bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pedestrian Crossing Decisions in Virtual Environments: Behavioral Validity in CAVEs and Head-Mounted Displays
Authors: Schneider Sonja , Maruhn Philipp , Dang Nguyen-Thong , Pala Prashant , Cavallo Viola , Bengler Klaus 
Published: February 2021

Objective To contribute to the validation of virtual reality (VR) as a tool for analyzing pedestrian behavior, we compared two types of high-fidelity pedestrian simulators to a test track. Background While VR has become a popular tool in pedestrian research, it is uncertain to what extent simulator studies evoke the same behavior as nonvirtual environments. Method An identical experimental procedure was replicated in a CAVE automatic virtual environment (CAVE), a head-mounted display (HMD), and on a test track. In each group, 30 participants were instructed to step forward whenever they felt the gap between two approaching vehicles was adequate for crossing. Results Our analyses revealed distinct effects for the three environments. Overall acceptance was highest on the test track. In both simulators, crossings were initiated later, but a relationship between gap size and crossing initiation was apparent only in the CAVE. In contrast to the test track, vehicle speed significantly affected acceptance rates and safety margins in both simulators. Conclusion For a common decision task, the results obtained in virtual environments deviate from those in a nonvirtual test bed. The consistency of differences indicates that restrictions apply when predicting real-world behavior based on VR studies. In particular, the higher susceptibility to speed effects warrants further investigation, since it implies that differences in perceptual processing alter experimental outcomes. Application Our observations should inform the conclusions drawn from future research in pedestrian simulators, for example by accounting for a higher sensitivity to speed variations and a greater uncertainty associated with crossing decisions.
Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases
Authors: Hosoya Makoto , Fujioka Masato , Ogawa Kaoru 
Published: February 2021

Objectives: Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis. Methods: We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications. Results: The average postoperative air–bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed. Conclusions: The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.
Changes in Single‐Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single‐Institution Analysis Over Time
Authors: Katz Andrew P. , Misztal Carly , Ghiam Michael K. , Hoffer Michael E. 
Published: February 2021

ObjectivesTo determine changes in the prescriptions of postoperative opioids in response to Florida state legislation restricting the number of days for which these medications could be prescribed to 3 days in most circumstances or 7 days at provider discretion.Study DesignA retrospective review was performed for all patients undergoing 7 common outpatient otolaryngology surgical procedures.SettingSingle‐institution academic center in Florida.MethodsQuery of the state’s online prescription drug monitoring program was used to compare prescription habits 3 months before and after the law and then again 1 year later.ResultsA total of 561 patients were identified meeting criteria. The number of days that opioids were prescribed decreased significantly, from 6.42 to 4.48 to 3.03 days. There was a significant decrease in the proportion of patients receiving any postoperative opioid prescription, from 0.80 to 0.52 to 0.32. The total morphine milligram equivalents prescribed decreased from 28.4 before the law to 18.4 at 1 year after.ConclusionsLegislative restrictions on the length of opioid prescriptions were associated with significant decreases in the proportion of patients receiving any opioids, the number of days that opioids were prescribed, and the total morphine milligram equivalents 3 months after the law went into effect, with even more dramatic changes at the 1‐year time point. We opine that these changes are due to providers learning that many procedures do not require postoperative opioids and therefore increasingly considering and utilizing nonopioid alternatives in this setting.
Systematic Review and Meta‐analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation
Authors: Ho Sandra , Patel Prayag , Ballard Daniel , Rosenfeld Richard , Chandrasekhar Sujana 
Published: February 2021

ObjectiveTo systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches.Data SourcesPubMed, Embase, and Web of Science.Review MethodsAn electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded.ResultsThe database search yielded 1317 studies; 12 remained after dual‐investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta‐analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6‐dB mean improvement in the change in air‐bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous.ConclusionsEndoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.
‘Civilized States’ and Situational Sovereignty: The Dilemmas of Romanian Neutrality, 1914–1916
Authors: Prestia Joseph D. 
Published: February 2021

At the 1914 Crown Council, which decided to keep Romania neutral in 1914, former Conservative prime minister Petre Carp offered his succinct and direct opinion about the direction of Romanian foreign policy in the opening days of the Great War. He admonished the Council that, if Romania wanted to remain among the ‘civilized states’ ( statele civilizate) it had to follow Germany and Austria-Hungary into war immediately. The idea of ‘civilized states’ that dominated the remainder of the Crown Council was not merely an intersubjective social construction. It was a legal term of art in fin de siècle international law that could be applied in the real world. It was only the legally-civilized states that enjoyed the full panoply of rights, privileges, and protections under international law. This is a study of how Romania’s policy-making elite, and Ion I. C. Brătianu’s government, in particular, confronted the challenges of ‘situational sovereignty’. It asserts that, during Romania’s two-year Period of Neutrality (3 August 1914–17 August 1916), Brătianu initially used bilateral conventions as both a method to establish recognition of Romania’s status (or at least a guarantee of territorial integrity) and as a litmus test to determine which (if any) foreign powers recognized Romania as a legal equal. Although he was able to achieve a short-term victory of having an equality clause inserted into the August 1916 political convention with the Entente, it is unclear if that clause could have been durable. Ultimately, Brătianu was trapped between a desire to secure Romania’s recognition through international agreement, but confronted with the reality that Romania’s lack of recognition as a legally-civilized equal meant those very conventions could be unenforceable.
Multimodal ultrasound parameters aided carotid plaque risk stratification in patients with asymptomatic carotid stenosis
Authors: Li Yi , Zheng Shuai , Zhang Jinghan , Wang Fumin , He Wen 
Published: February 2021

Background Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.
TRESK background potassium channel modifies the TRPV1-mediated nociceptor excitability in sensory neurons
Authors: Lengyel Miklós , Hajdu Dominika , Dobolyi Alice , Rosta Judit , Czirják Gábor , Dux Mária , Enyedi Péter 
Published: February 2021

Background TWIK-related spinal cord potassium channel (TRESK) background potassium channels have a key role in controlling resting membrane potential and excitability of sensory neurons. A frameshift mutation leading to complete loss of TRESK function has been identified in members of a family suffering from migraine with aura. In the present study, we examined the role of TRESK channels on nociceptor function in mice. Methods Calcium imaging was used to investigate the role of TRESK channels in the modulation of the response evoked by transient receptor potential vanilloid 1 (TRPV1) receptor stimulation in dorsal root ganglion neurons. Release of calcitonin gene-related peptide from trigeminal afferents and changes in meningeal blood flow were also measured. Experiments were performed on wild-type and TRESK knockout animals. Results Inhibition of TRESK increased the TRPV1-mediated calcium signal in dorsal root ganglion neurons and potentiated capsaicin-induced increases in calcitonin gene-related peptide release and meningeal blood flow. Activation of TRESK decreased the capsaicin sensitivity of sensory neurons, leading to an attenuation of capsaicin-induced increase in meningeal blood flow. In TRESK knockout animals, TRPV1-mediated nociceptive reactions were unaffected by pretreatment with TRESK modulators. Conclusions Pharmacological manipulation of TRESK channels influences the TRPV1-mediated functions of nociceptors. Altered TRESK function might contribute to trigeminal nociceptor sensitization in migraine patients.
The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity
Authors: Goulart Alessandra C , Olmos Rodrigo Diaz , Santos Itamar S , Tunes Gisela , Alencar Airlane P , Thomas Neil , Lip Gregory YH , Lotufo Paulo A , Benseñor Isabela M 
Published: February 2021

Background Atrial fibrillation is a predictor of poor prognosis after stroke. Aims To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up. Methods All-cause mortality was analyzed by Kaplan–Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors. Results Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46–2039) vs. non-atrial fibrillation (1808, IQR: 334–3301), p-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43–2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36–3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30–0.50, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect ≥ 6 months: multivariable OR, 0.09; 95% CI: 0.01–0.65, p-value = 0.02), but not cardiovascular mortality. Conclusions Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality.
Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion
Authors: Wang Alicia , Zhou Guangwei , Kawai Kosuke , O’Brien Michael , Shearer A. Eliot , Brodsky Jacob R. 
Published: February 2021

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.
Smell and Taste Impairment in a Nationwide Sample of US Adults With Chronic Rhinosinusitis Symptoms
Authors: Kim James H. , Choi Janet , Jang Sophie S. , Wrobel Bozena B. , Ference Elisabeth H. 
Published: February 2021

ObjectiveTo estimate the prevalence of objectively confirmed olfactory and gustatory dysfunction in US adults reporting chronic rhinosinusitis (CRS) symptoms in a nationally representative database.Study DesignCross‐sectional epidemiologic analysis.SettingData were analyzed from the smell and taste component of the 2013‐2014 NHANES data set (National Health and Nutrition Examination Survey).MethodsIndividuals reporting the presence of ≥2 cardinal CRS symptoms (nasal blockage, sinus pain, discolored mucus, and dysosmia) were identified as patients with a potential diagnosis of CRS. Associations were examined between the presence of CRS symptoms and both self‐reported and objectively measured smell and taste.ResultsOne‐third (33%) of adults who have ≥2 CRS symptoms report subjective olfactory impairment, though only 18% of these adults have quantifiable olfactory dysfunction on objective testing. Of these adults, 27% report subjective taste impairment, but just 17% have quantifiable gustatory dysfunction on objective testing. The presence of ≥2 CRS symptoms was not significantly associated with objective olfactory or gustatory dysfunction, although the individual symptoms of subjective dysosmia and discolored mucus were associated with objectively confirmed olfactory dysfunction.ConclusionThe prevalence of objective olfactory and gustatory dysfunction was higher among adults reporting the presence of ≥2 CRS symptoms, but the differences were not statistically significant. Specific sinonasal symptoms, including discolored mucus and subjective smell dysfunction, were significantly associated with objective smell impairment.
Role of Interleukin 5 Inhibition in the Treatment of Eosinophilic Otitis Media
Authors: Breslin Nathaniel K. , Heindel N. Hadley , Haberman Rex S. 
Published: February 2021

ObjectiveEosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL‐5), have demonstrated efficacy in controlling eosinophil‐driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti‐IL‐5 drugs on chronic ear disease.Study DesignRetrospective chart review.SettingUniversity of Florida Health, an academic medical center.MethodsA review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections.ResultsAfter starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow‐up. The remaining 2 patients did not have effusions at the time when anti‐IL‐5 therapy was initiated, and they have not relapsed since starting treatment.ConclusionEOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti‐IL‐5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti‐IL‐5 therapies.
Dynamic angiopoietin-2 assessment predicts survival and chronic course in hospitalized patients with COVID-19
Authors: Villa Erica , Critelli Rosina , Lasagni Simone , Melegari Alessandra , Curatolo Angela , Celsa Ciro , Romagnoli Dante , Melegari Gabriele , Pivetti Alessandra , Di Marco Lorenza , Casari Federico , Arioli Dimitriy , Turrini Fabrizio , Zuccaro Valentina , Cassaniti Irene , Riefolo Mattia , de Santis Elena , Bernabucci Veronica , Bianchini Marcello , Lei Barbara , De Maria Nicola , Carulli Lucia , Schepis Filippo , Gozzi Chiara , Malaguti Silvio , Del Buono Mariagrazia , Brugioni Lucio , Torricelli Pietro , Trenti Tommaso , Pinelli Giovanni , Bertellini Elisabetta , Bruno Raffaele , Cammà Calogero , d’Errico Antonia 
Published: February 2021

Abstract
This study examined the association between dynamic angiopoietin-2 assessment and COVID-19 short- and long-term clinical course. We included consecutive hospitalized patients from 1 February to 31 May 2020 with laboratory-confirmed COVID-19 from 2 Italian tertiary referral centers (derivation cohort, n = 187 patients; validation cohort, n = 62 patients). Serum biomarker levels were measured by sandwich enzyme-linked immunosorbent assay. Lung tissue from 9 patients was stained for angiopoietin-2, Tie2, CD68, and CD34. Cox model was used to identify risk factors for mortality and nonresolving pulmonary condition. Area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of 3- and 10-day angiopoietin-2 for in-hospital mortality and nonresolving pulmonary condition, respectively. Three-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality by multivariate analysis (hazard ratio [HR], 6.69; 95% confidence interval [CI], 1.85-24.19; P = .004) with AUROC = 0.845 (95% CI, 0.725-0.940). Ten-day angiopoietin-2 of at least twofold from baseline was instead significantly associated with nonresolving pulmonary condition by multivariate analysis (HR, 5.33; 95% CI, 1.34-11.77; P ≤ .0001) with AUROC = 0.969 (95% CI, 0.919-1.000). Patients with persistent elevation of 10-day angiopoietin-2 levels showed severe reticular interstitial thickening and fibrous changes on follow-up computed tomography scans. Angiopoietin-2 and Tie2 were diffusely colocalized in small-vessel endothelia and alveolar new vessels and macrophages. Angiopoietin-2 course is strongly associated with COVID-19 in-hospital mortality and nonresolving pulmonary condition. Angiopoietin-2 may be an early and useful predictor of COVID-19 clinical course, and it could be a relevant part of disease pathogenesis. Angiopoietin-2 blockade may be a COVID-19 treatment option.