bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the Seattle Suprastomal Safety Score (5S): A Novel Measure in Pediatric Tracheostomy‐Dependent Patients
Authors: Pattisapu Prasanth , Abts Matthew F. , Bly Randall A. , Bonilla‐Velez Juliana , Dahl John P. , DeYoung Sarah C. Hofman , Horn David L. , Johnson Kaalan E. , Parikh Sanjay R. 
Published: September 2021

ObjectiveSuprastomal collapse and granulation are common sequelae of pediatric tracheostomy. We present the first measure of suprastomal obstructive pathology, the Seattle Suprastomal Safety Score (5S), an instrument with 2 domains: collapse and granulation.Study DesignCross‐sectional repeated testing survey.SettingElectronic survey.MethodsA library of images was assembled from still pictures of the suprastomal area in 50 patients who previously underwent trachea‐bronchoscopy at a quaternary children’s hospital. Five pediatric otolaryngologists and 2 pediatric pulmonologists reviewed the images in random, blinded fashion and provided 5S scores. Participants repeated this process 2 to 4 weeks later. Interrater agreement was calculated with an intraclass correlation coefficient (ICC) with a 2‐way random‐effects model and Fleiss’s κ. Intrarater agreement was measured with an ICC using a 2‐way mixed‐effects model as well as with test‐retest correlations using Spearman rank coefficient. All measures were performed separately on collapse and granulation domains.ResultsICC for interrater agreement was 0.88 (95% CI, 0.82‐0.93) for collapse and 0.97 (95% CI, 0.96‐0.98) for granulation, indicating almost perfect agreement. Fleiss’s κ demonstrated moderate agreement for collapse and almost perfect agreement for granulation. ICC for intrarater agreement was 0.95 (95% CI, 0.93‐0.97) and 0.99 (95% CI, 0.98‐0.99) for collapse and granulation, respectively, indicating almost perfect agreement. Spearman rank correlation for test‐retest demonstrated substantial agreement for collapse and almost perfect agreement for granulation.ConclusionThe 5S demonstrates excellent interrater and intrarater agreement, making it highly reliable as a novel measure of suprastomal collapse and granulation in tracheostomy‐dependent pediatric patients.
Access Challenge Index: A Novel Disparity Measure Predictive of Language Outcomes in Children Who Are Deaf/Hard of Hearing
Authors: Florentine Michelle M. , Strohl Madeleine P. , Benvenuti C. Sayard , Eiseman Molly , Ho Melissa , Meyer Anna K. , Scarpelli Chiara , Chan Dylan K. 
Published: September 2021

ObjectiveTo evaluate the effect of demographic disparities on language outcomes in a diverse group of children who are deaf or hard of hearing.Study DesignRetrospective cohort study.SettingUCSF Benioff Children’s Hospital (a tertiary care center).MethodsForty‐four patients aged <18 years were identified with sensorineural hearing loss managed with a behind‐the‐ear hearing aid or cochlear implant. Demographic and clinical data were extracted from the medical record. The primary outcome measure was the Preschool Language Scales–5 at least 6 months after intervention. Predictors of language outcome were assessed: hearing level at the time of hearing intervention, cochlear implant status, age of identification and intervention, travel time to site of hearing care, home language, race/ethnicity, insurance type, and Access Challenge Index—a novel measure of educational environment and family support based on the Child Cochlear Implant Profile. Multivariate and univariate analysis assessed predictors for association with intervention and receptive, expressive, and total language scores.ResultsOverall 82% of patients had cochlear implants. The median age at hearing intervention was 12 months. The sample was 59% female, 52% non‐White, and 61% publicly insured, and 20% had a non‐English primary home language. Accounting for multiple demographic and clinical predictors, a high Access Challenge Index score was independently associated with longer time to intervention (P =. 01) and poorer language outcomes (P <. 001).ConclusionAccess Challenge Index—a novel comprehensive measure of educational and family environment—is a strong independent predictor of language outcomes in children who are deaf or hard of hearing.
Survival Predictors of Head and Neck Burkitt’s Lymphoma: An Analysis of the SEER Database
Authors: Ahsanuddin Salma , Cadwell Joshua B. , Sangal Neel R. , Grube Jordon G. , Fang Christina H. , Baredes Soly , Eloy Jean Anderson 
Published: September 2021

ObjectiveTo analyze population‐level data for Burkitt’s lymphoma of the head and neck.Study DesignRetrospective study of a national cancer database.SettingAcademic medical center.MethodsThe SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt’s lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences.ResultsA total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10‐year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P <. 001) and higher stage at presentation had increased risk of mortality (P <. 001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P <. 001) and 1996 and 2005 (HR, 0.53; P =. 001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival (P <. 001).ConclusionBurkitt’s lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival.
Experiences of meaningful connection in the first weeks of the COVID-19 pandemic
Authors: Smallen Dave 
Published: September 2021

This qualitative study explored the question, “What kinds of interactions did people experience as meaningful connections with others during the first weeks of the COVID-19 pandemic in the Unites States?” Eighty-eight participants completed an online survey, 3 to 7 weeks following the World Health Organization’s declaration of global pandemic. Participants completed open-ended questions about social interactions they experienced as meaningful connections with people of three levels of familiarity. Thematic analysis of participant responses identified four overarching themes: openness to the other, affirmation of the self, emotional uplift, and meeting of basic needs. A secondary research question explored, “In what ways did people perceive the onset of the COVID-19 pandemic as affecting how meaningful connections were motivated, enacted, and experienced?” The context of the pandemic enhanced the meaning of social connection, offered a common struggle to connect over, and motivated prosociality. This study offers a descriptive window into the interactions experienced as meaningful connections in the first weeks of the COVID-19 pandemic and may usefully inform future research and applied work promoting social connections in current and future collective crises.
Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper
Authors: Keegan Orla , Murphy Irene , Benkel Inger , Limonero Joaquim T , Relf Marilyn , Guldin Mai-Britt 
Published: September 2021

Background: The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. Aim: The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. Design: In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%–79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. Setting/participants: The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. Results: In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% ( n = 87) and a follow-up response-rate of 79% ( n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. Conclusions: The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.
‘It was like taking an inner bath’: A qualitative evaluation of a collaborative advance care planning-approach
Authors: Pedrosa Carrasco Anna J , Koch Martin , Machacek Teresa , Genz Anna , Herzog Svenja , Riera Knorrenschild Jorge , von Blanckenburg Pia , Seifart Carola 
Published: September 2021

Background: Impaired readiness may hinder purposeful advance care planning in cancer patients. To reduce barriers to participation in end-of-life decision-making, a collaborative intervention was developed combining a psycho-oncological approach of dignity-based and cognitive-behavioural interventions, followed by a standardised advance care planning-process. Aim: To evaluate the novel collaborative advance care planning-approach by synthetising cancer patient and carer perspectives on communicational and relational effects. Design: As a sub-project of a mixed-methods evaluation study, we conducted an inductive content analysis of qualitative interviews with advanced cancer patients and caregivers to deeply explore the focused impact of a collaborative advance care planning-approach on communication and relationship dynamics. Setting/participants: Twelve patients with advanced cancer and 13 carers who participated in a collaborative advance care planning-intervention. Results: The collaborative advance care planning-approach was consistently evaluated positively by participants. Transcriptions of the semi-structured interviews were coded, analysed and merged under three main themes concerning communicational and relationship dynamics: action readiness, content readiness and impact on future communication and relationship. Conclusions: The novel intervention served to foster individual readiness – including action and content readiness – for advance care planning-discussions by addressing highly individualised barriers to participation, as well as specific end-of-life issues. In addition, societal readiness could be promoted. Although the brief psycho-oncological intervention could not fully meet the needs of all participants, it can be used to develop individual psychotherapeutic strategies to improve different facets of readiness. The collaborative advance care planning-approach might require more time and human resources, but could pioneer successful advance care planning.
Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor
Authors: Liu Jia , Tan Yuyong , Liu Deliang , Li Chenjie , Le Meixian , Zhou Hejun 
Published: September 2021

Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.
Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature
Authors: Kapetanakis Stylianos , Gkantsinikoudis Nikolaos , Charitoudis Georgios 
Published: September 2021

Background: Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. Purpose: To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. Results: Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. Conclusion: PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.
Effects of bis(2-ethylhexyl)-2,3,4,5-tetrabromophthalate on liver injury in Balb/c mice
Authors: Yin Jing , Zhang Bao 
Published: September 2021

Bis(2-ethylhexyl) 2,3,4,5-tetrabromophthalate (TBPH) has been used as a replacement in some commercial flame-retardant mixtures. It is widely used in industrial products, so the probability of human exposure to TBPH is high. Yet, little is known about how it is metabolized or its toxicity. To this end, we investigated what effect oral exposure of Balb/c mice to TBPH at concentrations of 200 mg kg−1 had on hepatic damage. Staining results showed liver injury in the mice exposed to TBPH. Oxidative stress markers and endoplasmic reticulum stress associated proteins were altered in the TBPH exposed mice, and these changes could be attenuated by administration of curcumin at 25 mg kg−1. Overall, TBPH induces hepatic damage via increasing oxidative stress, and curcumin plays a protective role in alleviating the TBPH-mediated histopathological alterations in the liver.
Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man
Authors: Oberhelman-Eaton Sara , Chang Alice , Gonzalez Cesar , Braith Andrew , Singh Ravinder J. , Lteif Aida 
Published: September 2021

Introduction: Transgender and gender diverse individuals may choose to provide their infants with human milk. Lactating transgender men may experience gender dysphoria and desire to initiate or reinitiate gender-affirming testosterone therapy. However, there is limited safety data regarding use of testosterone during lactation. Main Issue: A 30-year-old G2P2 transgender man with gender dysphoria sought to initiate gender-affirming testosterone therapy while lactating. Management: Subcutaneous testosterone was self-administered beginning at 13 months post-partum. We prospectively collected data on circulating testosterone concentrations in parent serum, milk, and infant serum over 5 months until the infant self-weaned. The infant was monitored for growth and development at routine pediatric outpatient appointments. Parent serum testosterone concentrations rose with the initiation of testosterone therapy, reaching therapeutic concentrations by Day 14. Milk testosterone concentrations also increased with a maximum concentration of 35.9 ng/dl when the lactating parent was on a dose of 80 mg subcutaneous testosterone cypionate weekly. The calculated milk/plasma ratio remained under 1.0 and the calculated relative infant dose remained under 1%. The infant had no observable side effects, and his serum testosterone concentrations remained undetectable throughout the study period. Conclusion: This is the first study with data regarding human milk and infant serum testosterone concentrations during the initiation of gender-affirming testosterone therapy in a lactating individual. This evidence can help families and clinicians with decisions regarding lactation and testosterone use.
Visual hallucinations in psychiatry – what aren’t we seeing?
Authors: Ayalde Jeremiah , Wearne Deborah , Hood Sean , Waters Flavie 
Published: September 2021

Objective: To increase awareness of practising clinicians and researchers to the phenomenological distinctions between visual hallucinations and trauma-based, dissociative, visual re-experiencing phenomena seen in psychiatric disease. Conclusions: The experience of visual hallucinations is not exclusive to psychotic disorders in psychiatry. Different forms of experiences that resemble visual hallucinations may occur in patients with a trauma background and may potentially affect diagnosis. Given the paucity of literature around the subject, it is imperative that further research aims to characterise the distinction between visual hallucinations in psychosis and visual phenomena associated with trauma.
Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program
Authors: Ansari Aziz , Baron Aliza , Nelson-Becker Holly , Deamant Catherine , Fitchett George , Fister Erik , O’Mahony Sean , Levine Stacie 
Published: September 2021

Context: Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness. Objectives: To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2). Methods: Participants developed their PIPs based on their institutional needs and through a mentor, and participated in monthly meetings and bi-annual conferences, thereby allowing for continued process improvement and feedback. Results: Thirty-seven interdisciplinary participants implemented 30 PIPs encompassing 7 themes: (1) staff education; (2) care quality and processes; (3) access to care; (4) documentation of care delivered; (5) new program development; (6) assessing gaps in care/patient needs; and (7) patient/family education. The majority of projects did achieve completion, with 16 of 30 projects reportedly being sustained several months after conclusion of the required training period. Qualitative feedback regarding mentors’ expertise and availability was uniformly positive. Conclusion: The CPMTP-2 demonstrates the positive impact of PIPs in the development of skills for interdisciplinary learners as part of a longitudinal training program in primary PC. Participation in a PIP with administrative support may lead to operational improvement within PC teams.
Anatomical Study of Sinus Tarsi–Based Lateral Lengthening Calcaneal Osteotomy
Authors: Aurich Matthias , Lenz Mark , Hofmann Gunther O. , Schubert Wiebke , Knobe Matthias , Roth Klaus Edgar , Simons Paul , Klos Kajetan 
Published: September 2021

Background: Lateral lengthening calcaneal osteotomy (LL-CO) is commonly performed as a treatment for an abducted midfoot in pes planovalgus deformity. The purpose of this study is to investigate potential damage to medial structures with a sinus tarsi LL-CO. Methods: Sixteen cadaver feet were used. Eight feet had an extended lateral approach, and 8 had a limited lateral (sinus tarsi) approach. All underwent a sinus tarsi LL-CO. Specimens were then dissected to identify inadvertent injury to medial structures. Results: Sinus tarsi LL-CO was associated with damage to the sustentaculum tali and medial articular facets in 56% and 62.5% of specimens, respectively. No anterior or posterior facet injuries were found, although 56% of specimens had a confluent medial and anterior facet. Conclusion: Damage to the medial articular facet and sustentaculum is possible with a flat cut sinus tarsi LL-CO due to the curved nature of the relevant sinus tarsi and canal anatomy. Clinical Relevance: Sinus tarsi LL-CO needs to be performed with caution since damage to the subtalar joint is possible. Level of Evidence: Level II, prospective cohort study.