bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 as a disruptor: innovation and value in a national virtual fracture conference
Authors: Stein Matthew K. , Webb Matthew Loren , DeAngelis Ryan D. , Kerbel Yehuda E. , Mehta Samir , Donegan Derek J. 
Published: February 2021

Abstract

Objectives:
The aim of this study was to determine the educational value of a national virtual fracture conference implemented during the COVID-19 disruption of resident education.

Design:
Survey study.

Setting:
National virtual conference administered by the Orthopaedic Trauma Association.

Participants:
Attendees of virtual fracture conference.

Intervention:
Participation at a national virtual fracture conference.

Main outcome measure:
Surveys of perception of quality and value of virtual conferences relative to in-person conferences.

Results:
Ninety-six percent of participants rated the virtual fracture conference as similar or improved educational quality relative to conventional in-person fracture conference. Participants also felt they learned as much (35%) or more (57%) at each virtual fracture conference compared to the amount learned in-person. The quality of interpersonal interactions at both the resident–faculty level and faculty–faculty level was also perceived to be overall superior to those at participants’ own institutions. Learners felt they were more likely to engage the primary literature as well. Overall, 100% of participants were likely to recommend virtual conference to their colleagues and 100% recommended continuing this conference even after COVID-19 issues resolve.

Conclusions:
We found that learners find significant educational value in a national virtual fracture conference compared to in-person fracture conferences at their own institution. COVID-19 has proven to be a disruptor not only in health care but in medical education as well, accelerating our adoption of innovative and novel resident didactics.

Level of Evidence:
Therapeutic Level III.
Inadequate Engagement in HIV Care Among People With HIV Newly Diagnosed With a Sexually Transmitted Disease: A Multijurisdictional Analysis
Authors: Norkin Sarah K. , Benson Samantha , Civitarese Anna M. , Reich Amanda , Chomsky Albright Madison , Convery Christine , Kasarskis Irina M. , Cassidy-Stewart Hope , Howe Katharine , Wang Xueyan , Golden Matthew R. , Khosropour Christine M. , Glick Sara N. , Kerani Roxanne P. 
Published: February 2021

Background
A key challenge of HIV surveillance–based HIV care reengagement is locating people living with HIV (PLWH) who seem to be out of care to reengage them in care. Providing reengagement services to PLWH diagnosed with a sexually transmitted disease (STD)—individuals who are in jurisdiction and connected to the health care system—could be an efficient means of promoting HIV treatment and reducing HIV transmission.

Methods
Early and late syphilis (ES/LS) and gonorrhea (GC) cases diagnosed in 2016 and 2017 in Louisiana, Michigan, Mississippi, Oregon, Rhode Island, and Texas were matched to each state's HIV surveillance data to determine the proportion of PLWH with these infections who (1) did not have evidence of a CD4 count or viral load in the prior ≥13 months (out of care) or (2) had a viral load ≥1500 copies/mL on their most recent HIV RNA test before STD diagnosis (viremic).

Results
Previously diagnosed HIV infection was common among persons diagnosed with ES (n = 6942; 39%), LS (n = 4329; 27%), and GC (n = 9509; 6%). Among these ES, LS, and GC cases, 26% (n = 1543), 33% (n = 1113), and 29% (n = 2391) were out of HIV medical care or viremic at the time of STD diagnosis.

Conclusions
A large proportion of STD cases with prior HIV diagnosis are out of care or viremic. Integrating relinkage to care activities into STD partner services and/or the use of matching STD and HIV data systems to prioritize data to care activities could be an efficient means for relinking patients to care and promoting viral suppression.
Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers
Authors: Sherman Susan G. , Tomko Catherine , White Rebecca Hamilton , Nestadt Danielle Friedman , Silberzahn Bradley E. , Clouse Emily , Haney Katherine , Galai Noya 
Published: February 2021

Background
Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population.

Methods
Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia).

Results
Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion.

Conclusions
More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.
Oropharyngeal Squamous Cell Carcinoma With Discordant p16 and HPV mRNA Results
Authors: Shinn Justin R. , Davis Seth J. , Lang-Kuhs Krystle A. , Rohde Sarah , Wang Xiaowei , Liu Ping , Dupont William D. , Plummer Dale , Thorstad Wade L. , Chernock Rebecca D. , Mehrad Mitra , Lewis James S. 
Published: February 2021

Early studies estimate that 5% to 10% of oropharyngeal squamous cell carcinomas overexpress p16 but are unassociated with transcriptionally-active high-risk human papillomavirus (HPV). Patients with discordant HPV testing may experience clinical outcomes that differ from traditional expectations. To document the rate of p16 and HPV mRNA positivity, characterize patients with discordant testing, and identify features that may warrant selective use of HPV-specific testing after p16 IHC, a multi-institutional, retrospective review of oropharyngeal squamous cell carcinoma patients with p16 IHC and HPV mRNA testing by reverse transcriptase polymerase chain reaction was performed. Of the 467 patients, most had T1 or T2 tumors (71%), 82% were p16 positive, and 84% were HPV mRNA positive. Overall, most tumors were nonkeratinizing (378, 81%), which was strongly associated with p16 and HPV positivity (93% and 95%, respectively). Overall, 81% of patients were double positive, 14% double negative, and 4.9% discordant (3.4% p16 negative/HPV mRNA positive and 1.5% p16 positive/HPV mRNA negative). The survival rates of these discordant patient groups fell squarely between the 2 concordant groups, although in multivariate analysis for both disease-free survival and overall survival, discordant patients were not found to have statistically significantly different outcomes. Reclassifying patients by applying HPV mRNA testing when p16 results and morphology do not match, or when p16 results are equivocal, improved prognostication slightly over p16 or HPV mRNA testing alone. Patients with discordant testing demonstrate a borderline significant trend toward survival differences from those with concordant tests. When evaluated independently, patients who were p16 negative but HPV mRNA positive had a prognosis somewhat closer to double-positive patients, while those who were p16 positive, but HPV mRNA negative had a prognosis closer to that of double-negative patients. We suggest an algorithm whereby confirmatory HPV mRNA testing is performed in patients where p16 status is not consistent with tumor morphology. This captures a majority of discordant patients and improves, albeit modestly, the prognostication.
Performance of Pediatric Emergency Medicine Faculty After Point-of-Care Ultrasound Credentialing Implementation
Authors: Nti Benjamin K. , Kennedy Sarah , Sarmiento Elisa , Weinstein Elizabeth , Russell Frances 
Published: February 2021

Objective
As point-of-care ultrasound (POCUS) continues to evolve, a national standardized curriculum for training and credentialing pediatric emergency medicine (PEM) physicians is still lacking. The goal of this study was to assess PEM faculty in performing and interpreting POCUS during implementation of a training curriculum.

Methods
Sixteen full-time PEM faculty with either limited or no prior POCUS experience were trained to perform 4 ultrasound studies. Twelve of the 16 completed the training with a goal of credentialing within 12 months of implementation. For each faculty, we assessed competency by comparing precurriculum and postcurriculum test assessments and by evaluating quality of POCUS acquisition and accuracy of interpretation. We also monitored the amount of continuing medical education (CME) hours completed to ensure a minimum didactic component.

Results
We found a significant improvement in POCUS competency comparing precurriculum to postcurriculum test assessments (55.4% vs 75.6%, P < 0.0002). One thousand two hundred seventy images were submitted over the course of the curriculum. Accuracy, sensitivity, and specificity were 98.23% (confidence interval [CI] = 97.18–98.97), 97.01% (CI = 92.53–99.81), and 98.43% (CI = 97.33–99.81), respectively. Faculty self-rating of image quality was significantly higher than expert reviewer rating of image quality (3.4 ± 0.86 vs 3.2 ± 0.56, P < 0.0001). We found no change in expert reviewer rating of image quality over time. Faculty completed a combined 232.5 CME hours (average, 17.4 ± 10.8), with the majority of hours coming from an institutional POCUS CME workshop.

Conclusions
These results show that a structured curriculum can improve PEM faculty POCUS competency.
Funding Public Health: Achievements and Challenges in Public Health Financing Since the Institute of Medicine's 2012 Report
Authors: Yeager Valerie A. , Balio Casey P. , McCullough J. Mac , Leider Jonathon P. , Orr Jason , Singh Simone R. , Bekemeier Betty , Resnick Beth 
Published: February 2021

Objective:
The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report “For the Public's Health: Investing in a Healthier Future.”

Design:
Qualitative study involving key informant interviews.

Setting and Participants:
Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report.

Main Outcome Measures:
Qualitative feedback about changes to public health finance since the report.

Results:
Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow.

Conclusions:
Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level.

Implications for Policy and Practice:
Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.
Velocity of the Body Center of Mass During Walking on Split-Belt Treadmill
Authors: Tesio Luigi , Scarano Stefano , Cerina Valeria , Malloggi Chiara , Catino Luigi 
Published: February 2021

Abstract
Walking on split-belt treadmills (each belt rotating at a different velocity) has inspired a growing number of researchers to study gait adaptation and rehabilitation. An overlooked peculiarity of this artificial form of gait is that the mean velocity adopted by the participant, considered as a whole system represented by the body Center of Mass, can be different from the mean velocity of the two belts. Twelve healthy adults (21–34 yrs) were requested to walk for 15 mins on a treadmill with belts rotating at 0.4 and 1.2 m sec−1, respectively (mean = 0.8 m sec−1). Each belt was supported by four 3-dimensional force sensors. For each participant, six strides were analyzed during the 1st and the 15th minute of the trial. The mean Center of Mass velocity was computed as the sum of the velocities of each belt weighted by the percentage of time during which the resulting forces, underlying the accelerations of the Center of Mass, originated from each belt. Across early and late observations, the median Center of Mass velocities were 0.72 and 0.67 m sec−1, respectively (P < 0.05). Therefore, the real velocity of the Center of Mass and its time course should be individually assessed when studying walking on split-belt treadmills.
Lifetime Prevalence of Nonspecific Low Back Pain in Adolescents
Authors: Masiero Stefano , Sarto Fabio , Cattelan Manuela , Sarto Diego , Del Felice Alessandra , Agostini Francesco , Scanu Anna 
Published: February 2021

Background
Many nonconclusive studies have been conducted on low back pain (LBP) in adolescents and associated factors.

Objective
The aim was to assess the lifetime prevalence and associated factors of LBP in adolescents.

Materials and Methods
A questionnaire was administered in high school students (14–19-yr-old participants) in Veneto region (Italy). The self-administered, structured questionnaire included anthropometric data; psychologic factors and lifestyle; presence, intensity, and family history of LBP; referral to professional health care for LBP; and a short version of the International Physical Activity Questionnaire.

Results
A total of 6281 adolescents were recruited; 5204 questionnaires were included in the final analysis. A total of 2549 (48.98%) students reported one or more LBP episodes and 723 (13.89%) reported nonspecific disabling lumbar pain (i.e., no underlying pathology); 1040 (41.11%) subjects with LBP consulted a healthcare professional. A significant association emerged for LBP with sex (female), positive family history, time spent sitting or using electronic devices, sleep deprivation (<5 hrs/night), and low level of physical activity.

Conclusion
In a large sample of adolescents, LBP lifetime prevalence is high and often associated with disabling pain and sedentary lifestyle, requiring professional care. These findings may support the development of prevention and treatment strategies of LBP in adolescents, reducing the risk of developing chronic pain.
Safety of Every-Other-Day Fasting in the Treatment of Spinal Cord Injury
Authors: Zheng Jinqi , Liu Jiancheng , Jiang Yue , Pang Rizhao , Yang Xiao , Liu Hao , Lin Ning , Li Yunming , Xiong Deqi , Chen Xueqin , Yuan Li , Liu Jie , Plunet Ward T. , Wang Wenchun , Zhang Anren 
Published: February 2021

Abstract
Every-other-day fasting is effective for a variety of major human diseases, but the safety of these interventions is uncertain for patients with spinal cord injury. A randomized controlled study was conducted to investigate the safety of every-other-day fasting in patients with spinal cord injury. Participants who met the diagnostic inclusion and exclusion criteria were randomly divided into the control and every-other-day fasting groups. In the every-other-day fasting group, fasting lasted from 09:00 p.m. on day 1 to 06:00 p.m. on the following day (day 2). Dinner on day 2 was restricted to approximately 30% of the average daily calorie intake. The changes in plasma glucose were recorded daily for 2 days and every other day from the third day after every-other-day fasting intervention. The changes in albumin, prealbumin, plasma potassium, serum sodium, blood calcium, body weight, and body mass index were monitored at the baseline and at the end of the every-other-day fasting intervention. The results showed that compared with the control group, the mean blood glucose levels were significantly decreased from the second week after every-other-day fasting intervention. The body weight of patients in the every-other-day fasting group was notably reduced compared with that at baseline, whereas in body mass index, no obvious differences were observed before and after treatment with every-other-day fasting. In general, every-other-day fasting could be considered as a safe approach for individuals with spinal cord injury.
Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital
Authors: Kirshblum Steven C. , DeLauter Gabrielle , Eren Fatma , Pomeranz Bruce , DeLuca Robert , Hammerman Samuel , Gans Bruce M. 
Published: February 2021

Objective
The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital.

Design
This is a retrospective review.

Setting
The setting is three freestanding inpatient rehabilitation hospitals operating as one system.

Participants
The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer.

Interventions
A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital.

Outcome Measures
Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis.

Results
A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness.

Conclusions
The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.
Extracorporeal Shockwave Therapy With a Modified Technique on Tendon and Ligament for Knee Osteoarthritis
Authors: Ho Kun-Dong , Yang Chia-Ling , Lo Huei-Yu , Yeh Huan-Jui 
Published: February 2021

Background
There have been no definitive guidelines on the treatment method and specific points in the body.

Purpose
The aim of the study was to investigate the effects of extracorporeal shockwave therapy on treating the main tendons and ligaments of knee osteoarthritis.

Method
A total of 36 patients with knee osteoarthritis were enrolled in trial and organized into two groups: 3-wk extracorporeal shockwave therapy for the intervention group and 3-wk sham extracorporeal shockwave therapy for control group. Both groups received the same physical therapies: (1) transcutaneous electrical nerve stimulation, (2) magnetic field treatment, and (3) quadricep muscle strength training. Evaluation was performed before the start of treatment, at third week after the start of treatment, and 1 wk after the end of treatment. The study used randomized controlled trials (level of evidence, 1).

Result
Eextracorporeal shockwave therapy group had significant improvement in WOMAC pain score, physical function, and total score (mean difference = −2.8, P < 0.001; −5.1, P = 0.02; −8.3, P = 0.004, respectively), Visual Analog Scale score (mean difference = −2.3, P < 0.001), and the distance of 6-min walk test (mean difference = 28.7, P = 0.01) in the 1 wk after the end of treatment. Statistical significance in WOMAC pain, physical function, and total scores (mean difference = −3.0, P = 0.001; −5.6, P = 0.02; −9.3, P = 0.004, respectively) and Visual Analog Scale score (mean difference = −1.2, P = 0.027) was observed between the extracorporeal shockwave therapy group and control group.

Conclusions
Extracorporeal shockwave therapy for the tendons and ligaments has clinical benefits for pain and physical function improvement in knee osteoarthritis. In addition, improvement in physical performance was observed in the short-term follow-up.
Sustained Improvement in the Performance of Rapid Sequence Intubation Five Years after a Quality Improvement Initiative
Authors: Kerrey Benjamin T. , Mittiga Matthew R. , Boyd Stephanie , Frey Mary , Geis Gary L. , Rinderknecht Andrea S. , Ahaus Karen , Varadarajan Kartik R. , Luria Joseph W. , Iyer Srikant B. 
Published: February 2021

Introduction:
Many quality improvement interventions do not lead to sustained improvement, and the sustainability of healthcare interventions remains understudied. We conducted a time-series analysis to determine whether improvements in the safety of rapid sequence intubation (RSI) in our academic pediatric emergency department were sustained 5 years after a quality improvement initiative.

Methods:
There were 3 study periods: baseline (April 2009–March 2010), improvement (July 2012–December 2013), and operational (January 2014–December 2018). All patients undergoing RSI were eligible. We collected data using a structured video review. We compared key processes and outcomes with statistical process control charts.

Results:
We collected data for 615 of 643 (96%) patient encounters with RSI performed: 114 baseline (12 months), 105 improvement (18 months), and 396 operational (60 months). Key characteristics were similar, including patient age. Statistical process control charts indicated sustained improvement of all 6 key processes and the primary outcome measure (oxyhemoglobin desaturation) throughout the 5-year operational period.

Conclusions:
Improvements in RSI safety were sustained 5 years after a successful improvement initiative, with further improvement seen in several key processes. Further research is needed to elucidate the factors contributing to sustainability.