bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor Uncorrected Visual Acuity and Association With Sleep Duration and Screen Time: A Dose–Response Relationship Study
Authors: Hu Yueyang , Xu Qiaoyi , Shi Jikang , Lin Xinli , Fei Junsong , Hu Yuanchao , Mei Songli , Wu Xiaogang 
Published: October 2021

Background We aimed to investigate the prevalence of poor uncorrected visual acuity and the difference among students with different ages and residential areas in the Northeast of China. The relationships between screen time, nighttime sleep duration, and poor uncorrected visual acuity would be explored. Methods It was a cross-sectional study using multi-stage stratified random sampling method to recruit participants. 2149 students have completed questionnaires and underwent visual acuity examinations. The dose–response curve method was applied to examine the non-linear associations between sleep duration and poor uncorrected visual acuity under different screen time subgroups. Results The overall prevalence of poor uncorrected visual acuity and severe poor uncorrected visual acuity was 84.7% and 63.3%, respectively. The dose–response curve showed the odds ratios (ORs) of sleep duration for the poor uncorrected visual increased relatively slowly when screen time <1 hour, then increased dramatically in screen time ≥1 hours. The ORs of sleep time and poor uncorrected visual acuity showed a U-shaped change trend among students with 2 or more hours of screen time every day. Conclusion We found associations between nighttime sleep duration and poor uncorrected visual acuity in adolescents. However, these associations were not consistent across all screen time categories.
Urinary tract obstruction: Ultrasound-guided intervention
Authors: Lory Alexander , Stubbs Christopher , Wolstenhulme Stephen , Khan Atif 
Published: October 2021

Introduction Urinary tract obstruction (UTO) is a common clinical problem of which there are many potential causes. The aim of this feature article is to explore the role of ultrasound in diagnosing UTO, during guided interventional procedures and the potential procedural complications. Topic description and discussion: Ultrasound is an integral imaging modality throughout the management pathway of a patient with UTO and is often utilised as a first-line test in diagnosis and treatment. Percutaneous nephrostomy is an interventional technique, usually performed by radiologists or interventional sonographers, as either a short- or long-term management strategy. It can either be used in isolation or to gain access to the renal collecting system prior to more complex interventional or surgical techniques. Ultrasound-guided interventional techniques to relieve UTO can be employed in a number of clinical scenarios each with their own indications, contraindications and complications. Conclusion Ultrasound plays a unique role in the planning and active stages of intervention with the provision of dynamic imaging which is crucial for providing safe and effective patient management.
Learning Collaborative Events With Child Welfare and Health Care Providers Improve Systems Knowledge and Intent to Change
Authors: Scheid Jeanette M. , Sarinopoulos Issidoros , Cameron Sierra , Tanner Clare 
Published: October 2021

Introduction: Children in foster care are at higher risk of health problems. These risks present challenges to achieving permanency, safety, and well-being. Despite efforts to improve the systems serving children in foster care, gaps remain in achieving timely and quality health services. Based on stakeholder reports that health care provider knowledge about child welfare systems is a barrier to care, the Fostering Health Partnerships project conducted 2-session learning collaborative events across Michigan. The project team hypothesized that participants would increase knowledge of child welfare policy and that physician participants would identify and commit to practice change to improve health care services to children in foster care. Methods: Learning collaborative events included an in-person session followed by a live webinar session. Participants included child welfare professionals, physicians, and other health care representatives. Participants completed surveys assessing knowledge about child welfare health policy. Physician participants completed a post-event interview. The investigators used pre- and post-intervention survey design and qualitative evaluation of physician interview data to assess the impact of the learning collaborative events on knowledge and practice. Results: A total of 781 individuals attended the initial session and 383 attended the second session of 36 events for 80 counties in Michigan. 247 individuals completed pre- and post-event surveys and 7 physicians completed interviews after the events. Survey data showed that event participants demonstrated increased knowledge of child welfare policy related to health ( P < .001). Interviewed physicians reported making practice changes to improve health care services and indicated that the events were valuable though time intensive. Conclusion: An abbreviated learning collaborative process is an effective tool to improve knowledge and drive practice change. Future efforts will build on this project to improve access, coordination, and quality health services for children in foster care.
Characteristics of Rotavirus, ETEC, and Vibrio Cholerae Among Under 2-year Children Attending an Urban Diarrheal Disease Hospital in Bangladesh
Authors: Sarker Mohammad Habibur Rahman , Moriyama Michiko , Rahman Md Moshiur , Das Sumon Kumar , Uzzaman Md Nazim , Das Jui , Uddin Aftab , Banu Shakila , Khan Soroar Hossain , Shahid Abu SMSB , Shahunja K. M. , Chisti Mohammod Jobayer , Faruque Abu S. G. , Ahmed Tahmeed 
Published: October 2021

Background Information on comparative clinical and host characteristics of under-2 children with watery diarrhea caused by rotavirus, Enterotoxigenic Escherichia coli (ETEC), and Vibrio cholerae as single pathogens is lacking. We sought to investigate the sociodemographic, clinical, and host characteristics of under-2 children hospitalized due to these pathogens. Methodology We conducted a hospital-based case-control study using the icddr,b Diarrheal Diseases Surveillance System. Children of either sex, <2 years with diarrhea, who attended the hospital during 2014 to 2018, constituted the study population. Stool specimens having a single pathogen like rotavirus, ETEC, or Vibrio cholerae constituted the cases and stool specimens having no detectable common enteropathogens comprised the controls. Multinomial logistic regression analysis was done where control was the reference group. Results A total of 14 889 patients were enrolled, 6939 of whom were under-2 children, and 5245 (76%) constituted our study population. Among them 48% (n = 2532), 3% (n = 148) and 1% (n = 49) had rotavirus, ETEC, and Vibrio cholera, respectively. A control group (diarrhea without these 3 or Shigella, Salmonella, Aeromonas) accounted for 48% (n = 2516). In multinomial regression model, children with rotavirus (adjusted odds ratio [aOR], 1.36; 95% confidence interval [95% CI], 1.19-1.55) less often presented with dehydrating diarrhea compared to those with ETEC (aOR, 1.54; 95% CI, 1.05-2.26) and cholera (aOR, 2.25; 95% CI, 1.11-4.57). Rotavirus diarrhea was associated (aOR, 1.25; 95% CI, 1.07-1.46) with those who received antimicrobials prior to hospital admission and protectively associated with drinking tap water (aOR, 0.84; 95% CI, 0.73-0.95); however, ETEC diarrhea had protective association (aOR, 0.62; 95% CI, 0.43-0.92) with children who received antimicrobials prior to hospital admission and was associated with drinking tap water (aOR, 1.78; 95% CI, 1.19-2.66). Use of intravenous fluid was associated with cholera (aOR, 10.36; 95% CI, 4.85-22.16) and had protective association with rotavirus episodes (aOR, 0.64; 95% CI, 0.45-0.91). Conclusions Clinical presentations and host characteristics of rotavirus, ETEC, and Vibrio cholerae diarrhea differed from each other and the information may be helpful for clinicians for better understanding and proper management of these children.
Current Applications of Machine Learning in Spine: From Clinical View
Authors: Ren GuanRui , Yu Kun , Xie ZhiYang , Wang PeiYang , Zhang Wei , Huang Yong , Wang YunTao , Wu XiaoTao 
Published: October 2021

Study Design: Narrative review. Objectives: This review aims to present current applications of machine learning (ML) in spine domain to clinicians. Methods: We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2020 using terms (spine, spinal, lumbar, cervical, thoracic, machine learning) to examine ML in spine. Then exclude research of other domain, case report, review or meta-analysis, and which without available abstract or full text. Results: Total 1738 articles were retrieved from database, and 292 studies were finally included. Key findings of current applications were compiled and summarized in this review. Main clinical applications of those techniques including image processing, diagnosis, decision supporting, operative assistance, rehabilitation, surgery outcomes, complications, hospitalization and cost. Conclusions: ML had achieved excellent performance and hold immense potential in spine. ML could help clinical staff to improve medical level, enhance work efficiency, and reduce adverse events. However more randomized controlled trials and improvement of interpretability are essential to clinicians accepting models’ assistance in real work.
What Do Preambles Do? A Study of Constitutional Intent and Reality
Authors: Ummareddy Neha , Alam Aniket 
Published: October 2021

‘We, the people’ is the most popular phrase from the constitutions. In spite of the fact that the number of countries including preamble as part of their constitution has been on the rise, preambles have received scant attention in academia. The importance of preambles has been established in multiple studies yet preambles have been looked at in isolation from socio-economic-environmental contexts. Our article attempts to present a unique insight by correlating preambles with the socio-economic-environmental and infrastructural context within which they exist. It explores whether these correlations exist and if they do with which features and to what extent and the possibility of a causal link. We pursue a statistical study between various indicators that reflect the growth of a country and the presence or absence of various elements in preambles across the world. Our study finds that correlations exist between the economic-social-environmental and infrastructural context of a nation-state and different elements in their preambles. Our study rigorously engages with patterns in development indicators across years to provide correlational insights into the role of preambles not just as a dormant reference but as active fragments of the socio-political-economic reality of a nation-state. We hope our article establishes grounds for a further study of the manner in which preambles and the non-political aspects of a nation-state can engage with each other.
Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis
Authors: Farooqi Ali S. , Lee Alexander , Novikov David , Kelly Ann Marie , Li Xinning , Kelly John D. , Parisien Robert L. 
Published: October 2021

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.
Integrating physical and mental healthcare: Facilitators and barriers to success
Authors: Monaghan Karen , Cos Travis 
Published: October 2021

Introduction: Effective and appropriate provision of mental healthcare has long been a struggle globally, resulting in significant disparity between prevalence of mental illness and access to care. One attempt to address such disparity was the Patient Protection and Affordable Care Act (PPACA), 2010, mandate in the United States to integrate physical and mental healthcare in Federally Qualified Health Centers (FQHCs). The notion of integration is attractive, as it has demonstrated the potential to improve both access to mental healthcare and healthcare outcomes. However, while the PPACA mandate set this requirement for FQHCs, no clear process as to how these centers should achieve successful integration was identified. Methods: This research employed case study methods to examine the implementation of this policy in two FQHCs in New England. Data were obtained from in-depth interviews with leadership, management, and frontline staff at two case study sites. Results: Study findings include multiple definitions of and approaches for integrating physical and mental healthcare, mental healthcare being subsumed into, rather than integrated with, the medical model and multiple facilitators of and barriers to integration. Conclusion: This study asked questions about what integration means, how it occurs, and what factors facilitate or pose barriers to integration. Integration is facilitated by co-location of providers within the same department, a warm hand-off, collaborative collegial relationships, strong leadership support, and a shared electronic health record. However, interdisciplinary conflict, power differentials, job insecurity, communication challenges, and the subsumption of mental health into the medical model pose barriers to successful integration.
Circadian effects of ionizing radiation on reproductive function and clock genes expression in male mouse
Authors: Qin Fenju , Liu Ningang , Nie Jing , Shen Tao , Xu Yingjie , Pan Shuxian , Pei Hailong , Zhou Guangming 
Published: October 2021

AbstractBackgroundExposure to the ionizing radiation (IR) encountered outside the magnetic field of the Earth poses a persistent threat to the reproductive functions of astronauts. The potential effects of space IR on the circadian rhythms of male reproductive functions have not been well characterized so far.MethodsHere, we investigated the circadian effects of IR exposure (3 Gy X-rays) on reproductive functional markers in mouse testicular tissue and epididymis at regular intervals over a 24-h day. For each animal, epididymis was tested for sperm motility, and the testis tissue was used for daily sperm production (DSP), testosterone levels, and activities of testicular enzymes (glucose-6-phosphate dehydrogenase (G6PDH), sorbitol dehydrogenase (SDH), lactic dehydrogenase (LDH), and acid phosphatase (ACP)), and the clock genes mRNA expression such asClock,Bmal1,Ror-α,Ror-β, orRor-γ.ResultsMice exposed to IR exhibited a disruption in circadian rhythms of reproductive markers, as indicated by decreased sperm motility, increased daily sperm production (DSP), and reduced activities of testis enzymes such as G6PDH, SDH, LDH, and ACP. Moreover, IR exposure also decreased mRNA expression of five clock genes (Clock,Bmal1,Ror-α,Ror-β, orRor-γ) in testis, with alteration in the rhythm parameters.ConclusionThese findings suggested potential health effects of IR exposure on reproductive functions of male astronauts, in terms of both the daily overall level as well as the circadian rhythmicity.
A new model of inexpensive portable homemade PERC Mentor (IPHOM) and its validation
Authors: Shukla Abhishek , Sethi Gurwinder , Dutta Ananya , Aggarwal Puneet , Gupta Ayon 
Published: October 2021

Abstract
Background
Percutaneous nephrolithotomy (PCNL) is a complex surgery and has a flat learning curve. Due to this and the ethical issues, trainees do not get enough hands on exposure. Virtual simulator is very expensive and bulky. Animal model requires legal clearance. This inexpensive portable homemade PERC Mentor (IPHOM) teaches all the major aspects of PCNL surgery. This article has shown the way to make this model and its validation study.

Methods
IPHOM can be made at home with carton box, ball bearings, LED torch and some hospital wastes. After a short demonstration of IPHOM, 14 residents and 4 urologists were given 8 tasks to perform on it followed by 15-min supervised practice exercise on day 0 and day 1. Their performance was reassessed on day 2 and 3. Response to 17 feedback points was recorded on a seven-point Likert scale.

Results
There was significant difference between the performance of expert and novice on day 0. Expert completed all the tasks in less time and no. of attempts. The time for tract dilatation and duration of radiation exposure were significantly less in the expert group. The performance of both expert and novice improved on day 2 and 3, but the improvement was significantly more in novice. Response to the feedback points showed no difference between expert and novice (p > .05).

Conclusions
We have found that training on IPHOM has improved the concept and skills of PCNL in residents. The simplicity and low cost of the model make it constructible at home.
Quantitative effect of subretinal fluid and intraretinal edema on visual acuity in uveitic cystoid macular edema
Authors: Weldy Eric W. , Patnaik Jennifer L. , Pecen Paula E. , Palestine Alan G. 
Published: October 2021

Abstract
Background
The effect of subretinal fluid (SRF) in uveitic cystoid macular edema (CME) is not fully understood. This study evaluates the quantitative effect of SRF and intraretinal thickness on visual acuity in eyes with uveitic CME. We separately measured SRF and intraretinal area on Optical Coherence Tomography (OCT) to determine the associations of each component with visual acuity and response to treatment.

Main text
Medical records were reviewed of patients with CME presenting to the University of Colorado uveitis clinic from January 2012 to May 2019. All available OCTs were reviewed to classify eyes as either having only CME or CME with SRF. Intraretinal area was manually measured using Image J along the central 1-mm section of B-scan OCT spanning from the internal limiting membrane to the outer most portion of the outer retina including both cysts and retinal tissue. SRF cross-sectional area was measured spanning from the outermost portion of the outer retina to retinal pigment epithelium. Response to treatment was assessed one to four months after presentation. Eyes with CME secondary to structural or non-inflammatory causes were excluded.
Forty-seven (50.5%) eyes had CME alone and 46 (49.5%) eyes had SRF with CME. Measured SRF cross-sectional area was not associated (p = 0.21) with LogMAR at presentation. Conversely, intraretinal area was strongly correlated with visual acuity in eyes with SRF (p < 0.001) and without SRF (p < 0.001). Following treatment, there was a significant decrease in intraretinal area for both groups (p < 0.001), with a larger decrease in the SRF group compared to the non-SRF group (p = 0.001). Similarly, logMAR improved in both groups (p = 0.008 for SRF eyes and p = 0.005 for non-SRF eyes), but the change was more prominent in the SRF group (p = 0.06).

Conclusions
There was no direct association observed between the amount of SRF and visual acuity. In contrast, increased intraretinal area was significantly associated with decreased visual acuity. This relationship between intraretinal thickening and visual acuity may explain differences observed in response to treatment between SRF and non-SRF eyes, with a larger decrease in the intraretinal cross-sectional area in SRF eyes associated with a greater improvement in logMAR visual acuity.
The genetic impact of an Ebola outbreak on a wild gorilla population
Authors: Fontsere Claudia , Frandsen Peter , Hernandez-Rodriguez Jessica , Niemann Jonas , Scharff-Olsen Camilla Hjorth , Vallet Dominique , Le Gouar Pascaline , Ménard Nelly , Navarro Arcadi , Siegismund Hans R. , Hvilsom Christina , Gilbert M. Thomas P. , Kuhlwilm Martin , Hughes David , Marques-Bonet Tomas 
Published: October 2021

AbstractBackgroundNumerous Ebola virus outbreaks have occurred in Equatorial Africa over the past decades. Besides human fatalities, gorillas and chimpanzees have also succumbed to the fatal virus. The 2004 outbreak at the Odzala-Kokoua National Park (Republic of Congo) alone caused a severe decline in the resident western lowland gorilla (Gorilla gorilla gorilla) population, with a 95% mortality rate. Here, we explore the immediate genetic impact of the Ebola outbreak in the western lowland gorilla population.ResultsAssociations with survivorship were evaluated by utilizing DNA obtained from fecal samples from 16 gorilla individuals declared missing after the outbreak (non-survivors) and 15 individuals observed before and after the epidemic (survivors). We used a target enrichment approach to capture the sequences of 123 genes previously associated with immunology and Ebola virus resistance and additionally analyzed the gut microbiome which could influence the survival after an infection. Our results indicate no changes in the population genetic diversity before and after the Ebola outbreak, and no significant differences in microbial community composition between survivors and non-survivors. However, and despite the low power for an association analysis, we do detect six nominally significant missense mutations in four genes that might be candidate variants associated with an increased chance of survival.ConclusionThis study offers the first insight to the genetics of a wild great ape population before and after an Ebola outbreak using target capture experiments from fecal samples, and presents a list of candidate loci that may have facilitated their survival.