bluuebunny/crossref_metadata_2025_split huggingface dataset:
Headaches
Authors: Hershey Andrew D. 
Published: June 2021

Abstract
This chapter discusses recurrent headaches, especially when episodic, which are much more likely to represent primary headache disorders. Primary headaches are intrinsic to the nervous system and are the disease itself. Early recognition of the primary headaches in patients should result in improved response and outcome, minimizing the impact of the primary headaches and disability. Primary headaches can be grouped into migraine, tension-type headaches, and trigeminal autonomic cephalalgia, and an additional grouping of rarer headaches without a secondary cause. The primary headache that has the greatest impact on a child’s quality of life and disability is migraine, and subsequently is the most frequent primary headache brought to the attention of parents, primary care providers, and school nurses.
Occupational and physical therapy for pain in pediatric clients
Authors: Tupper Susan M. , Engel Joyce M. , Swiggum Mary , Holsti Liisa 
Published: June 2021

Abstract
Occupational therapists (OTs) and physical therapists (PTs) are rehabilitation therapists with distinct but complementary roles who contribute to pain assessment and management in young people either as solo providers, or as a critical component of the interdisciplinary treatment team. Pain in infants, children, and adolescents interferes with their ability to engage in essential interactions with caregivers, acquisition of developmental milestones, and with participation in activities related to self-care, leisure, play, school, and work. OTs and PTs use specific treatment strategies, such as positioning, splinting, adaptive equipment, exercise, manual therapy, electrophysical agents, education on energy conservation, joint protection strategies, and pain self-management training to facilitate participation in valued life activities and occupations. This chapter provides an overview of important theoretical frameworks for rehabilitation therapists, reviews evidence for OT and PT interventions, and describes a framework for planning procedural pain management for rehabilitation therapists when working with pediatric clients.
Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center
Authors: Jaskiewicz Jennifer L , Garry Conor B , Ernst Andrew J , Cole Jacob H , Allen Miranda L , Fox Catherine C , Gendron Richard T , Gentry Shari L , Hughey Scott B , Stedje-Larsen Eric T 
Published: June 2021

ABSTRACT

Objective
In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics.

Design
This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines.

Methods
Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period.

Results
Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence.

Conclusion
Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.
‘Conversion Therapy’ As Degrading Treatment
Authors: Trispiotis Ilias , Purshouse Craig 
Published: June 2021

Abstract—
This article responds to the widespread uncertainty in UK and international human rights law over the legality of ‘conversion therapy’, a set of practices that aim to eradicate LGBTIQ+ sexualities and gender identities. The article pursues two main arguments. First, it is argued that all forms of ‘conversion therapy’ are disrespectful of the equal moral value of LGBTIQ+ people and violate specific protected areas of liberty and equality that are inherent in the idea of human dignity. Secondly, the article develops a theoretical account of degrading treatment under article 3 of the European Convention on Human Rights that illuminates the relationship between the prohibition of degrading treatment, human dignity and antidiscrimination. It is then argued that ‘conversion therapy’, in all its different forms, spawns the specific kind of degradation that UK and international human rights law prohibit. The article ends by analysing the positive state obligations that arise in this context.
The UV sensitivity of the Higgs potential in Gauge–Higgs Unification
Authors: Yamada Atsuyuki 
Published: June 2021

Abstract
In this paper, we discuss the UV sensitivity of the Higgs effective potential in a Gauge--Higgs Unification (GHU) model. We consider an $SU(\mathcal N)$ GHU on $\mathbf M^4\times S^1$ spacetime with a massless Dirac fermion. In this model, we evaluate the four-Fermi diagrams at the two-loop level and find them to be logarithmically divergent in the dimensional regularization scheme. Moreover, we confirm that their counter-terms contribute to the Higgs effective potential at the four-loop level. This result means that the Higgs effective potential in the GHU depends on UV theories as well as in other non-renormalizable theories.
Legal landscape of trust law in Thailand: the fading twilight of common law trusts and the sunrise of statutory trusts
Authors: Reekie Adam , Reekie Surutchada , Ruengsrichaiya Kaipichit 
Published: June 2021

Abstract
The creation of trusts in Thailand was strictly prohibited by the adoption of the Civil and Commercial Code in 1935. However, this civil law jurisdiction is currently home to a number of trusts: those created prior to 1935 in accordance with English law and trusts for use in capital markets, a statutory exception introduced in 2008. With a bill introducing trusts for personal asset management in the legislative pipeline, this article presents a timely overview of this little-known but evolving trust law landscape.
Functional Imaging of the Cerebellum during Action Execution and Observation
Authors: Raos Vassilis , Savaki Helen E 
Published: June 2021

Abstract
We employed the 14C-deoxyglucose autoradiographic method to map the activity in the cerebellar cortex of rhesus monkeys that performed forelimb movements either in the light or in the dark and of monkeys that observed forelimb movements executed by a human experimenter. The execution of forelimb movements, both in the light and in the dark, activated the forelimb representations in the cerebellar hemispheric extensions of 1) vermian lobules IV–VI and 2) vermian lobule VIIIB, ipsilaterally to the moving forelimb. Activations in the former forelimb representation involved both a paravermal and a lateral hemispheric region. Also, Crus II posterior in the ansiform lobule (the hemispheric expansion of lobule VIIB) was activated bilaterally by execution of movements in the light but not in the dark. Action observation activated the lateral-most region of the forelimb representation in the lateral hemispheric extension of vermian lobules IV–VI, as well as the crus II posterior, bilaterally. Our results demonstrate that the cerebellar cortex, in addition to its involvement in the generation of movement, is also recruited in the perception of observed movements. Moreover, our findings suggest a modularity gradient in the primate cerebellar cortex, which progresses from unimodal (medially) to multimodal (laterally) functional areas.
Mechanism Exploration of 3-Hinge Gyral Formation and Pattern Recognition
Authors: Razavi Mir Jalil , Liu Tianming , Wang Xianqiao 
Published: June 2021

Abstract
The 3-hinge gyral folding is the conjunction of gyrus crest lines from three different orientations. Previous studies have not explored the possible mechanisms of formation of such 3-hinge gyri, which are preserved across species in primate brains. We develop a biomechanical model to mimic the formation of 3-hinge patterns on a real brain and determine how special types of 3-hinge patterns form in certain areas of the model. Our computational and experimental imaging results show that most tertiary convolutions and exact locations of 3-hinge patterns after growth and folding are unpredictable, but they help explain the consistency of locations and patterns of certain 3-hinge patterns. Growing fibers within the white matter is posited as a determining factor to affect the location and shape of these 3-hinge patterns. Even if the growing fibers do not exert strong enough forces to guide gyrification directly, they still may seed a heterogeneous growth profile that leads to the formation of 3-hinge patterns in specific locations. A minor difference in initial morphology between two growing model brains can lead to distinct numbers and locations of 3-hinge patterns after folding.
Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children’s Schooldays
Authors: Sugawara Ryo , Kikkawa Ichiro , Watanabe Hideaki , Taki Naoya , Tomisawa Hiroko , Takeshita Katsushi 
Published: June 2021

Background:
Cast and brace treatment is a conservative treatment for early-onset scoliosis (EOS). We analyzed the clinical results of this treatment when extended into patients’ schooldays.

Methods:
Twenty-two children with EOS underwent alternatively repetitive cast and brace treatment (ARCBT). Cast was applied under general anesthesia and remained for some weeks, and the brace was continuously worn, which was repeatedly applied when scoliosis progressed. The change in the major curve angle, requirement for surgical intervention, and complications of ARCBT were analyzed.

Results:
Six patients had idiopathic scoliosis (IS), 9 had syndromic scoliosis (SS), and 7 had neuromuscular scoliosis. Cast treatment started at 4.9±2.1 years of age, and the patients were followed up for 8.3 years. The average total number of cast applications was 5.5 per patient. The mean major scoliosis angle was 45.4±12.5 degrees at the first visit; this was corrected to 26.5±8.7 degrees at the first cast application and progressed to 75.4±22.1 degrees at the final visit. Nine patients whose scoliosis progressed finally underwent surgery. The mean age at surgery was 11.0 years (range, 8.8 to 13.1 y), and the mean period from first cast application to surgery was 6.1 years (range, 5.0 to 8.9 y). Four patients’ IS rapidly progressed after 9 years of age, and all of them underwent final fusion surgery with a correction rate of 56.9%. Among patients with SS, 1 final fusion, and 2 growth-friendly surgeries were performed at a mean age of 9.2 years; the correction rate was 21.5%. Among patients with neuromuscular scoliosis, 2 final fusion surgeries were performed at a mean age of 11.3 years; the correction rate was 30.7%. The cast-related complication rate was 5.0%, and most complications were skin problems.

Conclusions:
Long-term ARCBT extended into schooldays might be effective for IS. This should be considered as a time-saving treatment option for EOS.

Level of Evidence:
Level IV—case series.
A CASE OF HIGH-RISK CILIARY BODY MELANOMA ARISING IN AN EYE AFTER RESECTION OF AN IRIDOCILIARY MELANOCYTOMA
Authors: Lee Terry , Semenova Ekaterina , Proia Alan D. , Materin Miguel A. 
Published: June 2021

Purpose:
To report a case of a benign iridociliary melanocytoma recurring as malignant melanoma after excision.

Methods:
Observational case report with clinical data, slit-lamp examination findings, ultrasound biomicroscopy results, and histopathological and genetic analyses.

Results:
A 40-year-old African American woman initially presented with a superonasal iridociliary mass with a maximal thickness of 2.5 mm. Visual acuity of the involved eye was 20/25, intraocular pressure was 52 mmHg on maximal pressure-lowering medications, and Humphrey visual field testing revealed an inferior altitudinal defect. Fine-needle aspiration biopsy and incisional biopsy followed by tumor excision confirmed a benign melanocytoma. After 5 years of stability, possible recurrence was detected on ultrasound biomicroscopy as an increase in ciliary body thickness. The new lesion grew to a thickness of 5.1 mm over the next 18 months of observation. Fine-needle aspiration biopsy and gene expression profile of the recurrent lesion diagnosed a malignant melanoma with high metastatic potential (Class 2). The patient underwent plaque brachytherapy and has ongoing regression of the tumor.

Conclusion:
Transformation of benign iridociliary melanocytoma to melanoma is rare. To the best of the authors' knowledge, this is the first documented case of a melanoma arising in an eye after initial excision of a melanocytoma. Close monitoring of these patients is warranted even years after the initial excision.
Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis
Authors: Ahammout Chaima , Perez Francisco A. , Birgfeld Craig B. , Koudstaal Maarten J. , Ellenbogen Richard G. , Lee Amy , Heike Carrie L. 
Published: June 2021

Background:
Postoperative computed tomography scans allow for evaluation of the structural results of cranial vault reconstruction and potential surgical concerns. The authors evaluated the clinical utility of routine postoperative scans to identify relevant surgical findings in children treated for craniosynostosis.

Methods:
The authors conducted a retrospective study of postoperative computed tomography reports for patients with craniosynostosis following cranial vault reconstruction during a 9-year period at their tertiary care pediatric hospital. They categorized postoperative computed tomography findings as typical, atypical, or indeterminate. Images with reported indeterminate or atypical findings were reviewed and verified by a pediatric neuroradiologist and a pediatric neurological surgeon. Clinical outcomes of patients with abnormal postoperative images were assessed with chart review for clinical relevance.

Results:
Postoperative computed tomography radiology reports for 548 operations in 506 participants were included. Most participants had single-suture craniosynostosis (89 percent), were male (64 percent), and under 1 year of age (78 percent). Surgically concerning scans were described in 52 reports (<9.5 percent), and the research team’s pediatric neuroradiologist confirmed abnormal findings in 36 (6.5 percent). Potentially relevant abnormal findings included subdural blood (n = 18), subarachnoid blood (n = 4), intraparenchymal findings (n = 6), bone abnormalities (n = 5), vascular injury (n = 3), and increased ventricular size (n = 2). Most cases with abnormal findings did not require additional observation nor intervention. Only three cases (of 548; 0.55 percent) required further intervention, which included additional medical management (n = 2) and return to the operating room (n = 1).

Conclusion:
Abnormal findings on routine computed tomography scans after cranial vault reconstruction are uncommon and rarely result in an urgent surgical or medical intervention.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
A Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: First-in-Human, Open, Prospective Clinical Trial
Authors: Morimoto Naoki , Mitsui Toshihito , Sakamoto Michiharu , Mahara Atsushi , Yoshimura Kenichi , Arata Jun , Jinno Chizuru , Kakudo Natsuko , Kusumoto Kenji , Yamaoka Tetsuji 
Published: June 2021

Background:
Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed.

Methods:
Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks.

Results:
Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin. The epithelized area of the reconstructed skin, as the percentage of the original target nevus, was 55.5 ± 19.4 percent at 12 weeks and 85.0 ± 32.4 percent at 52 weeks.

Conclusions:
The inactivated nevus caused inflammation and contracture for several months. However, no recurrence was observed, and combination therapy using an inactivated nevus with a cultured epidermal autograft may therefore be a novel treatment of giant congenital melanocytic nevi.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Intraoperative Scintigraphy With Portable Gamma Camera for the Localization of Interaortocaval Paraganglioma
Authors: Pérez-Santiago Leticia , Cassinello-Fernández Norberto , Alfonso-Ballester Raquel , Díaz-Expósito Rafael , Moscardó-Navarro Anaïs , Ortega-Serrano Joaquín 
Published: June 2021

Abstract
A 15-year-old adolescent girl diagnosed of interaortocaval paraganglioma with a positive 123I-MIGB SPECT/CT and 1 unsuccessful prior surgery was operated on with the assistance of a handheld gamma camera. Once the lesion was located and removed, 2 images were taken, one of the surgical field (without 123I-MIGB uptake) and another of the tumor ex vivo (with high 123I-MIGB uptake), confirming that the lesion had been satisfactorily excised. This case highlights the use of a portable gamma camera as a useful tool to locate this rare tumor, with a SPECT/CT positive for 123I-MIGB and a difficult anatomical location suspected.
Mandibular Distraction Osteogenesis for Tongue-Based Airway Obstruction Without Micrognathia
Authors: Kosyk Mychajlo S. , Carlson Anna R. , Zapatero Zachary D. , Kalmar Christopher L. , Cielo Christopher M. , Lioy Janet , Bartlett Scott P. , Taylor Jesse A. , Swanson Jordan W. 
Published: June 2021

Purpose
Mandibular distraction osteogenesis (MDO) effectively treats tongue-based airway obstruction (TBAO) in micrognathic patients with Robin Sequence. Mandibular distraction osteogenesis may also address TBAO in certain nonmicrognathic patients who have severe obstructive apnea, although there is no current literature to guide MDO use in these atypical patients. This study describes outcomes of MDO in a series of patients with TBAO without micrognathia.

Methods
Patients who underwent MDO for TBAO from 2013–20 were reviewed, and patients with micrognathia were excluded. Study subjects received baseline/follow up polysomnography. Polysomnography variables, including Obstructive Apnea Hypopnea Index, oxyhemoglobin saturation nadir (SpO2 nadir), percent sleep time end tidal CO2 greater than 50 mm Hg (%ETCO2 > 50), and respiratory-related arousals were compared before and after MDO. Demographics, syndromic/cleft palate status, airway anomalies, respiratory support, and feeding outcomes were collected.

Results
One hundred and twenty-four patients underwent MDO during this study period; 5 were nonmicrognathic and included in analysis. Sixty percent (n = 3) of the cohort was syndromic: 1 patient each had Trisomy 9, Beckwith Wiedemann syndrome, and duplicated pituitary gland plus syndrome. Forty percent (n = 2) of patients had a cleft palate, 60% (n = 3) had laryngomalacia, and 40% had tracheomalacia. Median (range) age at MDO was 53 days (47–167 days), and median length of distraction was 16 mm (14–20 mm). After MDO, median Obstructive Apnea Hypopnea Index decreased from x̃ = 60.7/h (11.6–109.4) to x̃ = 5.3/h (3.5–19.3) (P = 0.034). SpO2 nadir increased (69% [58–74] to 85% [80–88], P = 0.011), and median %ETCO2 > 50 mm Hg decreased (5.8% [5.2–30.1] to 0.0% [0.0–1.3], P ≤ 0.043). Continuous positive airway pressure was used by all patients immediately after MDO, and at 6 months postoperatively, 1 patient remained on continuous positive airway pressure and 1 patient required supplemental oxygen. At last follow up, no patients had significant residual airway obstruction or required a tracheostomy.

Conclusions
Mandibular distraction osteogenesis can effectively treat severe TBAO in some patients without micrognathia that would otherwise be candidates for tracheostomy. When used in select patients, MDO significantly improves obstructive sleep apnea and reduces need for ventilatory support, although feeding support is still needed in most patients at 6 months. Further study in a larger cohort will help identify appropriate candidates for MDO and characterize outcomes of unique patient populations.
Customized Two-Dimensional Computed Tomography-Guided Preoperative Pectus Bar Shaping
Authors: Ho Christopher Wei Guang , Tan Bien-Keem , Ong Boon Hean , Nakao Masakazu , Lim Chong-Hee 
Published: June 2021

Introduction
Successful minimally invasive repair of pectus excavatum relies on a pectus bar that closely conforms to the desired shape of the sternum and ribs to produce optimal elevation and remodeling. However, the present method of empirical intraoperative bar shaping is tedious and risks trauma to surrounding structures. To overcome this, we devised a technique using a life-sized computed tomography (CT) printout of the patient's chest wall to guide preoperative bar bending.

Methods
A 5-cm-wide polymethylmethacrylate block placed on the sternum as the patient underwent chest CT was used as a marker to guide scaling of an axial screenshot of the patient's chest to life-size. This life-size image was printed and the planned correction of the patient's chest wall was traced onto it. The pectus bar was bent according to this template. Patient demographics, Haller index, surgical indications, operative technique, complications, aesthetic and functional improvements, and overall satisfaction were assessed.

Results
Thirty patients (4 women) underwent primary minimally invasive repair of pectus excavatum with a single pectus bar shaped preoperatively over an 8-year period. The average age and Haller index was 20.6 years and 5.4, respectively. The mean operative time was 66.4 minutes. Satisfactory sternal elevation was attained with a single attempt at bar insertion in all cases. Two patients had pneumothoraxes that resolved without intervention. The mean follow-up period was 50.1 months. There were no cases of bar migration or recurrence of deformity after bar removal. On a 5-point Likert scale, all patients indicated an improvement in aesthetic appearance (4.6), and patients with physical symptoms (10) reported an improvement in function (4.4). The overall satisfaction score was 4.7.

Conclusions
This technique of CT-guided preoperative pectus bar shaping is straightforward, eliminates the need for intraoperative revisions to bar shape, and achieves effective correction of the pectus excavatum deformity. All patients were satisfied with the aesthetic, functional, and overall outcomes.