bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient Operative Management of Pediatric Supracondylar Humerus Fractures: An Analysis of Frequency, Complications, and Cost From 2009 to 2018
Authors: Modest Jacob M. , Brodeur Peter G. , Lemme Nicholas J. , Testa Edward J. , Gil Joseph A. , Cruz Aristides I. 
Published: November 2021

Background:
In an effort to increase the value of health care in the United States, there has been increased focus on shifting certain procedures to an outpatient setting. While pediatric supracondylar humerus fractures (SCHFs) have traditionally been treated in an inpatient setting, recent studies have investigated the safety and efficiency of outpatient surgery for these injuries. This retrospective study aims to examine ongoing trends of outpatient surgical care for SCHFs, examine the safety and complication rates of these procedures, and investigate the potential cost-savings from this shift in care.

Methods:
Pediatric patients less than 13 years old who underwent surgery for closed SCHF from 2009 to 2018 were identified using International Classification of Diseases-9/10 Clinical Modification and Procedural Classification System codes in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear regression was used to assess the shift in proportion of outpatient surgical management of these injuries over time. Multivariable Cox proportional hazards regression was used to compare return to emergency department (ED) visit, readmission, reoperation, and other adverse events. A 2-sample t test was performed on the average charge amount per claim for inpatient versus outpatient surgery.

Results:
A total of 8488 patients were included in the analysis showing there was a statistically significant shift towards outpatient management between 2009 (23% outpatient) and 2018 (59% outpatient) (P<0.0001). Relative to inpatient surgical management, outpatient surgical management had lower rates of return ED visits at 1 month (hazard ratio: 0.744, P=0.048). All other adverse events compared across inpatient and outpatient surgical management were not significantly different. The median amount billed per claim for inpatient surgeries was significantly higher than for outpatient surgeries ($16,097 vs. $9,752, P<0.0001). White race, female sex, and weekday ED visit were associated with increased rate of outpatient management.

Conclusions:
This study demonstrates the trend of increasing outpatient surgical management of pediatric SCHF from 2009 to 2018. The increased rate of outpatient management has not been associated with elevated complication rates but is associated with significantly reduced health care charges.

Level of Evidence:
Level III—retrospective cohort.
Reliability of 3 Radiologic Classifications for the Severity of the Developmental Dysplasia of the Hip in Children Older Than 4 Years
Authors: Singh Kumar A. , Ganjwala Dhiren , Gupta Parmanand , Vazhayil Kottamttavida Imthias , Varma Mahendra , Shah Hitesh 
Published: November 2021

Background:
Tonnis, International Hip Dysplasia Institute (IHDI), and lateral metaphyseal height (LMH) are commonly used classifications for grading the severity of the developmental dysplasia of the hip. The reliability of these classifications is not widely studied in older children. The aim of the study was to evaluate the reliability of these 3 radiologic classifications in children older than 4 years and compared with children younger than 4 years and evaluate the cases with varied inter-rater reliability.

Methods:
A purposeful sample of 40 children with untreated developmental dysplasia of the hip with ages between 6 months to 8 years was studied for the assessment of the severity grading according to all 3 classifications. Six pediatric orthopaedic surgeons classified all hips for all 3 categorical classifications as per the original description. Inter-rater and intrarater reliability was calculated according to the intraclass correlation coefficient. The cases with different ratings were assessed in detail to evaluate the reasons for the varied rating.

Results:
The interobserver and intraobserver reliability of all 3 classifications were excellent [intraclass correlation coefficient (ICC): 0.935, 0.820, and 0.935 for IHDI, Tonnis, and LMH classification, respectively]. The excellent reliability was also observed in younger and older children. Interobserver reliability of only dysplastic hips (52 hips) was good for Tonnis (ICC: 0.741) and excellent for IHDI (ICC: 0.911) and LMH classification (ICC-0.9). The main reason for the varied rating was because of the varied perception of the superolateral margin of the acetabulum in few hips.

Conclusion:
The inter-rater and intrarater reliability of all 3 classifications (IHDI, Tonnis, and LMH) is excellent. All classifications can be used till the age of 8 years. The difficulty in selecting the superolateral margin of the acetabulum is a major cause of inter-rater variability.

Level of Study:
Level III.
Evidence for Validity and Reliability, and Development of Performance Standards and Cut-Scores for Job-Related Tests of Physical Aptitude for Structural Firefighters
Authors: Scarlett Michael P. , Rogers W. Todd , Adams Eric M. , Dreger Randy W. , Petersen Stewart R. 
Published: November 2021

Objective:
This multi-part study aimed to revise an existing battery of physical aptitude tests for firefighter applicants. Test validity and reliability were evaluated and performance thresholds were determined.

Methods:
In Part I, 49 structural firefighters rated the similarity between the physical demands of the tests and corresponding work activities. In Part II, 23 participants completed the tests on 3 separate days. In Part III, cut-scores were determined using the Bookmark method by an expert panel of 25 firefighter supervisors.

Results:
Analysis revealed high levels of validity and reliability. The expert panel provided invaluable direction through a combination of independent and group work, leading to consensus on acceptable completion times.

Conclusion:
Rigorous processes established scientific credibility for the revised battery of tests. Expert knowledge from firefighter supervisors contributed to determining cut-scores following established scientific methods.
Health and Safety Practices and Perceptions of COVID-19 in Long-Haul Truck Drivers
Authors: Crizzle Alexander M. 
Published: November 2021

Objective:
To examine long-haul truck drivers (LHTD) perceptions of COVID-19 and their use of health and safety practices.

Methods:
146 LHTD completed an online survey to collect data on their experiences with COVID-19. Data were analyzed using descriptive and inferential statistics, and thematic analysis for open-ended responses.

Results:
LHTD were aged from 22 to 79 years (mean age 48.1 ± 11.8); 82.2% were men. Almost half of the sample were not concerned about COVID-19. Those not concerned were significantly less likely to employ health and safety practices (eg, wearing masks, social distancing), were less educated and healthier. They also perceived COVID-19 to not be real or a serious threat to their health.

Conclusions:
Tailored education approaches are needed to provide evidence-based data on COVID-19 risks and complications.
The diagnostic journey in adults with hypermobile Ehlers–Danlos syndrome and hypermobility spectrum disorders
Authors: Anderson Linda K. , Lane Kari R. 
Published: November 2021

ABSTRACT

Background:
Researchers have identified lengthy diagnosis delays in patients with hypermobile Ehlers–Danlos syndrome and hypermobility spectrum disorders (hEDS/HSD), but the reason for these delays is unclear.

Objective:
This review seeks to synthesize the existing qualitative research about hEDS/HSD to understand the reasons for diagnosis delay.

Data sources:
We searched PubMed, Scopus, CINAHL, Google Scholar, and Dissertations and Theses databases for all qualitative studies about hEDS/HSD that mentioned the diagnosis process. A total of 283 studies were retrieved, from which we identified 13 studies to include in this synthesis.

Conclusions:
The reviewers identified and organized diagnosis delay themes under four overarching categories: disease, patient, provider, and system. Disease factors included the nature of the symptoms and lack of a confirmatory test. Patient factors included psychological and emotional responses, seeing multiple providers, and receiving multiple diagnoses. Provider factors related to limited knowledge and attitudes. System factors included silo-based health care systems and bureaucratic barriers.

Implications for practice:
Diagnosis delays result from complex, overlapping, and interacting factors. Nurse practitioners have a critical role in improving care and reducing diagnosis delays in patients with hEDS/HSD. Further research is needed to understand the causes and consequences of diagnosis delays in hEDS/HSD.
Belching
Authors: Rangan Vikram , Sheth Tia , Iturrino Johanna , Ballou Sarah , Nee Judy , Lembo Anthony 
Published: November 2021

Purpose:Belching is a common condition that frequently overlaps with other functional gastrointestinal disorders. While not associated with any increase in mortality, it is associated with impaired health-related quality of life. Management is challenging, as there are no pharmacologic therapies specifically targeted towards this disorder. This review covers pathogenesis, prevalence, and treatments for this condition, with specific emphasis on the evolving role of behavioral treatments in management.Key Findings:The diagnosis of gastric and supragastric belching can usually be made clinically, without the need for invasive testing. If necessary, multichannel intraluminal impedance and pH testing can provide a more definitive diagnosis and can also be used to estimate the frequency of gastric and supragastric belching episodes, which each have a distinct appearance on impedance tracing. Belching disorders are commonly associated with gastroesophageal reflux disease and functional disorders of the gastrointestinal tract. Supragastric belching is also associated with behavioral disorders like anxiety and obsessive-compulsive disorder. Speech therapy, cognitive-behavioral therapy, and diaphragmatic breathing are all interventions that have recently shown promise in the management of this challenging disorder.
The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening
Authors: Sun Jiren , Perraillon Marcelo Coca , Myerson Rebecca 
Published: November 2021

Background:
Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening.

Objective:
The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening.

Research Design:
A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk.

Subjects:
A total of 11,163 individuals at high risk for lung cancer just above and below age 65.

Measure:
Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months.

Results:
A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%–30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: −19.8% to 23.0%, P=0.88).

Conclusions:
Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
Quality and Safety in Healthcare, Part XCII
Authors: Harolds Jay A. 
Published: November 2021

Abstract
Six Sigma is a methodology to diminish variation and errors and improve efficiency, quality, value, and profit, using certain defined steps and statistical analysis. For existing products and services, the DMAIC (Define, Measure, Analyze, Improve, and Control) acronym is used to stand for its steps. For new products and services, the Design for Six Sigma methodology is used. The goal of Six Sigma is to reduce the number of defects to no more than 3.4 for every million opportunities.
Dual-Phase 18F-Florbetaben PET/CT
Authors: Rudolphi-Solero Teodoro , Triviño Ibáñez Eva María , Aroui Tarik , Navidad Rocío Hervás , Gómez-Río Manuel 
Published: November 2021

Abstract
Dual-phase amyloid PET is considered a useful protocol to study patients with cognitive impairment. Early-phase 18F-florbetaben PET/CT has been proposed as a surrogate of 18F-FDG PET/CT providing information related to regional brain perfusion. We report the case of a 61-year-old woman referred to the cognitive impairment unit for study, preliminary diagnosed as probable Alzheimer disease. The dual-phase 18F-florbetaben PET/CT was shown as the main finding, no uptake in the left anterior thalamus. Memory and language symptoms have been described as primary clinical features of anterior thalamic infarctions that could be confused with the main manifestations of Alzheimer disease.
Rare Presentation of Late Complications After Undiagnosed Perforated Appendicitis Mimicking Recurrent Endometrial Carcinoma on 18F-FDG PET/CT
Authors: Dejanovic Danijela , Elgaard Tenna , Loft Annika , Mosgaard Berit Jul 
Published: November 2021

Abstract
Acute appendicitis is one of the most common causes of acute abdominal pain. Undiagnosed or untreated appendicitis can lead to serious complications. The most frequent complication of acute appendicitis is perforation with subsequent formation of a localized periappendiceal abscess or diffuse bacterial peritonitis. Late occurring complications following undiagnosed appendix perforation can pose a diagnostic challenge due to uncharacteristic clinical and imaging presentation. Herein, we describe late findings of undiagnosed perforated appendicitis that on 18F-FDG PET/CT mimicked recurrent endometrial carcinoma disease in a 67-year-old woman.
Radiation Recall Pneumonitis on FDG PET/CT Triggered by COVID-19 Vaccination
Authors: Hughes Nicola M. , Hammer Mark M. , Awad Mark M. , Jacene Heather A. 
Published: November 2021

Abstract
A 67-year-old man with metastatic lung adenocarcinoma was initially treated with whole-brain radiotherapy for intracranial metastases, followed by chemotherapy and pembrolizumab. After completing 2 years of systemic therapy, the primary right lung lesion was biopsy-proven to have residual adenocarcinoma, which was then treated with radiation (6000 cGy in 15 fractions). Follow-up serial FDG PET/CT showed radiation fibrosis. Eighteen months after radiotherapy, the patient received 2 doses of an mRNA COVID-19 vaccine. FDG PET/CT performed 4 days following his second vaccine dose showed FDG-avid multistation lymphadenopathy and radiation recall pneumonitis, likely vaccination-induced and mimicking recurrent disease. This resolved spontaneously without therapy.
Topographic Anatomy of the Zygomatico-Orbital Artery
Authors: Lee Hye-In , Park Jung-Ah , Yeo In-Seung , Koh Ki-Seok , Song Wu-Chul 
Published: November 2021

Abstract
The zygomatico-orbital artery (ZOA) originating from the superficial temporal artery and supplying the lower temporal region superficially has been reported. Previous studies of this artery have used definitions that are too ambiguous for the results to be directly adapted to clinical practice, including since they have resulted in marked variations in the reported incidence ofthe artery. This study dissected 193 hemifaces of 123 fixed human cadavers aged 36 to 102 years (119 males and 74 females). The authors investigated the ZOA based on the following definition: (1) it originates from the superficial temporal artery, (2) it runs mostly above the zygomatic arch, and (3) it terminates below the superior border of the orbicularis oculi muscle. The incidence of the ZOA was 22.8% (44 cases of 193 sides), and its mean diameter was 1.1 mm. The meanvertical distances from the superior borderofthe zygomatic arch to the artery were 29.6, 17.8, and 2.9 mm at the jugale, zygion, and the origin of the ZOA, respectively. An accurate definition of the ZOA and accurate knowledge of its incidence and course could be important for clinicians to avoid unintentional complications in clinical practice.
Early metabolic support for critically ill trauma patients: A prospective randomized controlled trial
Authors: Stolarski Allan E. , Young Lorraine , Weinberg Janice , Kim Jiyoun , Lusczek Elizabeth , Remick Daniel G. , Bistrian Bruce , Burke Peter 
Published: November 2021

BACKGROUND
There is a lack of consensus regarding the optimal nutritional support for trauma patients. We hypothesize that early postinjury metabolic support focusing on adequate protein would modify the metabolic signature and alter the inflammatory environment for critically ill trauma patients.

METHODS
We conducted a prospective randomized controlled pilot trial for adult patients admitted to the surgical intensive care unit following traumatic injury. Patients were randomized to receive early metabolic support (EMS) (peripheral amino acid infusions) or standard of care (enteral nutrition as soon as feasible). Routine laboratory assessments, nitrogen balance, cytokines, and metabolomic analyses were assessed at baseline and day 5 after intervention.

RESULTS
A total of 42 trauma patients were randomized into well-balanced groups with similar age (32 years), Injury Severity Score (25), and body mass index (27.4 kg/m2). Early metabolic support provided significantly more protein (1.43 g/kg vs. 0.35 g/kg; p < 0.0001) and more calories (12.6 kcal/kg vs. 7.5 g/kg; p = 0.0012) over the first 5 days as compared with the standard of care. Early metabolic support modified protein catabolism and synthesis as demonstrated by a larger median negative nitrogen balance (−16.3 g vs. −5.3 g; p = 0.03) and a unique metabolomic profile at day 5. The biochemical profile of patients who received EMS was defined by greater declines in circulating levels of stress hormone precursors and increased levels of amino acids. The inflammatory response following EMS resulted in a greater decrease in interleukin-1B (p = 0.02) and increase in soluble interleukin-6 receptor (p = 0.01) between baseline and day 5 as compared with the standard of care. The EMS group had a decreased length of stay (15 vs. 22 days) and decreased surgical intensive care unit length of stay (8 vs. 9 days); however, this disappeared after adjustment for Injury Severity Score in this small population.

CONCLUSIONS
Early metabolic support with amino acid is safe, modifies metabolism, and may downregulate the inflammatory state associated with significant trauma, warranting a larger trial to assess for improved outcomes.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
A more compact photoacoustic imaging system to detect periodontitis
Authors: Fu Lei , Ling Chen , Jin Zhicheng , Luo Jessica , Palma-Chavez Jorge , Wu Zhuohong , Zhou Jingcheng , Zhou Jiajing , Donovan Brian , Qi Baiyan , Mishra Aditya , He Tengyu , Jokerst Jesse V. 
Published: November 2021

AbstractPhotoacoustic imaging has shown value in periodontal disease, but the large size of conventional photoacoustic transducers prevents imaging of more posterior teeth, i.e., molars. Here, we report a clinical “hockey stick”-style transducer repurposed for photoacoustic (PA) via an integrated fiber bundle. The shape of the hockey stick transducer facilitates imaging of the 1st pre-molars in contrast to conventional photoacoustic transducer designs. This tool was then deployed for photoacoustic imaging of periodontal disease and the periodontal pocket via a food-grade contrast agent (cuttlefish ink). We characterized the resolution and imaging range and then validated the system with a swine model and human subjects. We could image four additional teeth per quadrant with the smaller design versus a commercial photoacoustic transducer. Three raters evaluated the performance of the hockey stick transducer. The measurements between the probing and the PA methods were blinded, but the outcomes were highly correlated. We showed a bias of ∼0.3 mm for the imaging-based technique versus conventional probing. In addition, the inter-reliability was over 0.60 for three different raters of varying experience suggesting that this approach to evaluating dental health is teachable and reproducible. Finally, we demonstrated the utility in a human subject and can image teeth much more posterior in the mouth than with conventional photoacoustic transducers.
Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared to the general population
Authors: Stubbs Jacob L. , Jones Andrea A. , Wolfman Daniel , Chan Ryan C. Y. , Vertinsky Alexandra T. , Heran Manraj K. , Su Wayne , Lang Donna J. , Field Thalia S. , Gicas Kristina M. , Woodward Melissa L. , Thornton Allen E. , Barr Alasdair M. , Leonova Olga , MacEwan G. William , Rauscher Alexander , Honer William G. , Panenka William J. 
Published: November 2021

ABSTRACTImportanceHomeless or precariously housed individuals live with poor health and experience premature mortality compared to the general population. With an increasing average age among this demographic, syndromes associated with neurogenerative disease are also increasing. Quantitative MRI measures may help define the roles of age and risk factors for poor brain health among these individuals.ObjectiveTo evaluate whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared to a general population sample.Design, setting, and participantsCross sectional comparison of baseline data from 312 community-based, precariously housed participants with a publicly available dataset of 382 participants recruited from the general population.Exposure(s)The primary exposure was housing status (precariously housed vs general population). Risk factors in the precariously housed sample included mental illness, substance dependence, intravenous drug use, HIV, and history of traumatic brain injury.Main outcome(s) and measure(s)The main outcomes were MRI measures of whole-brain tissue- to-intracranial volume ratio, fractional anisotropy, and mean diffusivity. Multiple linear regression and piecewise regression were used to evaluate differences in associations between MRI measures and age between the samples, and to explore associations with risk factors in the precariously housed sample.ResultsCompared to the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain FA (β=-0.32, p<0.0001), and higher whole-brain MD (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35-40 in the precariously housed sample. Frontal and temporal cortical thickness, corpus callosum volume, and diffusivity in the association tracts, corpus callosum, and thalamic radiations were the regions of interest most differentially affected. History of traumatic brain injury, stimulant dependence, and heroin dependence were associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample.Conclusions and relevanceOlder age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared to the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.