bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secular trends of grossly underreported snakebite burden in India, 2009–2018: analysis of data from India's National Health Profile
Authors: Rubeshkumar Polani , Sakthivel Manikandanesan , Venkatasamy Vettrichelvan , Ponnaiah Manickam , Murhekar Manoj 
Published: March 2021

Abstract

Background
India's National Health Profile (NHP) documents snakebite cases and deaths based on hospital-based reports, hence underrepresenting the actual burden. We describe secular trends of NHP data using population denominators for 2009–2018.

Methods
We abstracted the data on snakebite cases and deaths and calculated incidence and case fatality rate (CFR) by gender and by states using population denominators. We estimated the change in incidence and CFR over time by using a Poisson regression model. We computed the incidence rate ratio (IRR) and 95% confidence interval (CI) using Stata 14.0.

Results
The incidence of snakebites ranged from 89 to 141 per million population and without any specific pattern during 2009–2018 as per NHP reports. The incidence increased by 3% per year (IRR 1.03 [95% CI 0.99 to 1.07]). The incidence was higher among males (range 97–163) than females (range 71–115) and there was no difference in trends by gender (IRR 1.07 [95% CI 0.37 to 3.12]). The CFR was 5–13 deaths per 1000 cases, with an annual decline of 12% (IRR 0.88 [95% CI 0.85 to 0.92]). The CFR did not differ by gender (male 5–12, female 6–13; IRR 0.48 [95% CI 0.20 to 1.17]).

Conclusion
India's NHP snakebite data, representing an underestimate of the actual burden, suggests no specific secular trend and points to areas documenting consistent and significant burden.
Identifying and Addressing Statewide Nursing Simulation Needs
Authors: Herrington Alaina 
Published: March 2021

Abstract
A statewide simulation assessment was conducted in one southeastern state using the Program Assessment Survey for Simulation. Simulation coordinators from 22 prelicensure nursing programs were interviewed. The findings revealed several areas where faculty education was needed: theory, design, facilitation, debriefing, interprofessional education, and evaluation. A free online simulation fundamentals course was effective in addressing the areas where education was required.
Cochlear Implant Magnet Dislocation: Simulations and Measurements of Force and Torque at 1.5T Magnetic Resonance Imaging
Authors: Eerkens Hedwig J. , Smits Cas , Hofman Mark B. M. 
Published: March 2021

Objectives:
Dislocation of the magnet inside the implanted component of a cochlear implant (CI) can be a serious risk for patients undergoing a magnetic resonance imaging (MRI) exam. CI manufacturers aim to reduce this risk either via the design of the implant magnet or magnet housing, or by advising a compression bandage and cover over the magnet. The aim of this study is to measure forces and torque on the magnet for different CI models and assess the effectiveness of the design and preventative measures on the probability of magnet dislocation.

Design:
Six CI models from four manufacturers covering all the current CI brands were included. Each model was positioned on a polystyrene head with compression bandage and magnet cover according to the recommendations of the manufacturer and tested for dislocation in a 1.5T whole-body MRI system. In addition, measurements of the displacement force in front of the MRI scanner and torque at the MRI scanner isocenter were obtained.

Results:
Chance of CI magnet dislocation was observed for two CI models. The design of the magnet or magnet housing of the other models proved sufficient to prevent displacement of the magnet. The main cause for magnet dislocation was found to be the rotational force resulting from the torque experienced inside the magnet bore, which ranges from 2.4 to 16.2 N between the models, with the displacement force being lower, ranging from 1.0 to 1.8 N.

Conclusions:
In vitro testing shows that two CI models are prone to the risk of magnet dislocation. In these CI models, preparation before MRI with special compression bandage and a stiff cover are of importance. But these do not eliminate the risk of pain and dislocation requiring patient consulting before an MRI exam. Newer models show a better design resulting in a significantly reduced risk of magnet dislocation.
Minimally Invasive Versus Standard Surgery in Idiopathic Scoliosis Patients
Authors: Sarwahi Vishal , Galina Jesse M. , Hasan Sayyida , Atlas Aaron , Ansorge Alexandre , De Bodman Charlotte , Lo Yungtai , Amaral Terry D. , Dayer Romain 
Published: March 2021

Study Design.
Retrospective review of prospective case–control study.

Objective.
To compare minimally invasive scoliosis surgery (MIS) and posterior spinal fusion (PSF) in a large group of patients.

Summary of Background Data.
MIS, has been shown to have benefits over standard PSF in adolescent idiopathic scoliosis (AIS).

Methods.
Radiographic, clinical, and operative review of a multi-institutional prospective database from 2013 to 2018. MIS patients with minimum 2-year XR follow up were compared with open PSF technique patients.

Results.
Four hundred eighty five patients were included; 192 MIS and 293 PSF. Preoperative Cobb (P = 0.231) and kyphosis were similar (P = 0.501). Cobb correction was comparable (P = 0.46), however percent improvement in thoracic kyphosis was significantly higher in MIS (P < 0.001). MIS had significantly lower blood loss (P < 0.001), transfusions (P < 0.001), fixation points (P < 0.001), opioid consumption (P = 0.001), and hospital stay (P < 0.001). Operative time was shorter (P = 0.001) and 30-day complications rate was similar (P = 0.81).

Conclusion.
This is the largest study comparing the surgical outcomes of MIS and PSF. MIS patients benefit from increased kyphosis, fewer transfusion, lower opioid consumption, and shorter hospital stay with similar Cobb correction. Increased postoperative kyphosis is likely from muscle sparing dissection in MIS.

Level of Evidence: 3
National Rates, Reasons, and Risk Factors for 30- and 90-Day Readmission and Reoperation Among Patients Undergoing Anterior Cervical Discectomy and Fusion
Authors: Taylor Blake E.S. , Hilden Patrick , Hansen Rosemary T. Behmer , Nanda Anil , Gillick John L. 
Published: March 2021

Study Design.
Retrospective cohort study of the Nationwide Readmissions Database (NRD).

Objective.
To determine causes of and independent risk factors for 30- and 90-day readmission in a cohort of anterior cervical discectomy and fusion (ACDF) patients.

Summary of Background Data.
Identifying populations at high-risk of 30-day readmission is a priority in healthcare reform so as to reduce cost and patient morbidity. However, among patients undergoing ACDF, nationally-representative data have been limited, and have seldom described 90-day readmissions, early reoperation, or socioeconomic influences.

Methods.
We queried the NRD, which longitudinally tracks 49.3% of hospitalizations, for all adult patients undergoing ACDF. We calculated the rates of, and determined reasons for, readmission and reoperation at 30 and 90 days, and determined risk factors for readmission at each timepoint.

Results.
We identified 50,126 patients between January and September 2014. Of these, 2294 (4.6%) and 4152 (8.3%) were readmitted within 30 and 90 days of discharge, respectively, and were most commonly readmitted for infections, medical complications, and dysphagia. The characteristics most strongly associated with readmission were Medicare or Medicaid insurance, length of stay greater than or equal to 4 days, three or more comorbidities, and non-routine discharge, whereas surgical factors (e.g., greater number of vertebrae fused) were more modest. By 30 and 90 days, 8.2% and 11.7% of readmitted patients underwent an additional spinal procedure, respectively.

Conclusion.
Our analysis uses the NRD to thoroughly characterize readmission in the general ACDF population. Readmissions are often delayed (after 30 days), strongly associated with insurance status, and many result in reoperation. Our results are crucial for risk-stratifying future ACDF patients and developing interventions to reduce readmission.

Level of Evidence: 3
Identifying the Risk Factors and Estimating the Prognosis in Patients with Pelvis and Spine Ewing Sarcoma
Authors: Jiang Runyi , He Shaohui , Sun Haitao , Gong Haiyi , Yang Xinghai , Cai Xiaopan , Wei Haifeng , Xiao Jianru 
Published: March 2021

Study Design.
Retrospective analysis.

Objective.
The study was designed to: (1) figure out risk factors of metastasis; (2) explore prognostic factors and develop a nomogram for pelvis and spine Ewing sarcoma (PSES).

Summary of Background Data.
Tools to predict survival of PSES are still insufficient. Nomogram has been widely developed in clinical oncology. Moreover, risk factors of PSES metastasis are still unclear.

Methods.
The data were collected and analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. The optimal cutoff values of continuous variables were identified by X-tile software. The prognostic factors of survival were performed by Kaplan–Meier method and multivariate Cox proportional hazards modeling. Nomograms were further constructed for estimating 3- and 5-year cancer-specific survival (CSS) and overall survival (OS) by using R with rms package. Meanwhile, Pearson χ
2 test or Fisher exact test, and logistic regression analysis were used to analyze the risk factors for the metastasis of PSES.

Results.
A total of 371 patients were included in this study. The 3- and 5-year CSS and OS rate were 65.8 ± 2.6%, 55.2 ± 2.9% and 64.3 ± 2.6%, 54.1 ± 2.8%, respectively. The year of diagnosis, tumor size, and lymph node invasion were associated with metastasis of patients with PSES. A nomogram was developed based on identified factors including: age, tumor extent, tumor size, and primary site surgery. The concordance index (C-index) of CSS and OS were 0.680 and 0.679, respectively. The calibration plot showed the similar trend of 3-year, 5-year CSS, and OS of PSES patients between nomogram-based prediction and actual observation, respectively.

Conclusion.
PSES patients with earlier diagnostic year (before 2010), larger tumor size (>59 mm), and lymph node invasion, are more likely to have metastasis. We developed a nomogram based on age, tumor extent, tumor size, and surgical treatments for determining the prognosis for patients with PSES, while more external patient cohorts are warranted for validation.

Level of Evidence: 3
The Role of Vertebral Porosity and Implant Loading Mode on Bone-Tissue Stress in the Human Vertebral Body Following Lumbar Total Disc Arthroplasty
Authors: Bonnheim Noah B. , Adams Mark F. , Wu Tongge , Keaveny Tony M. 
Published: March 2021

Study Design.
Micro-computed tomography- (micro-CT-) based finite element analysis of cadaveric human lumbar vertebrae virtually implanted with total disc arthroplasty (TDA) implants.

Objective.
(1) Assess the relationship between vertebral porosity and maximum levels of bone-tissue stress following TDA; (2) determine whether the implant's loading mode (axial compression vs. sagittal bending) alters the relationship between vertebral porosity and bone-tissue stress.

Summary of Background Data.
Implant subsidence may be related to the bone biomechanics in the underlying vertebral body, which are poorly understood. For example, it remains unclear how the stresses that develop in the supporting bone tissue depend on the implant's loading mode or on typical inter-individual variations in vertebral morphology.

Methods.
Data from micro-CT scans from 12 human lumbar vertebrae (8 males, 4 females; 51–89 years of age; bone volume fraction [BV/TV] = 0.060–0.145) were used to construct high-resolution finite element models (37 μm element edge length) comprising disc-vertebra-implant motion segments. Implants were loaded to 800 N of force in axial compression, flexion-, and extension-induced impingement. For comparison, the same net loads were applied via an intact disc without an implant. Linear regression was used to assess the relationship between BV/TV, loading mode, and the specimen-specific change in stress caused by implantation.

Results.
The increase in maximum bone-tissue stress caused by implantation depended on loading mode (P < 0.001), increasing more in bending-induced impingement than axial compression (for the same applied force). The change in maximum stress was significantly associated with BV/TV (P = 0.002): higher porosity vertebrae experienced a disproportionate increase in stress compared with lower porosity vertebrae. There was a significant interaction between loading mode and BV/TV (P = 0.002), indicating that loading mode altered the relationship between BV/TV and the change in maximum bone-tissue stress.

Conclusion.
Typically-sized TDA implants disproportionately increase the bone-tissue stress in more porous vertebrae; this affect is accentuated when the implant impinges in sagittal bending.

Level of Evidence: N/A
Adolescent Weight Management Intervention in a Nonclinical Setting: Changes in Eating-Related Cognitions and Depressive Symptoms
Authors: Darling Katherine E. , Rancourt Diana , Evans E. Whitney , Ranzenhofer Lisa M. , Jelalian Elissa 
Published: March 2021

ABSTRACT:

Objective:
The present study was a secondary data analysis of a randomized controlled trial (RCT) to examine changes in depressive symptoms and eating-related cognitions in teens who participated in a nonclinic-based adolescent behavioral weight control treatment delivered by YMCA coaches. Differences in intervention effects were also examined by sex.

Methods:
Adolescents (N = 66; 13–17 years; 60.6% girls) with overweight (10.6%) or obesity (53.0% with severe obesity) participated in an RCT comparing 2 versions of an evidence-based intervention. Adolescents completed measures of eating-related cognitions (Eating Disorder Examination Questionnaire) and depressive symptoms (Children's Depressive Inventory-2) at baseline and end of active treatment (16 weeks).

Results:
There were no significant effects of group, time, or group by time interaction for depressive symptoms, global eating-related cognitions, dietary restraint, or eating concerns (ps > 0.05). Shape concerns (p = 0.04) and weight concerns (p = 0.02) significantly decreased over the intervention. Significant interactions between sex and time on global eating-related cognitions (p < 0.001), eating (p = 0.002), shape (p = 0.02), and weight concerns (p = 0.004) were detected such that female participants' scores decreased over the course of the treatment, but male participants' scores did not.

Conclusion:
The results demonstrate some positive and no detrimental effects of a nonclinic-based behavioral weight control intervention on adolescents' eating-related cognitions and depressive symptoms. The findings may mitigate concerns that dissemination of structured, nonclinic-based weight management programs for adolescents will produce negative eating and mood outcomes; however, replication of results in larger trials is needed.
Navigating Medical Care for a Young Adult with Developmental Disability
Authors: Goss Megan , Afghani Behnoosh , Piazza Cathleen C. , Sabapathy Thusa , Key Tayler , Keating Sarah , Nyp Sarah S. 
Published: March 2021

CASE:
Sam is a 20-year-old young man with intermittent gastritis, autism spectrum disorder, and intellectual disability who was admitted to the hospital because of nutritional concerns. His parents have legal guardianship and report that he has had increasing frequency of refusal to eat, resulting in a 15-pound weight loss over the past 3 months. On admission, a multidisciplinary team including specialists in gastroenterology, nutrition, feeding (behavioral and mechanical), psychiatry, palliative care, and social work was engaged to develop an evaluation and care plan. Sam's nutritional assessment was significant for severe malnutrition. An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.
An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.
A carefully obtained history found that Sam does not have a primary care physician. He was recently hospitalized at another facility because of his weight loss and nutritional concerns but was discharged against medical advice because of parental dissatisfaction with his care. His mother shared that she has tried many strategies to encourage Sam to eat including pushing spoons of food into his mouth, syringe feeding, and verbally pleading with Sam to take a bite, but all of these have been without success.
Because of concerns that persistent attempts to verbally and physically coerce Sam to eat may be contributing to his aversion to food/eating, the feeding team provided Sam's parents with education and coaching for utilization of behavioral cues to determine when Sam wanted to eat. Despite parents expressing their understanding of the importance of avoiding physical attempts to “make” Sam eat and the team palliative care physician meeting with Sam's parents to elicit their goals for Sam's care, his nurses reported observing several instances of Sam's mother tapping a loaded spoon on his lips. Because of minimal oral intake, a nasogastric tube was placed for provision of hydration and nutrition. Sam's parents consented to the use of soft restraints and the presence of a bedside patient care assistant because of Sam becoming agitated and pulling at the tube.
After 10 days of hospitalization, Sam was taking about 50% of his goal intake by mouth. Unfortunately, Sam removed his NG tube, and his parents refused to allow the tube to be replaced. Sam's parents then discharged him against medical advice, stating that they believed he would recover better at home. What are important considerations in caring for patients like Sam in the hospital setting and beyond?
Characterization of the 2019 Micrographic Surgery and Dermatologic Oncology Standardized Letter of Recommendation
Authors: Abidi Nadia Y. , Wanner Brian , Brown Mariah , Golda Nicholas , Hajar Tamar , Rohani Pooyan , Yu Siegrid S. , Carr David R. 
Published: March 2021

BACKGROUND
Traditional letters of recommendation used for postgraduate medical training applications have multiple limitations, including a lack of clarity, inflated and overly flattering assessments, and low reliability between interpreting faculty. A micrographic surgery and dermatologic oncology (MSDO) standardized letter of recommendation (SLOR) was created to improve the efficiency, validity, and stratification of applicants to dermatology fellowship training programs.

OBJECTIVE
To analyze the MSDO SLOR for trends in grading based on letter-writer and applicant characteristics and to evaluate its ability to demonstrate differences between applicants.

METHODS
Standardized letter of recommendations received by 4 fellowship programs from the 2019 San Francisco Match application cycle were reviewed retrospectively.

RESULTS
Two hundred forty-nine SLORs were analyzed from 140 applicants. Grade inflation and limited variability in scores were evident. Higher scores correlated with the length of the relationships between letter-writers and applicants and with female letter-writer gender. There was no applicant gender or ethnicity bias detected.

CONCLUSION
Despite score inflation, the MSDO SLOR allows for differentiation between fellowship applicants. Future studies are needed to further evaluate the reliability of the SLOR and find ways to improve its content.
Arabic Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12)
Authors: Elzayat Saad , Elfarargy Haitham H. , Mandour Mahmoud , Lotfy Rasha , Barbara Maurizio 
Published: March 2021

Objective:
Our study aimed to translate the chronic otitis media questionnaire-12 (COMQ-12) into the Arabic language, evaluate the internal consistency of the test and test-retest reliability, and validate the adaptation for further use in Arabic studies.

Study Design:
A prospective observation monocenter cohort study.

Settings:
This study was done at Kafrelsheikh University Hospital, Egypt.

Patients:
One hundred twenty five ear pathology-free patients were asked to complete the questionnaire forming group A. One hundred twenty five patients with different forms of COM completed the questionnaire 2 weeks before the planned ear surgery and the same day of the operation, forming group B. Those patients who underwent the ear surgery, completed the questionnaire again 6 months after the operation forming group C.

Intervention:
We did an Arabic forward and backward translation of the original COMQ-12. The patients in group B underwent ear surgery (tympanoplasty with or without mastoidectomy). After fulfilling the questionnaire in different groups, we assessed the psychometric properties of the Arabic version of COMQ-12: internal consistency, reliability, reproducibility, validity, and responsiveness.

Main Outcome Measures:
Cronbach's α was 0.973. The Spearman's rank correlation coefficient was 0.981, while the Intraclass correlation coefficient was 0.973.

Results:
A statistically significant difference was present between group A (average total score 2.38 ± 1.543) and group B (average total score 35.86 ± 5.98). Also, there was a statistically significant difference between group B and group C (average total score 7.46 ± 8.294). The calculated cut-off point of the total score was more than or equal to eight.

Conclusion:
The cross-culturally Arabic adaptation of COMQ-12 was reliable, valid with strong internal consistency and responsiveness. It can detect the significant effect of COM on the quality of life of Arabic patients. This effect would be improved obviously after surgical management that markedly enhanced the preoperative hearing problem.
Risk Factors for Suboptimal Bowel Preparation for Colonoscopy in Pediatric Patients
Authors: Reddy Pooja , Mencin Ali , Lebwohl Benjamin 
Published: March 2021

ABSTRACTBackground/Aims:Suboptimal bowel cleansing is common in children and can impact diagnostic and therapeutic outcomes. We aimed to identify risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.Methods:This was a retrospective study of all patients ages 0 to 21 years who underwent colonoscopy at a children's hospital from 2015 to 2019 in the United States. Demographics and clinical information were obtained from the electronic health record. The primary outcome was suboptimal bowel preparation measured by the endoscopist on a dichotomized Aronchik Scale. Univariate and multivariate regression modeling were used to determine independent predictors of suboptimal preparation.Results:Nine hundred and eight patients (mean age 12.17 years [±5.14], boys 465 (51.2%), were included in the analysis. Suboptimal preparation was noted in 242 (26.7%). On univariate analysis, suboptimal preparation was more common in those of younger age (38.6%), Medicaid (32.1%), Spanish as primary language (35.7%), and failure to thrive (FTT) (45.9%). Suboptimal preparations were less common in patients with inflammatory bowel disease (IBD) (11.6%). After adjustment for other covariates, IBD and FTT maintained their statistical associations, IBD (odds ratio [OR] 0.27 95% confidence interval [CI] 0.095–0.75, P = 0.01), FTT (OR 1.98 95% CI 1.28–3.06, P = <0.01).Conclusions:To our knowledge, this is the first investigation of pediatric patients to identify independent risk factors for suboptimal bowel preparation. We confirm Medicaid status and English as a second language as risk factors as well as highlight distinct associations from those reported in the adult literature including FTT and younger age. IBD was associated with optimal cleansing. Future research to understand the mechanisms of inferred risk or potential protection is required.