bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of sleep–wake intraindividual variability in digital cognitive behavioral therapy for insomnia: a mediation analysis of a large-scale RCT
Authors: Vestergaard Cecilie L , Vedaa Øystein , Simpson Melanie R , Faaland Patrick , Vethe Daniel , Kjørstad Kaia , Langsrud Knut , Ritterband Lee M , Sivertsen Børge , Stiles Tore C , Scott Jan , Kallestad Håvard 
Published: May 2021

Abstract

Study Objectives
Digital cognitive behavioral therapy for insomnia (dCBT-I) is an effective treatment for insomnia. However, less is known about mediators of its benefits. The aim of the present study was to test if intraindividual variability in sleep (IIV) was reduced with dCBT-I, and whether any identified reduction was a mediator of dCBT-I on insomnia severity and psychological distress.

Methods
In a two-arm randomized controlled trial (RCT), 1720 adults with insomnia (dCBT-I = 867; patient education about sleep = 853) completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and sleep diaries, at baseline and 9-week follow-up. Changes in IIV were analyzed using linear mixed modeling followed by mediation analyses of ISI, HADS, and IIV in singular sleep metrics and composite measures (behavioral indices (BI-Z) and sleep disturbance indices (SI-Z)).

Results
dCBT-I was associated with reduced IIV across all singular sleep metrics, with the largest between-group effect sizes observed for sleep onset latency (SOL). Reduced IIV for SOL and wake after sleep onset had the overall greatest singular mediating effect. For composite measures, SI-Z mediated change in ISI (b = −0.74; 95% confidence interval (CI) −1.04 to −0.52; 13.3%) and HADS (b = −0.40; 95% CI −0.73 to −0.18; 29.2%), while BI-Z mediated minor changes.

Conclusion
Reductions in IIV in key sleep metrics mediate significant changes in insomnia severity and especially psychological distress when using dCBT-I. These findings offer important evidence regarding the therapeutic action of dCBT-I and may guide the future development of this intervention.

Clinical trials
Name: Overcoming Insomnia: Impact on Sleep, Health and Work of Online CBT-I
Registration number: NCT02558647
URL: https://clinicaltrials.gov/ct2/show/NCT02558647?cond=NCT02558647&draw=2&rank=1
Face mask wearing during the COVID-19 pandemic: comparing perceptions in China and three European countries
Authors: Zhao Xiang , Knobel Phil 
Published: May 2021

Abstract
Face mask recommendations are conflicting across the world during the coronavirus disease 2019 (COVID-19) pandemic. While universal face mask wearing is a useful non-pharmaceutical preventive strategy, little is known about the perception of mask wearing during a pandemic. This study aimed to examine people’s face mask use in China and Europe. An online survey was conducted among residents in China, Austria, Germany, and Switzerland from the 1st to 10th of April 2020. With a convenience sampling approach, 655 valid answers were received including 267 Chinese and 388 European residents (261 from Austria, 101 from Germany, 26 from Switzerland). Self-reported face mask wearing status and related perceptions were assessed. Compared with the Europeans, Chinese participants showed a stronger pro-masking tendency. Subjective norm was an important predictor of face mask wearing in public. Wearing of face masks in the Chinese sample was also associated with risk perception as well as obedience to advice from local health authority. Discrepancies in face mask wearing suggest that targeted measures to promote face mask wearing are needed in Europe. Globally coordinated guidelines on pandemics are also warranted to face the next waves of COVID-19 and other infectious respiratory diseases.
Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial
Authors: Spruill Tanya M , Friedman Daniel , Diaz Laura , Butler Mark J , Goldfeld Keith S , O’Kula Susanna , Montesdeoca Jacqueline , Payano Leydi , Shallcross Amanda J , Kaur Kiranjot , Tau Michael , Vazquez Blanca , Jongeling Amy , Ogedegbe Gbenga , Devinsky Orrin 
Published: May 2021

Abstract
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86–93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06–0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08–1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
Acute Fixation of Displaced Intra-articular Calcaneus Fractures Is Safe Using the Sinus Tarsi Approach
Authors: Joseph Noah M. , Benedick Alex , McMellen Christopher , Napora Joshua , Wetzel Robert , Sontich John , Ochenjele George 
Published: May 2021

Objective:
To analyze the correlation between surgical timing and outcomes for calcaneus fractures treated using a sinus tarsi approach (STA).

Setting:
Single Level-1 trauma center.

Design:
Retrospective.

Patients/Participants:
Seventy consecutive intra-articular calcaneus fractures (OTA/AO 82C; Sanders II-IV) treated operatively using STA with a minimum of 1-year follow-up.

Intervention:
Open management using STA.

Main Outcome Measurement:
Surgery timing, wound complications, American Orthopaedic Foot and Ankle Society ankle and hindfoot and Patient-reported Outcomes Measurement System scores.

Results:
Patients were primarily men (68.6%) averaging 46 years (range, 18–77 years). Nineteen (27%) were obese, 27 (38.6%) were smokers, and 3 (4.3%) were diabetic, and 10 (14.3%) had open fractures. Sanders III fracture patterns were most common (45.7%). Mean time to surgery was 4.9 days (range, 0–23 days). Three patients (4.2%) developed postoperative infections requiring surgical debridement and antibiotics. Forty patients (57%) underwent operative repair within 72 hours of injury, 9 (22.5%) of which had open fractures. Of this group, only one patient developed wound necrosis. Restoration of Bohler angle and angle of Gissane and reductions in calcaneal varus angle and heel width were achieved (all P < 0.001). No differences in Ankle Society ankle and hindfoot or Patient-reported Outcomes Measurement System scores were noted between patients treated within or beyond 72 hours from injury.

Conclusion:
Intra-articular calcaneus fractures can be treated acutely within 72 hours of injury using STA with minimal wound complications and without compromising short-term functional outcome.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery
Authors: Willems Ariane , De Groote Françoise , Schmartz Denis , Fils Jean-François , Van der Linden Philippe 
Published: May 2021

BACKGROUND
Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss.

OBJECTIVE
To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products.

DESIGN
Double-blinded randomised controlled trial.

SETTING
Tertiary children's hospital from 2013 to 2016.

PATIENTS
Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study.

INTERVENTION
Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h.

MAIN OUTCOME MEASURE
The primary outcome measure was calculated blood loss until the third postoperative day (POD3).

RESULTS
A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1] ml kg−1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg−1], P = 0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups.

CONCLUSION
The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.

TRIAL REGISTRATION
EudraCT identifier: 2012-006034-17 and ClinicalTrial.gov identifier: NCT02584868.
Within-visit and between-visit intra-individual blood pressure variability in an unselected adult population from rural China
Authors: Fan Wei-guo , Wang Wen-ying , Meng Ya-xing , Sharman James E. , Parati Gianfranco , Campbell Norm R.C. , Su Hai 
Published: May 2021

Objective:
To assess the association between the variability of blood pressure (BP) readings within an initial clinic visit, the variability within subsequent visits and the variability between visits over 1 week in a general population.

Methods:
This study included 1401 adult residents, who were not taking antihypertensive drugs, having BP measurements at three visits over 1 week. The difference between maximal and minimal BP readings (ΔBP), ΔBP/BPm (the mean BP value in a visit), the standard deviation (SD) and coefficient of variation (coefficient of variation = SD × 100/mean) of three BP values in each visit were used to estimate the within-visit BP variability (BPV). The SD and coefficient of variation of all nine BP readings over the three visits were calculated as SD9 or CV9 to reflect the overall BPV during the study visits. The SD and coefficient of variation on the mean BP values (BPm) of three visits were computed as SD-3 or CV-3, whereas the difference between maximal and minimal BP in three visits was computed as ΔBP-3 to estimate visit-to-visit BPV. The average BP or HR was the mean values of nine BP or HR readings over three visits.

Results:
The systolic and diastolic mean BP (SBP and DBP) decreased from the first to the third visit. The ΔBP, SD and coefficient of variation for both SBP and DBP at the first visit were positively and significantly correlated with the corresponding variables computed at the second and third visits, as well as with overall BPV (ΔBP9, SD9 and CV9). A positive correlation was also found between overall BPV and visit-to visit BPV (SD-3, CV-3 and ΔBP9). Multivariate analysis showed: no association between average SBP and systolic coefficient of variation or ΔBP/BPm but a negative association between average DBP and coefficient of variation or ΔBP/BPm for DBP at the first visit, DBP-3 and DBP9. Age was positively correlated with coefficient of variation or ΔBP/BPm for SBP at the first visit, SBP-3 and SBP9, and correlated with coefficient of variation and ΔBP/BPm for DBP only at the first visit.

Conclusion:
In a general population, within-visit BPV at an initial visit is associated with within-visit BPV at subsequent visits and with visit-to-visit BPV over three visits within 1 week.
The role of environment in the pathogenesis of keratoconus
Authors: de Azevedo Magalhães Otávio , Gonçalves Mauro Cabral , Gatinel Damien 
Published: May 2021

Purpose of review
This study was conducted to demonstrate the importance of the environment in keratoconus (KC) genesis.

Recent findings
Genetic-related connective tissue disorders demonstrate the inconsistency of theories regarding KC pathogenesis since no corneal steepening was observed in the majority of these patients. Despite recent advances and decades of research into the genetics of KC, the identification of disease-causing KC genes has been frustrating. Variants found based on genome-wide and next-generation sequencing only seem to account for a small number of cases or play a limited role in KC pathogenesis.

Summary
The literature shows that mechanical manipulation may be the common underlying factor or the indispensable act precipitating the cascade of events leading to permanent corneal deformation. Hence, ophthalmologists have the opportunity to increase patient awareness about eye manipulation repercussions and treatment for ocular surface disorders.

Video abstract

http://links.lww.com/COOP/A42
Update on corneal collagen crosslinking for ectasia
Authors: Pasha Hamza , Palazzolo Laura , Prakash Gaurav , Jhanji Vishal 
Published: May 2021

Purpose of review
Corneal collagen crosslinking (CXL) is a minimally invasive treatment that can stabilize corneal ectatic disorders including keratoconus, pellucid marginal degeneration, or postrefractive surgery ectasia. The benefits of CXL have been well documented. New research is focused on modifying current treatment protocols with the goals of maximizing corneal stability while also shortening overall procedure time.

Recent findings
Accelerated CXL protocols have the goal of delivering the same ultraviolet A intensity as conventional protocols, but over a shorter time period. Accelerated protocols have shown success to date, but there are concerns for long-term corneal stability. Pulsed protocols may increase the long-term efficacy of the accelerated designs. In addition, transepithelial crosslinking protocols have been designed with the goal of reducing postoperative pain and lower the risk of infectious complications of epithelial-off conventional protocols.

Summary
Newer CXL protocols attempt to make the procedure safer and more effective. Current research is promising, but long-term studies are essential to understand how the new protocols may affect corneal stability.
Evaluating Arterial Blood Flow Limitation Using Muscle Oxygenation and Cycling Power
Authors: Arnold Jem , Yogev Assaf , Koehle Michael S. 
Published: May 2021

Objective:
To explore the combination of measuring muscle oxygenation with near-infrared spectroscopy (NIRS) and cycling power during provocative incremental exercise for the detection of iliac arterial blood flow limitation (IAFL) in an otherwise healthy, well-trained cyclist.

Design:
Case report and methodological pilot study.

Setting:
University research setting.

Patient:
A well-trained amateur competitive male cyclist, aged 31 years, presenting with symptoms consistent with IAFL, but in whom diagnostic imaging was equivocal.

Interventions:
Four ramp incremental cycling tests performed on separate days to exercise intolerance, in a randomized order, in either typical race position (RP) or modified upright position (UP).

Main Outcome:
A novel ratio of unilateral cycling power to NIRS-derived muscle oxygenation termed “power-deoxygenation factor” was measured during provocative incremental exercise and compared with other NIRS-derived measures of vascular responsiveness and performance outcomes across the 2 body position conditions.

Results:
The power–deoxygenation factor was able to show clinically important, progressive differences between the affected and unaffected limbs, coinciding with worsening performance impairments related to the body position that were not detected with traditional measures of vascular responsiveness taken after exercise.

Conclusions:
This method was used to detect bilateral differences consistent with IAFL in a cyclist where traditional diagnostic criteria were equivocal, but subsequent intraoperative findings confirmed the diagnosis. A similar screening test could be performed noninvasively and without requiring specialized medical care. Future work should investigate the validity and sensitivity of this methodology to improve the ability to identify and monitor athletes with IAFL.
Modified AngioVac System use With Extracorporeal Membrane Oxygenation in a Child With Fontan Thrombosis
Authors: Priest John R. , Brown Mark , Choi Daniel , Thiagarajan Ravi , Roy Nathalie , Esch Jesse , Moynihan Katie M. 
Published: May 2021

The AngioVac System (AVS) extracts venous and pulmonary artery (PA) thrombi. We report modified use of the second-generation AVS with concurrent venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a 10-year-old, 23 kg patient with failing Fontan circulation due to acute-on-chronic Fontan and PA thrombosis. Emergent femoral VA-ECMO was initiated for profound hypoxemia during cardiac catheterization. Fluoroscopy-guided thrombo-embolectomy was performed with AVS components. A two-venous limb inflow cannulation strategy was used; the AngioVac cannula (AVC) was positioned in the central PA and joined to the existing ECMO venous-limb. Thrombus extraction proceeded by clamping the ECMO venous-limb with the existing VA-ECMO centrifugal pump generating negative pressure to the AVC. Extracorporeal membrane oxygenation arterial-limb access was used for blood return. Settings to avoid cavitation were a maximal negative pressure of 100 mmHg using <3500 RPMs. To access the branch PAs, the AVC was replaced by a custom-modified 17 Fr arterial ECMO cannula. Clot retrieval was sufficient for improved clinical status enabling ECMO discontinuation within 24-hours, and discharge home 26-days later.
This is the first description of successful subtotal thrombo-embolectomy with AVS components in a child with Fontan physiology concurrently supported on VA-ECMO, using one centrifugal pump. Although feasible, circuit modifications and close monitoring are required to avoid complications.
Hemodynamic monitoring in cardiogenic shock
Authors: VanDyck Tyler J. , Pinsky Michael R. 
Published: May 2021

Purpose of review
Cardiogenic shock remains a major cause of mortality today. With recent advancements in invasive mechanical support strategies, reperfusion practice, and a new classification scheme is proposed for cardiogenic shock, an updated review of the latest hemodynamic monitoring techniques is important.

Recent findings
Multiple recent studies have emerged supporting the use of pulmonary artery catheters in the cardiogenic shock population. Data likewise continues to emerge on the use of echocardiography and biomarker measurement in the care of these patients.

Summary
The integration of multiple forms of hemodynamic monitoring, spanning noninvasive and invasive modalities, is important in the diagnosis, staging, initial treatment, and subsequent management of the cardiogenic shock patient.
Applications of artificial intelligence in prostate cancer imaging
Authors: Baltzer Pascal A.T. , Clauser Paola 
Published: May 2021

Purpose of review
The purpose of this review was to identify the most recent lines of research focusing on the application of artificial intelligence (AI) in the diagnosis and staging of prostate cancer (PCa) with imaging.

Recent findings
The majority of studies focused on the improvement in the interpretation of bi-parametric and multiparametric magnetic resonance imaging, and in the planning of image guided biopsy. These initial studies showed that AI methods based on convolutional neural networks could achieve a diagnostic performance close to that of radiologists. In addition, these methods could improve segmentation and reduce inter-reader variability. Methods based on both clinical and imaging findings could help in the identification of high-grade PCa and more aggressive disease, thus guiding treatment decisions. Though these initial results are promising, only few studies addressed the repeatability and reproducibility of the investigated AI tools. Further, large-scale validation studies are missing and no diagnostic phase III or higher studies proving improved outcomes regarding clinical decision making have been conducted.

Summary
AI techniques have the potential to significantly improve and simplify diagnosis, risk stratification and staging of PCa. Larger studies with a focus on quality standards are needed to allow a widespread introduction of AI in clinical practice.
Evaluation of Drug-Related Risk Behaviors Among Females Diagnosed With Early Syphilis in New York State (Excluding New York City), 2013 to 2018
Authors: Drame Fanta , Bomma Srikanth , Miranda Wilson , Gelberg Kitty , Hart-Malloy Rachel 
Published: May 2021

Abstract
This evaluation describes an increase in reported drug-related risk behaviors among females who are diagnosed with early syphilis over a 5-year span in New York State, excluding New York City. Integrating sexually transmitted infection prevention efforts with harm reduction services may help decrease syphilis rates in areas where drug-related risk behavior rates are high.
Case Series: High-resolution Optical Coherence Tomography as an Optical Biopsy in Ocular Surface Squamous Neoplasia
Authors: Aboumourad Rami J. , Galor Anat , Karp Carol L. 
Published: May 2021

SIGNIFICANCE
Ocular surface squamous neoplasias are superficial tumors of the cornea and conjunctiva that can be sight threatening if neglected. Therefore, accurate noninvasive diagnostic modalities are needed.

PURPOSE
The purpose of this case series was to describe the hallmark features of ocular surface squamous neoplasia on high-resolution optical coherence tomography (HR-OCT) imaging and its use in the evaluation and management of superficial ocular tumors.

CASE SERIES
Five eyes of four patients with ocular surface squamous neoplasia are described. Whereas two eyes displayed the classic clinical features of ocular surface squamous neoplasia, three of the five eyes had more subtle atypical features. However, all shared features on HR-OCT of epithelial thickening and hyperreflectivity with abrupt transitions between normal and abnormal tissue, classic features of ocular surface squamous neoplasia. All lesions ultimately underwent incisional or excisional biopsy and were confirmed to be ocular surface squamous neoplasia on histopathology.

CONCLUSIONS
Ocular surface squamous neoplasia may present as a classic tumor but can also have subtle features or masquerade. Accurate methods to diagnose and manage patients with ocular surface squamous neoplasia are necessary. With recent advancements in technology, HR-OCT has been demonstrated to accurately identify ocular surface squamous neoplasia with the repeatable optical findings of (1) epithelial thickening, (2) epithelial hyperreflectivity, and (3) abrupt transition zone between normal and abnormal tissue. This case series demonstrates how HR-OCT can help provide an optical biopsy to guide appropriate diagnosis and management of this neoplastic lesion.