bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic
Authors: Sugimoto Dai , Gearhart Marina G. , Kobelski Greggory P. , Quinn Bridget J. , Geminiani Ellen T. , Stracciolini Andrea 
Published: April 2021

Objective:
To investigate clinical diagnoses, sports participation, and return to sport timeline associated with hallux sesamoid injuries with sex comparisons.

Design:
Descriptive epidemiology study.

Setting:
Sports medicine clinics at a tertiary-level pediatric medical center.

Patients:
Six hundred eighty-three young athletes (546 women and 137 men).

Independent Variables:
Sex (women vs men).

Main Outcome Measures:
Clinical diagnoses, participating sports, and injury timeline.

Results:
The most common diagnosis was sesamoiditis (62.6%). The top 3 primary sports were dance (34.6%), running (13.7%), and soccer (11.7%). When stratified by sex, dance (40.1%), running (13.6%), and soccer (10.7%) were the top primary sports for women while running (19.4%), soccer (18.5%), and basketball (11.3%) were the leading diagnoses for male athletes. The mean time between injury occurrence and first clinic visit was 135.5 ± 229.3 days. The mean time between the first clinic visit and return to sport was 104.3 ± 128.2 days. Comparison by sex showed that women had a longer mean time than men (women: 111.5 ± 132.5 days, men: 67.2 ± 96.3 days, P = 0.001). The mean time from injury occurrence to return to sport was 235.2 ± 281.0 days. Women showed a longer mean timeline for return to sport compared with men (women: 245.2 ± 288.2 days, men: 179.3 ± 231.9 days, P = 0.014).

Conclusion:
Sesamoiditis was the most common diagnosis, and dance, running, and soccer were top 3 sports. The most salient finding was that women taking almost twice as long to return the sport or activity compared with men, which likely stems from delay of reporting symptom onset to clinics.
Nonoperative Management of Posterior Shoulder Instability: What Are the Long-Term Clinical Outcomes?
Authors: Lee Julia , Woodmass Jarret M. , Bernard Christopher D. , Leland Devin P. , Keyt Lucas K. , Krych Aaron J. , Dahm Diane L. , Camp Christopher L. 
Published: April 2021

Objective:
To report the injury characteristics, radiographic findings, and long-term outcomes of nonoperative management for posterior shoulder instability (PSI).

Design:
A retrospective review of 143 patients with PSI using a large geographic database.

Setting:
Single county between January 1994 and July 2012.

Patients:
A clinical history and diagnosis of PSI, one confirmatory imaging study to support the diagnosis, and a minimum of 5 years follow-up were required for inclusion. Patients with seizure disorders, anterior-only instability, multidirectional instability, and superior labrum from anterior to posterior diagnosis were excluded.

Interventions:
Patients with PSI were managed nonoperatively or operatively.

Main Outcome Measures:
Pain, recurrent instability, and progression into glenohumeral osteoarthritis at long-term follow-up.

Results:
One hundred fifteen patients were identified. Thirty-seven (32%) underwent nonoperative management. Twenty (54%) patients were diagnosed with posterior subluxation, 3 (8%) with a single dislocation, and 7 (19%) with multiple dislocations. Symptomatic progression of glenohumeral arthritis was observed in 8% (3) of patients. Pain improved in 46% (17) of patients and worsened in 19% (7). Recurrent instability and progression to osteoarthritis occurred in 15% (3/20) of patients with a traumatic instability event compared with 0% of atraumatic patients after nonoperative management (P = 0.234). Pain at follow-up was more common in nonoperative than operative patients (P = 0.017).

Conclusions:
Nonoperative management is a viable option for many patients with posterior shoulder instability; however, many may continue to have posterior shoulder pain.
Use of the Independent Medical Spotter in Identifying Head Injuries in Division I Football Players
Authors: Norton Adam A. , Wilson John J. 
Published: April 2021

Objective:
Sport-related concussion (SRC) is a known risk of contact sports and strategies to minimize risk have been used. We aimed to determine if an independent medical spotter (IMS) identified more SRCs than would otherwise be detected by trained sideline medical staff (SMS).

Design:
Prospective review of SRCs during competition in the 2019 season and retrospective review of SRCs in the 2015 to 2018 seasons, which also used an IMS.

Setting:
Division I football games (home and away) of a Big 10 Conference institution.

Participants:
All football team members who participated in competition.

Independent Variables:
Occurrence of SRC during competition and whether the IMS or SMS directly visualized the injury.

Main Outcome Measures:
The total number of SRCs that occurred during competition in the 2015 to 2019 football seasons and whom observed the SRC—SMS or IMS—or if a student athlete reported symptoms after competition.

Results:
Over the 5-year study period, 24 SRCs occurred during competition. Of those, 19 (79.2%) were observed by SMS, 2 (8.3%) by the IMS, and 3 (12.5%) were reported to SMS after competition ended.

Conclusions:
Most SRCs are accurately identified by SMS, but a small number were apparent only to the IMS who seemed to add sensitivity in detecting a SRC. Instances remain in which SRC recognition and diagnosis were delayed despite trained SMS and IMS.

Clinical Relevance:
An IMS allows for a small-added player protection benefit using different vantage points to identify potential SRCs during competition.
Incidences of hypothyroidism and autoimmune thyroiditis are increased in patients with nonalcoholic fatty liver disease
Authors: Loosen Sven H. , Demir Münevver , Kostev Karel , Luedde Tom , Roderburg Christoph 
Published: April 2021

Background & aims
Nonalcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease, with about one in four people being affected in most areas of the world. Due to its strong association with metabolic syndrome, NAFLD is associated with high morbidity and mortality. Recent data have suggested a pathophysiological association between NAFLD and thyroid disease, but most studies are explorative and results remained conflicting. Here, we aimed at evaluating a potential association between NAFLD and hypothyroidism as well as autoimmune thyroiditis primary care patients in Germany.

Methods
Incidence rates of hypothyroidism and autoimmune thyroiditis were compared between a cohort of n = 40,583 patients with NAFLD and a cohort of equal size without NAFLD that was matched by sex, age, index year, obesity and diabetes within 10 years from the index date.

Results
Within the 10 years observation period, incidence of hypothyroidism was significantly higher among patients with NAFLD compared to patients without NAFLD [hazard ratio: 1.53 (95% confidence interval, 1.43–1.64), P < 0.001]. Importantly, regression analysis revealed that the association was significant in both men and women patients as well as in patients from all age groups. Moreover, NAFLD patients showed a significantly higher incidence rate of autoimmune thyroiditis compared to patients without NAFLD [hazard ratio: 1.55 (95% confidence interval, 1.34–1.79), P < 0.001]. This association was most pronounced in patients >70 years.

Conclusion
Our study provides strong evidence for a significant association between NAFLD and hypothyroidism as well as autoimmune thyroiditis in a large population-based cohort in Germany. This finding should trigger a particular awareness of thyroid diseases in this increasingly important patient group.
The semirecumbent position for high-resolution esophageal manometry. Results of a feasibility study
Authors: Siboni Stefano , Riva Carlo G , Ferrari Davide , Capuzzo Matteo , Asti Emanuele , Bonavina Luigi 
Published: April 2021

Objective
Normative values for high-resolution manometry (HRM) have been obtained with the patient lying supine. The aim of the study was to compare supine, semirecumbent and sitting positions during HRM in terms of variation in normative metrics, diagnostic yield, and patient’s comfort.

Methods
A prospective, single-center feasibility study was planned in consecutive patients referred to the esophageal function laboratory. In each of the three positions, 10 consecutive 5 ml water swallows and three 10 ml multiple rapid swallows were administered. Validated reflux questionnaires were administered prior to the test, and a visual analogue scale (VAS) assessing the patient’s comfort after the test.

Results
Twenty patients presenting with gastroesophageal reflux symptoms completed the study protocol. The intra-abdominal segment of the lower esophageal sphincter was significantly longer in the sitting position (P = 0.013), and the multiple rapid swallow distal contractile integral was lowest in the supine position (P = 0.012). The VAS comfort score did not significantly differ in the three body positions (P = 0.295). The concordance in the final diagnosis was 80% for semirecumbent vs. sitting (kappa = 0.15; P = 0.001), 70% for supine vs. sitting and 65.0% for semirecumbent vs. supine.

Conclusion
Compared to the supine position, both the semirecumbent and sitting position seems to provide similar advantages. HRM metrics and the final manometric diagnosis may be affected by body position, but complementary maneuvers, such are the rapid drink challenge, can resolve diagnostic discrepancies and improve the overall accuracy of the test.
Optimizing a decision support system for damage-control resuscitation using mixed methods human factors analysis
Authors: Schmulevich Daniela , Cacchione Pamela Z. , Holland Sara , Quinlan Kristin , Hinkle Alyson , Meador Chris , Abella Benjamin S. , Cannon Jeremy W. 
Published: April 2021

BACKGROUND
Damage-control resuscitation (DCR) improves trauma survival; however, consistent adherence to DCR principles through multiple phases of care has proven challenging. Clinical decision support may improve adherence to DCR principles. In this study, we designed and evaluated a DCR decision support system using an iterative development and human factors testing approach.

METHODS
The phases of analysis included initial needs assessment and prototype design (Phase 0), testing in a multidimensional simulation (Phase 1), and testing during initial clinical use (Phase 2). Phase 1 and Phase 2 included hands-on use of the decision support system in the trauma bay, operating room, and intensive care unit. Participants included trauma surgeons, trauma fellows, anesthesia providers, and trauma bay and intensive care unit nurses who provided both qualitative and quantitative feedback on the initial prototype and all subsequent iterations.

RESULTS
In Phase 0, 14 (87.5%) of 16 participants noted that they would use the decisions support system in a clinical setting. Twenty-four trauma team members then participated in simulated resuscitations with decision support where 178 (78.1%) of 228 of tasks were passed and 27 (11.8%) were passed with difficulty. Twenty-three (95.8%) completed a postsimulation survey. Following iterative improvements in system design, Phase 2 evaluation included 21 trauma team members during multiple real-world trauma resuscitations. Of these, 15 (71.4%) completed a formal postresuscitation survey. Device-level feedback on a Likert scale (range, 0–4) confirmed overall ease of use (median score, 4; interquartile range, 4–4) and indicated the system integrated well into their workflow (median score, 3; interquartile range, 2–4). Final refinements were then completed in preparation for a pilot clinical study using the decision support system.

CONCLUSIONS
An iterative development and human factors testing approach resulted in a clinically useable DCR decision support system. Further analysis will determine its applicability in military and civilian trauma care.

LEVEL OF EVIDENCE
Therapeutic/Care Management, Level V.
Preparations of Dutch emergency departments for the COVID-19 pandemic: a questionnaire-based study
Authors: O’Connor Rory D , Barten Dennis G , Latten Gideon HP 
Published: April 2021

AbstractBackgroundThe onset of the COVID-19 pandemic was characterized by rapidly increasing patient volumes, which necessitated a swift emergency department (ED) overhaul. Challenges mainly concerned surge capacity, frontline staff protection and the segregation of patients with suspected COVID-19. To date, only few studies have assessed nation-wide ED preparedness for the COVID-19 pandemic. This study aimed to form an overview of preparations that were taken in Dutch EDs during the initial phase of this public health crisis.MethodsThis study was designed as a nation-wide, cross-sectional, questionnaire-based study among Dutch hospital organizations with ≥1 ED. The questionnaire was conducted between the first and the second wave of the COVID-19 pandemic in the Netherlands and contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in the hospital’s crisis organization.ResultsOverall response rate was 79.5%. All EDs had made preparations in anticipation of a possible COVID-19 surge. Treatment capacity was expanded in 69.7% of EDs, with a median increase of 49% (IQR 32.5–72.7%). COVID-19 suspected patients were segregated from non-COVID-19 patients in 86.4% of EDs. Non-COVID-19 patients were more often assessed at alternative locations than patients with suspected COVID-19 infection. In 81.8% of EDs the workforce was expanded, which mainly concerned expansion of nursing staff. A formal role of EPs in the hospital’s crisis organization was reported by 93.9% of EP staffed hospital organizations.ConclusionAll Dutch EDs made preparations for COVID-19 in a short time span and with many uncertainties. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs had a prominent role, both in direct patient COVID-19 ED care and in the hospitals’ crisis organizations. Although it is vital for EDs to be able to dynamically adapt to community needs, variability of pandemic ED preparedness was high.
Mutation bias shapes the spectrum of adaptive substitutions
Authors: Cano Alejandro V. , Rozhoňová Hana , Stoltzfus Arlin , McCandlish David M. , Payne Joshua L. 
Published: April 2021

ABSTRACTEvolutionary adaptation often occurs via the fixation of beneficial point mutations, but different types of mutation may differ in their relative frequencies within the collection of substitutions contributing to adaptation in any given species. Recent studies have established that this spectrum of adaptive substitutions is enriched for classes of mutations that occur at higher rates. Yet, little is known at a quantitative level about the precise extent of this enrichment, or its dependence on other factors such as the beneficial mutation supply or demographic conditions. Here we address the extent to which the mutation spectrum shapes the spectrum of adaptive amino acid substitutions by applying a codon-based negative binomial regression model to three large data sets that include thousands of amino acid changes identified in natural and experimental adaptation inS. cerevisiae,E. coli, andM. tuberculosis. We find that the mutation spectrum has a strong and roughly proportional influence on the spectrum of adaptive substitutions in all three species. In fact, we find that by inferring the mutation rates that best explain the spectrum of adaptive substitutions, we can accurately recover species-specific mutational spectra obtained via mutation accumulation experiments. We complement this empirical analysis with simulations to determine the factors that influence how closely the spectrum of adaptive substitutions mirrors the spectrum of amino acid variants introduced by mutation, and find that the predictive power of mutation depends on multiple factors including population size and the breadth of the mutational target for adaptation.SIGNIFICANCE STATEMENTHow do mutational biases influence the process of adaptation? Classical neo-Darwinian thinking assumes that selection alone determines the course of adaptation from abundant pre-existing variation. Yet, theoretical work shows that under some circumstances the mutation rate to a given variant may have a strong impact on the probability of that variant contributing to adaptation. Here we introduce a statistical approach to analyzing how mutation shapes protein sequence adaptation, and show that the mutation spectrum has a proportional influence on the changes fixed in adaptation observed in three large data sets. We also show via computer simulations that a variety of factors can influence how closely the spectrum of adaptive substitutions mirrors the spectrum of variants introduced by mutation.
Diversity of vaccination-induced immune responses can prevent the spread of vaccine escape mutants
Authors: Bouman Judith A , Capelli Céline , Regoes Roland R 
Published: April 2021

AbstractPathogens that are resistant against drug treatment are widely observed. In contrast, pathogens that escape the immune response elicited upon vaccination are rare. Previous studies showed that the prophylactic character of vaccines, the multiplicity of epitopes to which the immune system responds within a host, and their diversity between hosts delay the evolution and emergence of escape mutants in a vaccinated population. By extending previous mathematical models, we find that, depending on the cost of the escape mutations, there even exist critical levels of immune response diversity that completely prevent vaccine escape. Furthermore, to quantify the potential for vaccine escape below these critical levels, we propose a concept ofescape depthwhich measures the fraction of escape mutants that can spread in a vaccinated population. Determining this escape depth for a vaccine could help to predict its sustainability in the face of pathogen evolution.
Beyond the fish-Daphniaparadigm: testing the potential forNeoplea striola(Hemiptera: Pleidae) to cause a trophic cascade in subtropical ponds
Authors: Rakowski Chase J. , Leibold Mathew A. 
Published: April 2021

AbstractTrophic cascades, or indirect effects of predators on non-adjacent lower trophic levels, have become paradigmatic in ecology, though they are thought to be stronger in aquatic ecosystems. Most research on freshwater trophic cascades focused on temperate lakes, where fish are present and whereDaphniatend to dominate the zooplankton community. These studies identified thatDaphniaoften play a key role in facilitating trophic cascades by linking fish to algae with strong food web interactions. However,Daphniaare rare or absent in most tropical and subtropical lowland freshwaters, and fish are absent from small and temporary water bodies, where invertebrates fill the role of top predator. While invertebrate predators are ubiquitous in freshwater systems, most have received little attention in food web research. Therefore, we aimed to test whether trophic cascades are possible in small warmwater ponds where small invertebrates are the top predators andDaphniaare absent. We collected naturally occurring plankton communities from small fishless water bodies in central Texas and propagated them in replicate pond mesocosms. We removed zooplankton from some mesocosms, left the plankton community intact in others, and added one of two densities of the predaceous insectNeoplea striolato others. Following an incubation period we then compared biomasses of plankton groups to assess food web effects between the trophic levels including whetherNeopleacaused a trophic cascade by reducing zooplankton. The zooplankton community became dominated by copepods which prefer large phytoplankton and exhibit a fast escape response. Perhaps due to these qualities of the copepods and perhaps due to slow consumption rates byNeopleaon key grazers, no evidence for food web effects were found other than somewhat weak evidence for zooplankton reducing large phytoplankton. More research is needed to understand the behavior and ecology ofNeoplea, but trophic cascades may generally be weak or absent in fishless low-latitude lowland water bodies whereDaphniaare rare.
Human Leukocyte Antigen-C and Haplotypes: Associations with Resistance and Susceptibility to HIV-1 Infection among Serodiscordant Couples in Nigeria
Authors: Otuonye Ngozi Mirabel , Luo Ma , Enabulele Onaiwu Idahosa , James Ayorinde , Emele Felix , Ele Prince , Bielawny Thomas , Ojetunde Mercy Mayowa , Odunukwe Nkiruka Nnonyelum 
Published: April 2021

ABSTRACTINTRODUCTIONThe Human Leucocyte Antigen (HLA) class-1 is known to play a significant role in mediating resistance or susceptibility to HIV infection in the clinical course of AIDS. Recent studies have identified HLA-C as a key molecule that affects HIV disease progression. However, the role of HLA class 1 in heterosexual HIV-1 susceptibility or resistance in serodiscordant couples is not known in Nigeria. Therefore, this study evaluated the association between HLA-C susceptibility and resistance in HIV-1 transmission amongst heterosexual serodiscordant couples in Nigeria.METHODSA total of 271 serodiscordant, concordant HIV positive and negative couples who gave informed consent were enrolled into this study. Extracted genomic DNA was sequenced for high resolution HLA-C class 1 genotypes using allele-specific primers (on exons 2 and 3) for HLA-C sequencing and typing.RESULTSThe highest frequency distribution of high-resolution HLA-C alleles observed in the HIV positive subjects were: HLA-C*040101 178 (35.0%) followed by C*0701 124 (24.9%) compared with HIV negative subjects: C*040101 108(39.0%) followed by C*0701 64(24.7%). Alleles C*070201 (OR = 4.19, P<0.05) and C*0804 (OR = 3, P<0.045) were found to be independently associated with HIV-1 susceptibility in the cohort of serodiscordant couples. HLA-C*0802 (OR=0.5. P<0.005) and C*0304 (OR=0.34. P<0.002) were significantly associated with HIV-1 resistance to HIV-1 infection among the cohort.CONCLUSIONThe result has contributed to the importance of how host HLA-C genetic factors can influence HIV-1 disease susceptibility (HLA-C*070201; C*0804) and resistance (HLA-C*0802; C*0304) in serodiscordant couples. This information may contribute to the development of future effective HIV vaccine in Nigeria.