bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Self-Paced Physical and Cognitive Activities Across the First Week Postconcussion With Symptom Resolution in Youth
Authors: Yang Jingzhen , Yeates Keith Owen , Shi Junxin , Sullivan Lindsay , Xun Pengcheng , Taylor H. Gerry , Tiso Michael , Pommering Thomas , MacDonald James , Cohen Daniel M. , Hautmann Amanda , Asa Nicole , Singichetti Bhavna , Bailey Matthew , Lu Zhong-lin 
Published: March 2021

Objective:
To examine the association of objectively measured, self-paced physical and cognitive activities across the first week postconcussion with symptom resolution in youth.

Setting:
Emergency department or concussion clinics.

Participants:
Youth aged 11 to 17 years with physician-confirmed concussion.

Design:
Prospective cohort with repeated measures.

Main Measure(s):
Days from injury to symptom resolution, based on daily ratings by youth on the Post-Concussive Symptom Scale. Physical and cognitive activities were assessed using an ActiGraph and a Narrative Clip, respectively.

Results:
A total of 83 youth participants were included (n = 54 [65%] males; mean age = 14.2 years, SD = 1.9). While self-paced daily physical and cognitive activities increased across the first week postinjury, daily postconcussion symptoms decreased. Increased daily step count was associated with an increased likelihood of early symptom resolution (hazard ratio [HR] = 1.17; 95% confidence interval [CI], 1.02-1.34). However, this association was not statistically significant after adjusting for acute postconcussion symptoms and other covariates. Greater school attendance time was associated with earlier symptom resolution (adjusted HR = 1.14; 95% CI, 1.02-1.27).

Conclusion:
Self-paced physical and cognitive activities across the first week postinjury alone neither hastened nor prolonged concussion recovery. Youth with concussion may have some latitude to determine their activity levels.
Total keratometry for determination of true corneal power after myopic small-incision lenticule extraction
Authors: Lischke Roman , Mayer Wolfgang J. , Feucht Nikolaus , Siedlecki Jakob , Wiltfang Rainer , Kook Daniel , Priglinger Siegfried G. , Luft Nikolaus 
Published: March 2021

Purpose:
To gauge the value of total keratometry (TK) to estimate corneal power change in eyes that underwent small-incision lenticule extraction (SMILE) for treatment of myopia or myopic astigmatism.

Setting:
Department of Ophthalmology, Ludwig-Maximilians-University, and SMILE Eyes Clinic Munich Airport, Munich, Germany.

Design:
Prospective cross-sectional trial.

Methods:
A total of 40 eyes of 40 patients who had undergone myopic SMILE were enrolled in this prospective study. Total corneal refractive power (TCRP; Pentacam HR) and TK (IOLMaster 700, Carl Zeiss Meditec AG) values were compared with the clinical history method (CHM). The surgically induced changes in TCRP (ΔTCRP) and TK (ΔTK) were also compared with the changes in spherical equivalent on the corneal plane (ΔSEco).

Results:
Of the 40 eyes analyzed, the correlation between TK and CHM (R
2 = 0.91, P < .001) was stronger than that between TCRP and CHM (R
2 = 0.87, P < .001). When compared with the CHM, TCRP underestimated corneal power by a mean relative error of 0.59 diopter (D) and TK by 0.17 D. Linear regression analysis of ΔTCRP/ΔTK and the difference between preoperative and postoperative manifest refraction spherical equivalent at the corneal plane (ΔSEco) showed stronger correlation in ΔTK (R
2 = 0.88) than that in ΔTCRP (R
2 = 0.82).

Conclusions:
The findings endorse TK as an accurate measure for corneal power after myopic SMILE.
Accuracy of Vaginal pH Testing Before and After Addition of Sterile Saline
Authors: Bakir Sarah , Elas Diane , Stockdale Colleen K. , Zimmerman M. Bridget , Hardy-Fairbanks Abbey 
Published: March 2021

Objective
Complaints of vaginal discharge are common, and vaginal pH is important diagnostically. Vaginal pH is measured either directly using pH paper or after wet mount analysis. This study aims to analyze whether a significant change in vaginal pH after saline addition exists.

Methods
This prospective, diagnostic accuracy study included 97 persons with a vagina between the ages of 18–80 years who received care at an academic center. Two samples of vaginal discharge were collected, with pH measured by direct application to pH paper and after wet prep analysis. Outcome measurements included pH measurements and demographic variables collected from electronic medical records. A Wilcoxon signed-rank test was performed, with a p value less than .05 considered significant. It was hypothesized that addition of saline to vaginal discharge increases pH artificially.

Results
Primary outcome included pH difference between both samples. Sixty four (66%) of the subjects had a pH difference of 0.50 and 3 (3%) had a difference of 1.0. Twenty nine (30%) of the subjects had no difference. One subject (1%) had a decrease of 0.50 in pH after saline. Reproductive age and nonuse of vaginal medications were significantly associated with a pH difference of 0.50 or higher after saline addition. Of the demographic variables, reproductive age and nonuse of vaginal medications within the past week or the day of collection were associated with a significant pH difference after saline addition (79%, p = .025; 79%, p = .001; 76%, p = .002, respectively).

Conclusions
It may be reasonable to subtract 0.50 from final pH reading in patients of reproductive age and in those who have not used vaginal medications recently.
Knowledge, Attitudes, and Experiences of Anal Cancer and Anal Cancer Screening Among a Clinical Sample of Hispanic Women
Authors: Ortiz Ana P. , García-Camacho Sandra I. , Ramos-Cartagena Jeslie M. , Colón-López Vivian , Estremera-Rodríguez Lianeris M. , Berríos-Toledo Kyara M. , Romaguera Josefina 
Published: March 2021

Objective
Anal cancer screening has been recommended for women with lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high risk for anal cancer and their counterparts.

Methods
This is a cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 278 women 21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high risk or non–high risk for anal cancer. The high-risk group included women with a history of lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation.

Results
Overall, 40.7% of the study population were at high risk for developing anal cancer. History of anal cancer screening was low among high-risk and non–high-risk women (11.5% vs 5.6%, p > .05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes, or screening history were observed between high-risk and non–high-risk women.

Conclusions
Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection, and improve disease outcomes.
Follow-up After Loop Electrosurgical Excision of Cervical Intraepithelial Neoplasia: The Use of Combined Cytology and Human Papillomavirus Testing
Authors: Anderson Kristi Bøgh , Frandsen Anna Poulsgaard , Sandal Preben , Søgaard-Andersen Erik 
Published: March 2021

Objectives
The aims of the study were to investigate how many women after 1 or 2 follow-up examinations, based on combined cervical cytology and human papillomavirus (HPV) testing, could finish posttreatment follow-up and continue with the general screening program and to determine the 5-year risk of recurrence in this group.

Methods
This is a prospective observational study that includes women, who underwent loop electrosurgical excision procedure (LEEP) in the North Denmark Region, from January 1, 2012, to May 31, 2014. All included women had histologically verified diagnosis of high-grade cervical intraepithelial neoplasia (CIN 2+) or adenocarcinoma in situ (AIS) before LEEP and posttreatment follow-up with cervical cytology and HPV combination testing. Study period was until October 2019.

Results
Totally, 563 women were included in the study. After finishing the posttreatment follow-up, 439 (78%) could continue to the general screening program and 362 of them had a screening during the study period. Six women (1.7%) had either cervical dysplasia and/or HPV infection in the cervical screening, and of these, 3 (0.8%) had high-grade dysplasia corresponding to CIN 2. None was diagnosed with CIN 3, AIS, or invasive carcinoma. One hundred twenty-one women (36%) chose to be screened sooner than recommended in the national guidelines.

Conclusions
Human papillomavirus and cytology combination test after LEEP allows women, irrespective of margin status, safely to continue with the general screening program after a short posttreatment follow-up period. Improved information is mandatory to reduce “opportunistic” screening after finishing posttreatment follow-up.
A Novel Capacitive Cochlear Implant Electrode Array Sensing System to Discriminate Failure Patterns
Authors: Hou Lei , Du Xinli , Boulgouris Nikolaos , Coulson Chris , Irving Richard , Begg Philip , Brett Peter 
Published: March 2021

Objectives:
The research is to propose a sensing system to ensure the electrode array being correctly placed inside the cochlea. Instead of applying extra sensors to the array, the capacitive information from multiple points of the array is gathered and analyzed to determine the state and behavior of the electrode array.

Methods:
The sensing system measures electrode bipolar capacitances between multiple pairs of electrodes during the insertion. The principal component analysis (PCA) method is then applied to analysis the recorded data to discriminate insertion patterns.

Results:
In total, 384 capacitance profiles from electrode pair (1, 2), and electrode pair (15, 16) were analyzed and compared. In an account of both the electrode pairs, the threshold distance was examined to be d = 1.99 at the average comparison type. The experiment results showed the success rate is over 80% to identify buckling during the insertion on a 2D cochlear model.

Conclusion:
This early-stage investigation shows great potential compared with the current practice, which does not provide any feedback to surgeons. The system demonstrates the feasibility of a sensing method for auto-reoccupation electrodes behavior, and it will help surgeons to avoid misplacement of the electrode array inside the cochlea.
Adaptation of the Standardized Hearing Outcomes Scattergram to Hearing Preservation in Cochlear Implantation
Authors: Perkins Elizabeth L. , Manzoor Nauman F. , Haynes David S. , O’Malley Matthew , Gifford René , Rivas Alejandro 
Published: March 2021

Objective:
Encourage adaptation of a standardized format for reporting hearing preservation outcomes in cochlear implantation (CI).

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
One hundred seventy-eight postlingually deafened adults with bilateral SNHL and a preoperative low-frequency pure-tone average (LFPTA) 80 dB HL or better at 125, 250, and 500 Hz in the ear to be implanted.

Interventions:
Subjects underwent unilateral CI from 2013 to 2019 at a large referral center. Pre- versus postoperative LPFTA was used to generate a scattergram.

Main Outcomes Measures:
Pre- versus postoperative activation LPFTA, percentage of patients fit with electric and acoustic stimulation, scattergram plot.

Results:
Average postoperative LFPTA was 68.6 dB HL (range 18–68) compared with 48.7 dB (range 5–80), preoperatively. At activation, the average LFPTA shift at CI activation was 20.5 dB HL (range 0–60) and 83.5% (n = 137) patients had hearing preserved, of whom 41.6% were fit with electric and acoustic stimulation throughout the study period. The scattergram successfully illustrates the distribution and number of patients with their respective audiometric outcomes.

Conclusions:
The scattergram developed for reporting hearing outcomes in clinical trials is highly adaptable to reporting hearing preservation results in cochlear implant surgery. It represents a transparent and accessible option for reporting outcomes that can be used as a consistent format to allow for interstudy comparison and future meta-analysis.
Does Sinusitis Affect Lateralization of a Tuning Fork Weber Test?
Authors: Ungar Omer J. , Wengier Anat , Cavel Oren , Abergel Avraham , Safadi Ahmad , Warshavsky Anton , Horowitz Gilad , Handzel Ophir , Oron Yahav , Shilo Shahaf 
Published: March 2021

Objective:
To describe the effect of sinusitis on Weber test lateralization which normally lateralizes toward the ear of a conductive hearing loss and away from the ear of a sensorineural hearing loss; to investigate whether the presence of an extra-aural condition might affect Weber test results.

Study Design:
Descriptive study.

Setting:
Tertiary referral center.

Subjects and Methods:
Consecutive adult patients with maxillary and/or frontal sinusitis were included (study group), as well as patients with normal sinus structure and function (control group) were enrolled between February and September 2019. Presence or absence of paranasal disease and middle ear aeration was confirmed by computerized tomography. Subjects with otologic condition were excluded. The physical examinations, tympanograms, and audiograms were unremarkable. The Weber test consisted of 512, 1024, and 2048 Hz tuning forks that were applied on the central incisors and frontal midline, and lateralization patterns were compared with the extent of paranasal pathology.

Results:
There were 44 participants (M:F=26:18), age 19 to 63 years (average 51). The cohort included 39 patients with sinusitis, affecting the frontal and/or maxillary sinus(es), as well as 5 controls without evidence of paranasal disease. There was a match between the extent of paranasal disease and the results of all 3 Weber test frequencies in 35 patients (80%). Omission of the 2048 and 1024 Hz tuning forks from the analysis yielded a match in 40 (91%) and 43 (98%) patients, respectively. No Weber test lateralized to the nondiseased sinus in any subject. Weber test lateralization was observed in 11% of patients, after the sinonasal pathology was successfully addressed.

Conclusion:
Weber test lateralization in the absence of aural pathology may be explained by asymmetry related to paranasal disease and may alert to its presence.
Comparison of Medial Underlay and Lateral Underlay Endoscopic Type I Tympanoplasty for Anterior Perforations of the Tympanic Membrane
Authors: Choi Sung-Won , Kim Hwabin , Na Han-Seul , Lee Jung Woo , Lee Seokhwan , Oh Se-Joon , Kong Soo-Keun 
Published: March 2021

Objectives:
To compare the outcomes of medial and lateral underlay endoscopic type I tympanoplasty for anterior tympanic membrane (TM) perforations.

Study Design:
Retrospective chart review.

Setting:
Tertiary care academic referral center.

Patients:
Patients who were diagnosed with either chronic otitis media with dry and stable anterior TM perforations or traumatic anterior TM perforations and underwent endoscopic type I tympanoplasty between 2017 and 2019.

Interventions:
Medial or lateral underlay type I endoscopic tympanoplasty.

Main Outcome Measures:
Patient demographics, size, and location of TM perforation, graft success rate, and hearing outcome.

Results:
Of the 170 patients, 68 and 102 patients underwent the medial and lateral underlay techniques, respectively. Patient demographics were not significantly different between groups, except the middle ear mucosa status. Graft success rates were significantly different between groups regardless of the perforation size (85.3 and 95.1%, p < 0.001). The lateral underlay group had a significantly better outcome (p < 0.001) when anterior superior quadrant TM perforation was included than the medial underlay group (p = 0.552). Hearing outcomes did not significantly differ between groups, but a significant audiological improvement was observed in both groups (p < 0.05).

Conclusion:
Lateral underlay type I endoscopic tympanoplasty can be challenging as it requires dissection of the malleus. However, the lateral underlay group had a high graft success rate without sensorineural hearing loss in the repair of anterior TM perforations. Thus, lateral underlay type I endoscopic tympanoplasty should be considered for repairing anterior TM perforations, especially when the anterior superior quadrant is involved.
Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization
Authors: Badulak Jenelle , Antonini M. Velia , Stead Christine M. , Shekerdemian Lara , Raman Lakshmi , Paden Matthew L. , Agerstrand Cara , Bartlett Robert H. , Barrett Nicholas , Combes Alain , Lorusso Roberto , Mueller Thomas , Ogino Mark T. , Peek Giles , Pellegrino Vincent , Rabie Ahmed A. , Salazar Leonardo , Schmidt Matthieu , Shekar Kiran , MacLaren Graeme , Brodie Daniel 
Published: March 2021

Disclaimer:
This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19–related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19–related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19.
Salvage ablation for locally recurrent prostate cancer
Authors: Lomas Derek J. , Woodrum David A. , Mynderse Lance A. 
Published: March 2021

Purpose of review
This review aims to summarize the latest evidence for the use of salvage ablation of localized prostate cancer recurrences after primary therapy radiotherapy or prostatectomy.

Recent findings
Savage ablation represents a treatment option in select patients with localized recurrences following primary therapy of prostate cancer. Following radiotherapy, salvage cryotherapy and high-intensity focused ultrasound (HIFU) demonstrate encouraging oncologic outcomes. Biochemical recurrence-free survival ranged from 71% at 2 years to 44.2% at 10 years for cryotherapy and from 51% at 5 years to 28.7% at 10 years for HIFU. Rates of adverse effects appear to be more favorable with ablation compared to salvage surgery. Focal salvage ablation may offer a further balance between oncologic control and adverse effects. Following radical prostatectomy, recent data on the use of salvage ablation of local recurrences are less robust with only a few small studies published in the last 2 years.

Summary
Salvage ablation is an option for localized disease recurrences following primary treatment. Its role is most established for postradiation recurrence. It can also be utilized in postprostatectomy recurrence, although published data is more limited. Future studies are needed to further explore the role of ablation in both cohorts.
Withdrawal of Combination Immunotherapy in Paediatric Inflammatory Bowel Disease—An International Survey of Practice
Authors: Meredith Joseph , Henderson Paul , Wilson David C. , Van Limbergen Johan , Wine Eytan , Russell Richard K. 
Published: March 2021

ABSTRACTObjectives:To assess current practices around the use of combination immunosuppression in paediatric inflammatory bowel disease (PIBD) with a focus on the subsequent withdrawal process.Methods:A web‐based, 43‐question survey.Results:Surveys were completed by 70 paediatric gastroenterologists (PGs) from 27 nations across Europe, North America, Oceania and Asia from 62 centres covering approximately 15,000 PIBD patients (median of 200 patients [interquartile range (IQR) 130–300] per centre). Routine use of co‐immunosuppression was significantly higher with infliximab (IFX) versus adalimumab (ADL) ([61/70, 87.1%] compared with [23/70, 32.9%]; P < 0.01). Thiopurines (azathioprine [AZA] or 6‐mercaptopurine) were the preferred option overall for co‐immunosuppression. They were favoured with either IFX or ADL (76% and 77%, respectively) and in both ulcerative colitis (UC) and Crohn disease (CD) (84% and 69%) compared with methotrexate (MTX).Immunomodulators were the preferred choice as the initial drug to be withdrawn from the combination therapy rather than anti‐tumour necrosis factor‐alpha (anti‐TNFα) therapy (59/67, 88% [P < 0.01]). The most common withdrawal time was after 6–12 months, with this decision usually based on clinical assessment rather than a scheduled withdrawal time (51/67, 76% vs 16/67, 24%). Indicators of mucosal healing and therapeutic drug monitoring results tended to be the most important “clinical factors” in the withdrawal decision (P = 0.05).Conclusion:Most PG's favour initial withdrawal of immunomodulator (usually thiopurines) rather than biologic therapy in the step‐down process, usually after 6–12 months based on sustained clinical remission. This survey precedes an in‐depth, multicentre study of clinical outcomes of withdrawal of co‐immunosuppression in PIBD.
Positive Emotion Dysregulation Identifies Trauma-Exposed Community Individuals at Risk for Suicide and Nonsuicidal Self-Injury
Authors: Raudales Alexa M. , Darosh Angela G. , Contractor Ateka A. , Schatten Heather T. , Dixon-Gordon Katherine L. , Weiss Nicole H. 
Published: March 2021

Abstract
Emotion dysregulation is associated with increased risk for suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI). However, research in this area has focused almost exclusively on dysregulation stemming from negative emotions. The present study aimed to address this gap in the literature by examining the associations between the specific domains of positive emotion dysregulation and both STBs and NSSI. Participants included 397 trauma-exposed community adults (M
age = 35.95; 57.7% female; 76.8% White). Results demonstrated significant associations between positive emotion dysregulation and both STBs and NSSI. In particular, higher levels of nonacceptance of positive emotions were found to be significantly related to risk for STBs (versus no risk), higher severity of STBs, and history of NSSI (versus no history). Findings suggest positive emotion dysregulation may play an important role in the etiology and treatment of both STBs and NSSI among trauma-exposed individuals.