does not correlate with preclinical atherosclerosis. This finding underlines the complexity of the interplay between diabetes and atherosclerosis.
Clinical Anatomy of the Posterior Meniscofemoral Ligament of Wrisberg: An Original MRI Study, Meta-analysis, and Systematic Review
Authors: Pękala Przemysław A. , Łazarz Dominik P. , Rosa Mateusz A. , Pękala Jakub R. , Baginski Adam , Gobbi Alberto , Wojciechowski Wadim , Tomaszewski Krzysztof A. , LaPrade Robert F. 
Published: February 2021

Background: The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial femoral condyle and passes posteriorly to the posterior cruciate ligament (PCL). The pMFL plays a role in recovery after PCL injuries and offers stability to the lateral meniscus, promoting normal knee function. Purpose/Hypothesis: The aim of the magnetic resonance imaging (MRI) arm of this study was to evaluate the prevalence of the pMFL in Polish patients. The purpose of the systematic review and meta-analysis was to evaluate the clinical relevance of the pMFL in knee surgery. It was hypothesized that extensive variability exists in reports on the prevalence, function, and clinical significance of the pMFL. Study Design: Cross-sectional study and systematic review; Level of evidence, 3. Methods: A retrospective MRI investigation was conducted on 100 randomly selected lower limbs of Polish patients (56 male, 44 female) performed in 2019 to determine the prevalence of the pMFL. Additionally, an extensive literature search of major online databases was performed to evaluate all reported data on the pMFL. Assessments of article eligibility and data extraction were completed independently by 2 reviewers, and all disagreements were resolved via a consensus. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool. Results: In the MRI arm of this study, the pMFL was observed in 73 of the 100 limbs. In the meta-analysis, 47 studies were included, totaling 4940 lower limbs. The pooled prevalence of the pMFL was found to be 70.4% (95% CI, 63.4%-76.9%); the mean length was 27.7 mm (95% CI, 24.8-30.5 mm) and the mean widths were 4.5, 6.1, and 4.1 mm for the meniscal and femoral attachments and midportion, respectively. The mean pMFL thickness was 2.3 mm (95% CI, 1.8-2.7 mm). Conclusion: Despite the variability in the literature, the pMFL was found to be a prevalent and large anatomic structure in the knee joint. The shared features of this ligament with the PCL necessitate the consideration of its value in planning and performing arthroscopic procedures of the knee.
Telemedicine Foot and Ankle Visits in the COVID-19 Era
Authors: Labib Sameh A. , Goel Rahul , Manz Wesley , Bariteau Jason 
Published: February 2021

Background: The COVID-19 pandemic created a difficult environment to provide musculoskeletal care to patients with foot and ankle pathology given the limitations placed on in-office visits. Telemedicine offered a unique avenue to reach these patients; however, the efficacy of telemedicine visits in patients with foot and ankle pathology is not well studied. We propose a telemedicine protocol that has allowed us to effectively see and treat patients with foot and ankle pathology. Methods: A 12-step standardized telemedicine protocol was created within the Foot and Ankle division that was used for seeing patients through telemedicine. Also included in this is previsit preparation and follow-up recommendations. Press Ganey surveys were retrospectively reviewed to understand patient experience with telemedicine. Results: 85.2% of patients surveyed responded with scores indicating excellent care. When comparing patients who were seen in-office and through telemedicine, 89.2% and 83.4% responded with scores indicating excellent care, respectively ( P = .37). Conclusion: Telemedicine offers an effective and convenient way to provide excellent musculoskeletal care to patients affected with foot and ankle pathology. This is the first study that evaluated a comprehensive protocol for telemedicine encounters and can be used to implement telemedicine by others using this approach. Level of Evidence: Level V, expert opinion.
Treatment Intensity of Psoriasis Decreases With Age
Authors: Muddasani Suraj , Fleischer Alan B. 
Published: February 2021

Background: Elderly patients have worse skin related quality of life regardless of psoriasis severity. Despite this, there may be risks to starting systemic immunosuppressant therapy, a mainstay for moderate to severe psoriasis, in elderly patients. Objective: We assessed how age relates to treatment intensity for psoriasis. We defined treatment intensity as a continuous scale with a value of 0 indicating no treatment, 1 indicating topical treatment only, and 2 through 4 indicating progressive degrees of systemic treatment. Methods: We assessed the National Ambulatory Medical Care Survey from 1997 to 2016 to determine if treatment intensity for psoriasis was related to a patient’s age. Results: Between 1997 to 2006, a 1-year increase in age was not associated with a change in treatment intensity score for the younger ( p = .4) and older ( p = .8) age groups. Between 2007 to 2016, a 1-year increase in age was associated with a .01 (95% confidence interval .005, .02) decrease in the treatment intensity score ( p = .003) for patients aged 52 or older. When controlling for sex and race, a 1-year increase in age was associated with a decrease of .01 (.02, .005) in the treatment intensity score ( p = .005). There was no association with those who were younger than 52 ( p = .5). Discussion: Physicians provide less intense treatments for elderly patients with psoriasis. This effect has appeared in the last decade. It remains unknown if physicians are being cautious with more intense treatments in elderly patients or if they are unintentionally undertreating this population.
Addition of lenalidomide to intensive treatment in younger and middle-aged adults with newly diagnosed AML: the HOVON-SAKK-132 trial
Authors: Löwenberg Bob , Pabst Thomas , Maertens Johan , Gradowska Patrycja , Biemond Bart J. , Spertini Olivier , Vellenga Edo , Griskevicius Laimonas , Tick Lidwine W. , Jongen-Lavrencic Mojca , van Marwijk Kooy Marinus , Vekemans Marie-Christiane , van der Velden Walter J. F. M. , Beverloo Berna , Michaux Lucienne , Graux Carlos , Deeren Dries , de Weerdt Okke , van Esser Joost W. J. , Bargetzi Mario , Klein Saskia K. , Gadisseur Alain , Westerweel Peter E. , Veelken Hendrik , Gregor Michael , Silzle Tobias , van Lammeren-Venema Daniëlle , Moors Ine , Breems Dimitri A. , Hoogendoorn Mels , Legdeur Marie-Cecile J. C. , Fischer Thomas , Kuball Juergen , Cornelissen Jan , Porkka Kimmo , Juliusson Gunnar , Meyer Peter , Höglund Martin , Gjertsen Bjorn T. , Janssen Jeroen J. W. M. , Huls Gerwin , Passweg Jakob , Cloos Jacqueline , Valk Peter J. M. , van Elssen Catharina H. M. J. , Manz Markus G. , Floisand Yngvar , Ossenkoppele Gert J. 
Published: February 2021

Abstract
Lenalidomide, an antineoplastic and immunomodulatory drug, has therapeutic activity in acute myeloid leukemia (AML), but definitive studies about its therapeutic utility have been lacking. In a phase 3 study, we compared 2 induction regimens in newly diagnosed patients age 18 to 65 years with AML: idarubicine-cytarabine (cycle 1) and daunorubicin and intermediate-dose cytarabine (cycle 2) without or with lenalidomide (15 mg orally on days 1-21). One final consolidation cycle of chemotherapy or autologous stem cell transplantation (auto-SCT) or allogeneic SCT (allo-SCT) was provided according to a prognostic risk and minimal residual disease (MRD)–adapted approach. Event-free survival (EFS; primary end point) and other clinical end points were assessed. A second random assignment in patients in complete response or in complete response with incomplete hematologic recovery after cycle 3 or auto-SCT involved 6 cycles of maintenance with lenalidomide (10 mg on days 1-21) or observation. In all, 392 patients were randomly assigned to the control group, and 388 patients were randomly assigned to lenalidomide induction. At a median follow-up of 41 months, the study revealed no differences in outcome between the treatments (EFS, 44% ± 2% standard error and overall survival, 54% ± 2% at 4 years for both arms) although in an exploratory post hoc analysis, a lenalidomide benefit was suggested in SRSF2-mutant AML. In relation to the previous Dutch-Belgian Hemato-Oncology Cooperative Group and Swiss Group for Clinical Cancer Research (HOVON-SAKK) studies that used a similar 3-cycle regimen but did not pursue an MRD-guided approach, these survival estimates compare markedly more favorably. MRD status after cycle 2 lost prognostic value in intermediate-risk AML in the risk-adjusted treatment context. Maintenance with lenalidomide showed no apparent effect on relapse probability in 88 patients randomly assigned for this part of the study.
Contact Stress Distribution of a Pear Cam Profile with Roller Follower Mechanism
Authors: Yousuf Louay S. , Hadi Nabil Hassan 
Published: February 2021

AbstractThe problem of this paper is the high contact stress at the point of contact between the cam and the follower. A pear cam and roller follower mechanism were studied and analyzed for different position of the follower and different contact compression load. The objective of this paper is to study the effect of contact compression load on the contact stress distribution of the cam profile at the point of contact. Four different positions of the follower with the cam was considered (0°, 90°, 180°, and 270°). The theory of circular plate was applied to derive the analytic solution of the contact stress. The numerical simulation had been done using ANSYS Ver. 19.2 package to determine the contact stress, while SolidWorks software was used to investigate follower displacement, velocity, and acceleration. Four distinct values of the compression contact load, such as 3.121 N, 6.242 N, 9.364 N, and 12.485 N, were used in the numerical simulation. In the experiment setup, a photo-elastic technique was carried out in the field of polarized light to exhibit the stress distribution on the cam specimen. The annealed PSM-4 backalate material was used in the experiment setup. The experimental value of contact stress was checked and verified analytically and numerically at the point of contact. The innovation in this paper the use of spring-damper system which reduce the value of contact stress at the point of contact. The contact stress was maximum 2.136 MPa when the follower located at 270° with the cam, while the contact stress was minimum 1.802 MPa when the follower located at 180° at compression load 12.485 N.
Secondary analysis of change in physical function after exercise intervention in older adults with hyperkyphosis and low physical function
Authors: Gladin Amy , Katzman Wendy B. , Fukuoka Yoshimi , Parimi Neeta , Wong Shirley , Lane Nancy E. 
Published: February 2021

AbstractBackgroundHyperkyphosis is common in older adults and associated with low physical function and reduced health related quality of life (HrQol). Improved kyphosis has been previously established in kyphosis-targeted interventions in randomized controlled trials in older adults with hyperkyphosis; however, evidence for improved physical function is conflicting. Few studies have investigated change in physical function after a targeted kyphosis intervention in older adults with low physical function. The primary aim in this descriptive study was to explore change in physical function after a progressive high-intensity 3-month targeted kyphosis exercise and posture training intervention in older adults with low physical function and hyperkyphosis. Secondary aims were to explore change in HrQol, spinal strength and spinal curvature, and adherence and safety of the intervention.MethodsIn this secondary analysis of the Specialized Center of Research (SCOR) Kyphosis randomized trial, 101 community dwelling older men and women with hyperkyphosis who completed the intervention were divided into a low function group (LFG) and high function group (HFG). Baseline characteristics were compared between LFG and HFG. Physical function, HrQol, spinal strength and spinal curvature (kyphosis and lordosis) pre/post intervention change scores were explored within and between groups. Adherence and adverse events were examined in the LFG and HFG.ResultsTwenty-six (26%) older adults were LFG, mean Short Phyiscal Performance Battery (SPPB) 9.62 (SD = 1.17) points. At baseline, the LFG was older than HFG (p = 0.005), experienced more pain, (p = 0.060), had worse physical function and HrQol (p ≤ 0.001), and comparable kyphosis (p = 0.640). SPPB changed 0.62 (95% CI: − 0.20 to 1.44) points in the LFG and - 0.04 (95%CI: − 0.28 to 0.19) points in the HFG,p = 0.020. Gait speed changed 0.04 (95% CI: − 0.02 to 0.10) m/s in the LFG. Kyphosis improved equally in both groups. Adherence to the intervention was 83% in the LFG and 79% in the HFG. There were no adverse events in either group.ConclusionsOlder adults with low physical function and hyperkyphosis may improve physical function after a kyphosis targeted intervention. Older adults with low physical function may safely participate in targeted high-intensity kyphosis exercise and posture training. This observation needs to be confirmed in larger adequately powered studies.Trial registrationClinicaltrials.gov identifier:NCT01766674.
Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study
Authors: Thelen Julinha M. , Buenen A. G. ( Noud) , van Apeldoorn Marjan , Wertheim Heiman F. , Hermans Mirjam H. A. , Wever Peter C. 
Published: February 2021

Abstract
Background
During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance.

Methods
We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes.

Results
A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1).

Conclusions
We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.