bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproductive period and preclinical cerebrospinal fluid markers for Alzheimer disease: a 25-year study
Authors: Najar Jenna , Hällström Tore , Zettergren Anna , Johansson Lena , Joas Erik , Fässberg Madeleine Mellqvist , Zetterberg Henrik , Blennow Kaj , Kern Silke , Skoog Ingmar 
Published: July 2021

Abstract

Objective:
The aim of the study was to examine the association between reproductive period, as an indicator of endogenous estrogen, and levels of cerebrospinal fluid (CSF) biomarkers for Alzheimer disease (AD).

Methods:
A population-based sample of women from Gothenburg, Sweden was followed from 1968 to 1994 (N = 75). All women had natural menopause and were free from dementia. Information on reproductive period (age at menarche to age at menopause) was obtained from interviews from 1968 to 1980. Lumbar puncture was performed from 1992 to 1994 and CSF levels of Aβ42, Aβ40, P-tau, and T-tau were measured with immunochemical methods. Linear regression models adjusted for potential confounders were used to analyze the relationship between reproductive period and CSF biomarkers for AD.

Results:
Longer reproductive period was associated with lower levels of Aβ42 (β = −19.2, P
= 0.01), higher levels of P-tau (β = 0.03, P
= 0.01), and lower ratio of Aβ42/Aβ40 (β = −0.02, P
= 0.01), while no association was observed for T-tau (β = 0.01, P
= 0.46). In separate analyses, examining the different components of reproductive period, earlier age at menarche was associated higher levels of P-tau (β = −0.07, P
= 0.031) and lower ratio of Aβ42/Aβ40 (β = 0.05, P
= 0.021), whereas no association was observed with Aβ42 (β = 31.1, P
= 0.11) and T-tau (β = −0.001, P
= 0.98). Furthermore, no association was observed between age at menopause and CSF biomarkers for AD.

Conclusions:
Our findings suggest that longer exposure to endogenous estrogen may be associated with increased levels of AD biomarkers in the preclinical phase of AD. These findings, however, need to be confirmed in larger samples.

Video Summary:

http://links.lww.com/MENO/A804.
FSS-ICU Scores at ICU Discharge Differ Across Postacute Care Dispositions
Authors: Skrzat Julie M. , Pechulis Michael , DiFiore Marcel , Fink Amanda , Fischer George , Jordan Maria , Lebron Erika , Rieger Alyssa 
Published: July 2021

Purpose:
To determine whether Functional Status Score for the Intensive Care Unit (FSS-ICU) scores acquired within 24 hours of medical-surgical intensive care unit (MSICU) discharge differ among postacute care discharge dispositions in a nonsurgical patient population.

Methods:
A retrospective medical record review for data collection was conducted over 12 months for patients in an MSICU. FSS-ICU scores were collected within 24 hours of MSICU discharge. Subjects were categorized into 4 postacute care discharge dispositions: home, subacute rehabilitation (SAR), inpatient rehabilitation (IP), or other. A 1-way analysis of variance and post hoc analyses were performed.

Results:
One hundred fifteen subjects were included. FSS-ICU scores acquired within 24 hours of MSICU discharge were significantly different (P < .001) between postacute care discharge dispositions. Post hoc analysis showed a statistically significant difference between home and SAR (P < .001), home and IP (P < .001), and home and other (P = .005).

Conclusions:
A difference was found in FSS-ICU scores acquired within 24 hours of MSICU discharge between home and all other postacute care discharge dispositions in a nonsurgical patient population. An FSS-ICU score less than 27 at MSICU discharge indicates that discharge planning to a postacute care discharge disposition other than home may be warranted.
Cause of Death Among Cardiac Patients With and Without Anxiety
Authors: Christensen Anne Vinggaard , Cromhout Pernille Fevejle , Jørgensen Martin Balslev , Ekholm Ola , Juel Knud , Svendsen Jesper Hastrup , Rasmussen Trine Bernholdt , Borregaard Britt , Mols Rikke Elmose , Thrysoee Lars , Thorup Charlotte Brun , Berg Selina Kikkenborg 
Published: July 2021

Background
Mental distress is reported internationally among patients with cardiac disease. A Danish survey found that 25% of patients with cardiac disease experienced symptoms indicating anxiety and that anxiety was associated with an increased risk of death.

Aim
The aims of this study were to (1) compare cause of death patterns among deceased cardiac patients with anxiety to those without anxiety and (2) examine the association between anxiety symptoms and specific causes of death.

Methods
We used data from the DenHeart survey to evaluate symptoms of anxiety at discharge by using the Hospital Anxiety and Depression Scale. Data on mortality in the 3 years after discharge and cause of death according to International Classification of Diseases-10 classification came from national registers. Cause of death was compared between patients with and without anxiety using χ
2 tests. The association between symptoms of anxiety and cause of death was investigated using logistic regression.

Results
Of 12 913 patients included, a total of 1030 (8%) died within 3 years. After 1 year, 4% of patients with anxiety symptoms had died versus 2% of patients without; after 3 years, the proportions were 9% versus 8%, respectively. Almost all died of natural causes irrespective of anxiety symptoms. No statistically significant differences were found regarding the cause of death between patients with and without anxiety.

Conclusion
Despite higher mortality rates in patients with cardiac disease with anxiety symptoms, the pattern of cause of death was identical for patients with cardiac disease with and without anxiety symptoms. It seems that an acceleration of morbid processes leading to mortality is more likely than a difference in cause of death. However, further research is needed to better understand the behavioral and pathophysiological processes that cause the higher mortality seen among patients reporting symptoms of anxiety.
Improving Healthcare Cost, Quality, and Access Through Artificial Intelligence and Machine Learning Applications
Authors: Ball Helen Callie 
Published: July 2021

EXECUTIVE SUMMARY
Since the early 1970s, technology has increasingly become integrated into the healthcare field. Today, artificial intelligence (AI) and machine learning (ML, a set of learning techniques used by AI) have the capacity to revolutionize the delivery of patient care. This essay examines the mechanics and processes of machine learning through discussion of deep learning and natural language processing and then discusses the application of these learning techniques in pattern recognition of malignant tumors in comparison to present methods of diagnostic imaging assessment. The discussion also covers the implications of AI assistive technology more broadly regarding ethical policy making, patient autonomy, and the healthcare Iron Triangle of cost, quality, and access. It concludes with the idea that failure to incorporate AI and ML techniques in healthcare may be malpractice.
Health-Related and Lifestyle Factors as Predictors of Intentions to Improve Lifestyle Habits in Employees Participating in a Workplace Health Promotion Program
Authors: Kugathasan Thiffya Arabi , Lecot François , Laberge Suzanne , Tremblay Jonathan , Mathieu Marie-Eve 
Published: July 2021

Objectives:To explore employees’ intentions to improve lifestyle habits, investigate the health and lifestyle-related predictors of these intentions, and how it translated into behavioral improvement.Methods:Employees participating in theActivate Your HealthWHPP completed a questionnaire of their demographics, health-related variables, as well as six lifestyle habits and intention to improve them.Results:At baseline (n = 2729), most employees wanted to focus on physical activity and eating habits. Many predictors were identified for each intention. Majority of intentions were associated with behavioral improvement post-program (n = 525), especially inHigh.Conclusions:In the context of WHPPs, intention to improve may lead to actual behavioral improvement. Exploring employees’ intentions to improve various lifestyle habits at the start of the program could improve the effectiveness of these programs.
Urinary Nickel and Progesterone in Workers Exposed to Urban Pollutants
Authors: Tomei Francesco , Rosati Maria Valeria , Di Pastena Claudia , Tomei Gianfranco , Giammichele Grazia , De Marco Federica , Corsale Silvia , Suppi Anastasia , Ricci Pasquale , Sacco Carmina , Ricci Serafino , Monti Carlo 
Published: July 2021

Objective:
The aim of this study is to evaluate whether the exposure to a low dose of nickel could determinate a variation in levels of progesterone in outdoor workers.

Materials and methods:
Two hundred sixty one subjects were divided by sex, task, age, seniority, and cigarette smoking habit. For each workers was evaluated the dose of blood progesterone and urinary nickel.
The statistical analysis was performed.

Results:
The Pearson correlation showed a statistically significant correlation between urinary nickel levels and progesterone. The multiple linear regression showed a significant correlation between progesterone and urinary nickel in the total sample and in the subgroups of smokers and workers with tasks of traffic direction.

Conclusions:
The results of our study suggest that occupational exposure to low doses of nickel present in urban pollution may influence to progesterone levels in outdoor workers.
The Need for a Mandatory Sex Trafficking Component in Physician Assistant Education
Authors: Brooks Brandy 
Published: July 2021

Purpose
Examine the possible deficit of education, training, and confidence among physician assistants (PAs) for assisting patients who have been victims of sex trafficking and determine if there is support for a nationwide mandatory sex trafficking component in the PA curriculum.

Methods
This quantitative study examined 184 United States PAs' predictors of confidence in assisting victims of trafficking using a modified PROTECT survey and used bivariable logistic regression to analyze data.

Results
This study identified a significant association between confidence in assisting in the care of sex trafficking patients and a nationwide curriculum requirement (OR = 5.389, p = .016) and past training (OR = .096, p = .000).

Conclusion
Due to the majority of PAs not having the confidence or past training to assist in the care of patients who have been victims of sex trafficking, this study supports the need for a curriculum requirement dedicated to this topic in US PA programs.
Year-Long Use of Ankle-Foot Orthosis–Footwear Combination with Talar Flange Modification in an Adult Poststroke
Authors: McGovern Donald , Fatone Stefania 
Published: July 2021

ABSTRACT

Introduction
There are limited examples in the literature of detailed orthotic management related to triplanar control of the ankle-foot complex. The aim of this case report was to describe year-long use of an ankle-foot orthosis–footwear combination (AFO-FC) augmented with a talar flange that aimed to stabilize the subtalar joint during gait in an individual with poststroke hemiplegia who presented with both knee hyperextension and an unstable subtalar joint.

Materials and Methods
A 40-year-old woman 1-year poststroke with right hemiplegia presented with right equinovarus and knee hyperextension, with complaint of pain in the ankle and knee. Her right talocrural joint measured 15° plantarflexion with clinically significant inversion instability.

Results
A right solid AFO-FC, designed using published algorithms, was provided. In addition, a talar flange modification was incorporated to control subtalar inversion. During year-long use of the AFO-FC, the patient was able to return to community ambulation without pain. Successful orthotic intervention required that the device met not only biomechanical goals but also broader patient goals, which changed over time. Therapy with the device was also important for successful orthotic intervention.

Conclusions
This case illustrates use of a talar flange in an AFO-FC to provide triplanar control of the ankle-foot complex and improve gait in a person poststroke.
Nurse practitioner–owned practices and value-based payment
Authors: O'Reilly-Jacob Monica , Perloff Jennifer , Berkowitz Sandy , Bock Lorraine 
Published: July 2021

ABSTRACT

Background:
The United States is steadily shifting away from volume-based payments toward value-based payment for health care. The nursing model's emphasis on high-value care, such as disease prevention and health maintenance, ideally positions nurse practitioner (NP) practice owners to contribute to the goals of value-based care. However, little is known about NP participation in value-based care.

Purpose:
To better understand NP-owned practice participation in value-based care.

Methodology:
Using convenience sampling, we developed a registry of NP owned practices, which we used to conduct a web-based survey from November 2019 to February 2020.

Results:
Of the 47 NP-owner respondents, 40 practice in primary or specialty care. Practices are relatively small with a mean clinical staff of 4 full-time equivalent (FTE; range: 1–17), mean total staff of 7 FTE (1–28.5), and with a mean of 325 patient visits annually. A third participate in value-based payment arrangements, whereas a half are considering and three quarters are knowledgeable about value-based payment arrangements. Over 70% of practice owners report lack of knowledge, lack of financial protections, and lack of payer partnership as barriers to participation in value-based payment models.

Conclusions:
NP practice owners face many challenges to taking on risk, including insufficient patient volume.

Implications:
Joining together may allow small NP practices to participate in and thrive under value-based payment. Reducing the barriers and regulation of all NPs will enable the health care system to capitalize on the nursing model to meet the goals of value-based care.
Temporal Bone Pathology Secondary to Head Trauma—A Human Temporal Bone Study
Authors: Uchiyama Mio , Monsanto Rafael da Costa , Sancak Irem Gul , Park Grace Sinae , Schachern Patricia , Kobayashi Hitome , Paparella Michael M. , Cureoglu Sebahattin 
Published: July 2021

Hypothesis/Background:
We hypothesize that following head trauma there is a difference in temporal bone (TB) pathology in cases with and without skull fracture. Although conductive, sensorineural, mixed hearing loss, and TB pathology following head trauma have been reported, to our knowledge, there are no studies that have compared the pathology of the TB in cases with and without skull fracture.

Methods:
We analyzed 34 TBs from donors who had a history of head trauma (20 with skull fracture and 14 without fracture), and 25 age-matched controls without clinical or histological evidence of otologic disorders. We documented the presence and location of TB fracture, ossicular injury, and cochlear hemorrhage and evaluated the loss of spiral ganglion cells and sensory hair cells, damage to the stria vascularis, and the presence of endolymphatic hydrops.

Results:
We found a significant loss of outer hair cells in the upper basal, lower, and upper middle turns of the cochlea (p = 0.009, =0.019, =0.040, respectively), a significant loss of spiral ganglion cells (p = 0.023), and cochlear hemorrhage predominantly in the basal turns secondary to head trauma. Interestingly, these findings were significantly observed in TBs from donors with a history of head trauma without skull fracture.

Conclusion:
The greatest damage was to the cochlear basal turn. Our findings suggest that head trauma may result in tonotopic high frequency sensorineural hearing loss. TBs from donors with skull fracture have less pathologic changes than those without.
A Rare Presentation of Primary Cutaneous Low-Grade Neuroendocrine Tumor of the External Auditory Canal
Authors: Bhardwaj Priya , Tanenbaum Zachary G. , Nguy Peter L. , Jay Ann K. , Dimopoulos Yiannis Petros , Hoa Michael 
Published: July 2021

Objective:
To describe the first case of a primary cutaneous low-grade neuroendocrine tumor (cLGNET) originating from the external auditory canal as well as our team's surgical management.

Patient:
A healthy 34-year-old female presented with a low-grade neuroendocrine tumor of her right external auditory canal (EAC) which extended from the posterior–superior aspect of the EAC into the middle ear.

Intervention:
A complete otological examination was performed in addition to CT and MRI imaging. The low-grade neuroendocrine tumor was surgically biopsied and further surgery was recommended for complete resection.

Results:
Audiogram revealed profound right sensorineural hearing loss. CT scan demonstrated complete opacification of the right EAC, middle ear, and mastoid air cells, dystrophic calcification in the mesotympanum overlying the cochlear promontory, and no associated osseous erosion. MRI revealed abnormal FLAIR hyperintensity and enhancement of the labyrinthine segment of the right facial nerve, cochlea, and horizontal and posterior semicircular canals. An enhancing mass opacifying the right EAC demonstrating restricted diffusion on diffusion-weighted image was also evident. Pathologic examination and immunohistochemical staining confirmed a diagnosis of primary cLGNET of the EAC.

Conclusion:
Primary cLGNETs of the external ear are exceedingly rare but should be considered if an adult patient presents with a mass in the EAC. Management should include early biopsy and surgical excision followed by histological and immunohistochemical confirmation.
Deep neck infections with mediastinum abscess and respiratory failure in a pediatric patient
Authors: Guo Bei-Cyuan , Wu Han-Ping 
Published: July 2021

Abstract

Rationale:
Deep neck infections are infections of the potential fascial planes and spaces of the head and neck. They can be life-threatening due to complications of upper airway compression or obstruction, sepsis or septic shock or acute respiratory syndrome. The most common pathogens are Streptococcus viridans and Staphylococcus aureus.

Patient concerns:
A one-year one-month-old girl was admitted to our pediatric emergency department due to fever, rhinorrhea, and erythematous swelling in the right preauricular area for 3 days. A day later, she had dyspnea, dysphagia, decreased activity, and the swelling extended to the right neck area.

Diagnosis:
The initial soft neck tissue radiograph showed prevertebral soft tissue thickening, and neck sonography revealed hypoechoic nodes, which were highly suggestive of a deep neck infection. Subsequent computed tomography of the neck and chest showed an abscess of the right deep neck spaces over the parapharyngeal, carotid, parotid, and submandibular areas with intrathoracic extension, as well as an abscess over the anterior mediastinum and bilateral empyema.

Interventions:
Drainage from deep neck incisions and thoracoscopic decortication of the right-side pleura were performed.

Outcomes:
After appropriate surgical interventions, critical care with antibiotics and ventilator support, the patient's condition stabilized and was discharged home.

Lessons:
Complications of deep neck infections are potentially fatal, especially in children. Clinicians should be aware of such infections in children and should not underestimate their potential severity. Children with deep neck infections should be more closely monitored throughout their hospitalization.
Risk of Stroke After Transcatheter Aortic Valve Implantation: Epidemiology, Mechanism, and Management
Authors: Ciobanu Andrea-Olivia , Gherasim Leonida , Vinereanu Dragos 
Published: July 2021

Background:
Transcatheter aortic valve implantation (TAVI) has become an established and increasingly used approach for management of severe symptomatic aortic stenosis, showing similar or even superior outcomes compared with standard surgical aortic valve replacement (SAVR). Stroke after TAVI is a relatively rare, but serious complication, associated with potential prolonged disability and increased mortality.

Areas of Uncertainty:
The overall incidence of 30-day stroke in TAVI patients is 3%–4%, but varies between different trials. Initial data suggested a higher risk of stroke after TAVI when compared with SAVR. The association between subclinical leaflet thrombosis and cerebral embolism, presented as stroke, transient ischemic accident, or silent cerebral ischemia is not entirely elucidated yet. Moreover, TAVI for severe bicuspid aortic stenosis is a relatively new issue, bicuspid anatomy being initially excluded from the pivotal clinical trials investigating TAVI procedure. Efficient stroke prevention strategies are under investigation.

Data Sources:
In the present manuscript, we used the available published data from the most relevant clinical trials, registries, and meta-analysis of patients from different risk categories who underwent TAVI or SAVR.

Therapeutic Advances:
Predictors of acute stroke are mainly procedure related. Technological development, improvements in bioprosthesis valve delivery catheters, and implantation technique may explain the decrease of stroke over the years since the beginning of TAVI procedures.

Conclusions:
The overall evidences confirm similar or lower rate of stroke in TAVI versus SAVR. Risk predictors for acute stroke after TAVI are generally related to procedural factors, whereas late stroke is mainly associated with patient characteristics, with a variable impact on cognitive function. The optimal choice for the antithrombotic treatment in TAVI for stroke prevention is yet to be determined. Current data do not support routine use of cerebral embolic protection devices during TAVI.
Methodological Challenges and Statistical Approaches in the COMprehensive Post-Acute Stroke Services Study
Authors: Psioda Matthew A. , Jones Sara B. , Xenakis James G. , D’Agostino Ralph B. 
Published: July 2021

Background:
The COMprehensive Post-Acute Stroke Services study was a cluster-randomized pragmatic trial designed to evaluate a comprehensive care transitions model versus usual care. The data collected during this trial were complex and analysis methodology was required that could simultaneously account for the cluster-randomized design, missing patient-level covariates, outcome nonresponse, and substantial nonadherence to the intervention.

Objective:
The objective of this study was to discuss an array of complementary statistical methods to evaluate treatment effectiveness that appropriately addressed the challenges presented by the complex data arising from this pragmatic trial.

Methods:
We utilized multiple imputation combined with inverse probability weighting to account for missing covariate and outcome data in the estimation of intention-to-treat effects (ITT). The ITT estimand reflects the effectiveness of assignment to the COMprehensive Post-Acute Stroke Services intervention compared with usual care (ie, it does not take into account intervention adherence). Per-protocol analyses provide complementary information about the effect of treatment, and therefore are relevant for patients to inform their decision-making. We describe estimation of the complier average causal effect using an instrumental variables approach through 2-stage least squares estimation. For all preplanned analyses, we also discuss additional sensitivity analyses.

Discussion:
Pragmatic trials are well suited to inform clinical practice. Care should be taken to proactively identify the appropriate balance between control and pragmatism in trial design. Valid estimation of ITT and per-protocol effects in the presence of complex data requires application of appropriate statistical methods and concerted efforts to ensure high-quality data are collected.