bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury
Authors: Swan Alicia A. , Akin Faith W. , Amuan Megan E. , Riska Kristal M. , Hall Courtney D. , Kalvesmaki Andrea , Padilla Silvia , Crowsey Eden , Pugh Mary Jo 
Published: July 2021

Objective:
To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms.

Setting:
Administrative medical record data from the Department of Veterans Affairs (VA).

Participants:
Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation.

Design:
A cross-sectional, retrospective, observational study.

Main Measures:

International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory.

Results:
Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses.

Conclusions:
Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
Family Burden in Adolescents With Refractory Postconcussion Symptoms
Authors: Brooks Brian L. , Kumari Jeshna , Virani Shane 
Published: July 2021

Objective:
A significant minority of adolescents will have persistent postconcussion symptoms after an injury, potentially having a negative impact on family functioning. However, the reasons for a family's negative impact are not clearly understood. The objective of this study was to determine whether preinjury/demographic factors, injury characteristics, and/or worse postinjury symptoms are associated with higher levels of family stress in youth with refractory postconcussion symptoms.

Setting:
Pediatric refractory concussion clinic in a tertiary care center.

Participants:
A total of 121 adolescents (13-18 years old) who were 1 to 12 months postconcussion.

Measures:
Primary outcome was the mean stress rating on the Family Burden of Injury Interview (FBII), a 27-item questionnaire rating the impact on a family as a result of an injury. Preinjury/demographic and injury details were collected. Youth and their parents also completed measures of postconcussion symptoms, depression, anxiety, and behavioral problems.

Results:
Participants had a mean age of 16.0 years (SD = 1.3), of which, 65% identified as female, and were on an average 5.2 months (SD = 2.4) postconcussion. FBII ratings were not significantly correlated with demographics, preinjury functioning, injury severity, duration of persistent postconcussion problems (ie, time since injury), or self-reported postconcussion symptoms. Greater family burden (higher FBII ratings) significantly correlated with worse parent-reported postconcussion symptoms, worse psychological functioning (self-reported depression, parent-reported anxiety, and depression), and worse behavioral functioning (parent-reported conduct problems and peer problems). A multiple linear regression model revealed that parent-perceived postconcussion cognitive symptoms (β = .292, t = 2.56, P = .012) and parent-perceived peer problems (β = .263, t = 2.59, P = .011) were significantly associated with family burden (F
8,105 = 6.53; P < .001; R
2 = 0.35).

Conclusion:
Families of youth with refractory postconcussion symptoms can experience a negative impact. The severity of reported family burden in those with slow recovery from concussion was significantly associated with parents' perception of their child's cognitive symptoms and peer problems. These results could provide support for family-based interventions in this population.
Repetitive Traumatic Brain Injury Among Older Adults
Authors: Chauhan Aparna Vadlamani , Guralnik Jack , dosReis Susan , Sorkin John D. , Badjatia Neeraj , Albrecht Jennifer S. 
Published: July 2021

Objective:
To determine the incidence of and assess risk factors for repetitive traumatic brain injury (TBI) among older adults in the United States.

Design:
Retrospective cohort study.

Setting:
Administrative claims data obtained from the Centers for Medicare & Medicaid Services' Chronic Conditions Data Warehouse.

Participants:
Individuals 65 years or older and diagnosed with TBI between July 2008 and September 2012 drawn from a 5% random sample of US Medicare beneficiaries.

Main Measures:
Repetitive TBI was identified as a second TBI occurring at least 90 days after the first occurrence of TBI following an 18-month TBI-free period. We identified factors associated with repetitive TBI using a log-binomial model.

Results:
A total of 38 064 older Medicare beneficiaries experienced a TBI. Of these, 4562 (12%) beneficiaries sustained at least one subsequent TBI over up to 5 years of follow-up. The unadjusted incidence rate of repetitive TBI was 3022 (95% CI, 2935-3111) per 100 000 person-years. Epilepsy was the strongest predictor of repetitive TBI (relative risk [RR] = 1.44; 95% CI, 1.25-1.56), followed by Alzheimer disease and related dementias (RR = 1.32; 95% CI 1.20-1.45), and depression (RR = 1.30; 95% CI, 1.21-1.38).

Conclusions:
Injury prevention and fall-reduction interventions could be targeted to identify groups of older adults at an increased risk of repetitive head injury. Future work should focus on injury-reduction initiatives to reduce the risk of repetitive TBI as well as assessment of outcomes related to repetitive TBI.
Blast Wound Dehiscence During Descemet Membrane Endothelial Keratoplasty Rebubbling in a Previous Penetrating Keratoplasty: A Case Report
Authors: Coco Giulia , Borgia Alfredo , Romano Davide , Kaye Stephen B. , Romano Vito 
Published: July 2021

Purpose:
The purpose of this study was to describe a rare complication of Descemet membrane endothelial keratoplasty (DMEK) rebubbling.

Methods:
An 86-year-old woman with bilateral penetrating keratoplasty (PK) performed 20 years previously for Fuchs endothelial dystrophy underwent DMEK surgery for endothelial corneal decompensation in the left eye. Surgery was complicated in the postoperative period by repeated DMEK graft detachments requiring rebubbling.

Results:
The third rebubbling procedure caused a traumatic PK wound dehiscence at the graft–host junction with full-thickness opening of approximately 180 degrees. PK wound dehiscence was resutured in the theater, DMEK lenticule was removed from the eye, and the full-thickness graft was repeated.

Conclusions:
DMEK graft rebubbling in patients with previous PK may lead to traumatic wound dehiscence. Avoidance of excessive increases in intraocular pressure during the rebubbling procedure should be encouraged to decrease the risk of this rare complication.
Fabrication of hyaluronic acid-gold nanoparticles with chitosan to modulate neural differentiation of mesenchymal stem cells
Authors: Shen Chiung-Chyi , Yang Meng-Yin , Chang Kai-Bo , Tseng Chia-Hsuan , Yang Yi-Ping , Yang Yi-Chin , Kung Mei-Lang , Lai Wei-Yi , Lin Tzu-Wei , Hsieh Hsien-Hsu , Hung Huey-Shan 
Published: July 2021

Background:
Chitosan (Chi) is a natural material which has been widely used in neural applications due to possessing better biocompatibility. In this research study, a novel of nanocomposites film based on Chi with hyaluronic acid (HA), combined with varying amounts of gold nanoparticles (AuNPs), was created resulting in pure Chi, Chi-HA, Chi-HA-AuNPs (25 ppm), and Chi-HA-AuNPs (50 ppm).

Methods:
This study focused on evaluating their effects on mesenchymal stem cell (MSC) viability, colony formation, and biocompatibility. The surface morphology and chemical position were characterized through UV-visible spectroscopy (UV-Vis), Fourier-transform infrared spectroscopy (FTIR), SEM, and contact-angle assessment.

Results:
When seeding MSCs on Chi-HA-AuNPs (50 ppm), the results showed high cell viability, biocompatibility, and the highest colony formation ability. Meanwhile, the evidence showed that Chi-HA-Au nanofilm was able to inhibit nestin and β-tubulin expression of MSCs, as well as inhibit the ability of neurogenic differentiation. Furthermore, the results of matrix metalloproteinase 2/9 (MMP2/9) expression in MSCs were also significantly higher in the Chi-HA-AuNP (50 ppm) group, guiding with angiogenesis and wound healing abilities. In addition, in our rat model, both capsule thickness and collagen deposition were the lowest in Chi-HA-AuNPs (50 ppm).

Conclusion:
Thus, in view of the in vitro and in vivo results, Chi-HA-AuNPs (50 ppm) could not only maintain the greatest stemness properties and regulate the neurogenic differentiation ability of MSCs, but was able to also induce the least immune response. Herein, Chi-HA-Au 50 ppm nanofilm holds promise as a suitable material for nerve regeneration engineering.
Image-enhanced endoscopy for detection of second primary esophageal neoplasms in patients with hypopharyngeal cancer: Prevalence, risk factors, and characteristics
Authors: Huang Yu-Wen , Wang Yen-Po , Lee Tsung-Lun , Chang Chia-Fan , Hou Ming-Chih , Tai Shyh-Kuan , Chu Pen-Yuan 
Published: July 2021

Background:
Esophageal second primary neoplasms (ESPNs) are common in hypopharyngeal squamous cell carcinoma (HPSCC) patients and are associated with poor prognoses. The effectiveness of image-enhanced endoscopy (IEE) has not been well established.

Methods:
We reviewed the patients between April 2016 and April 2018 with HPSCC receiving ESPNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy.

Results:
Of 99 eligible patients, ESPNs prevalence was 31%. Of the 69 patients assigned to the follow-up group, 23 with positive findings showed significantly increased previous histories of second primary malignancies in the upper aerodigestive tract. Among them, patients without symptoms at the time of IEE screening showed less advanced T stages and higher percentages of receiving minimal invasive therapy.

Conclusion:
The present study represented the clinical utility of routine IEE screening in HPSCC patients and proposed routine surveillance may help identify and properly manage early-stage ESPN.
Ischemic Stroke Risk Among Adult Brain Tumor Survivors: Evidence to Guide Practice
Authors: Figuracion Karl Cristie F. , Jung Wonkyung , Martha Sarah R. 
Published: July 2021

ABSTRACT

INTRODUCTION: Primary brain tumors are the leading cause of cancer mortality in the United States affecting approximately 90,000 Americans each year. A major complication for brain tumor survivors is acute ischemic stroke (AIS). Currently, there are limited research to provide guidelines for AIS prevention and management in adult brain tumor survivors. The purpose of this review is to discuss the most common risk factors for AIS in adult brain tumor survivors along with best evidence for assessment, screening, and strategies to prevent AIS in this population. METHODS: Relevant literature was identified by searching CINAHL and PubMed databases using the following keywords: “brain tumor survivors,” “adults,” “stroke,” “risk factors,” “guidelines,” “prevention,” and “management”. Articles not pertaining to adult brain tumor survivors and AIS were excluded. RESULTS: The location of the tumor, dose, extent, and type of radiation contribute to the development of vascular injury and subsequent carotid stenosis among brain tumor survivors. Endothelial growth factor inhibitor and chemotherapy drugs induces vascular remodeling. Other symptoms such as neurological impairments and co-morbidities are also present among brain tumor survivors. Furthermore, AIS increases from the time of primary brain tumor diagnosis and incidence further increases among patients who were diagnosed with a brain tumor as a child. CONCLUSION: Nurses play a key role in the assessment, prevention, and identifying individuals who are at risk of AIS during brain tumor survivorship. Engaging patients and their caregivers on minimizing their risks of AIS is crucial in the outpatient setting. Annual surveillance visits that include intracranial artery imaging should be used to identify individuals considered most at risk for developing AIS symptoms.
Extracellular matrix: paving the way to the newest trends in atherosclerosis
Authors: Gialeli Chrysostomi , Shami Annelie , Gonçalves Isabel 
Published: July 2021

Purpose of review
The extracellular matrix (ECM) is critical for all aspects of vascular pathobiology. In vascular disease the balance of its structural components is shifted. In atherosclerotic plaques there is in fact a dynamic battle between stabilizing and proinflammatory responses. This review explores the most recent strides that have been made to detail the active role of the ECM – and its main binding partners – in driving atherosclerotic plaque development and destabilization.

Recent findings
Proteoglycans-glycosaminoglycans (PGs-GAGs) synthesis and remodelling, as well as elastin synthesis, cross-linking, degradation and its elastokines potentially affect disease progression, providing multiple steps for potential therapeutic intervention and diagnostic targeted imaging. Of note, GAGs biosynthetic enzymes modulate the phenotype of vascular resident and infiltrating cells. In addition, while plaque collagen structure exerts very palpable effects on its immediate surroundings, a new role for collagen is also emerging on a more systemic level as a biomarker for cardiovascular disease as well as a target for selective drug-delivery.

Summary
The importance of studying the ECM in atherosclerosis is more and more acknowledged and various systems are being developed to visualize, target and mimic it.
Simulation-based User-centered Design: An Approach to Device Development during COVID-19
Authors: Colman Nora , Saldana Christopher , Craig Kentez , Edwards Nicole , McGough Jennifer , Mason Carrie , Hebbar Kiran B. 
Published: July 2021

Introduction:
Since the onset of COVID-19, intubations have become very high risk for clinical teams. Barrier devices during endotracheal intubation protect clinicians from the aerosols generated. Simulation-based user-centered design (UCD) was an iterative design process used to develop a pediatric intubation aerosol containment system (IACS). Simulation was anchored in human factor engineering and UCD to better understand clinicians’ complex interaction with the IACS device, elicit user wants and needs, identify design inefficiencies, and unveil safety concerns.

Methods:
This study was a prospective observational study of a simulation-based investigation used to design a pediatric IACS rapidly. Debriefing and Failure Mode and Effect Analysis identified latent conditions related to 5 device prototypes. Design iterations made were based on feedback provided to the engineering team after each simulation.

Results:
Simulation identified 32 latent conditions, resulting in 5 iterations of the IACS prototype. The prototypes included an (1) intubation box; (2) IACS shield; (3) IACS frame with PVC pipes; (4) IACS plexiglass frame, and finally, (5) IACS frame without a plexiglass top.

Conclusions:
Integration of simulation with human factor ergonomics and UCD, in partnership with mechanical engineers, facilitated a novel context to design and redesign a pediatric IACS to meet user needs and address safety concerns.
Quantifying Discharge Medication Reconciliation Errors at 2 Pediatric Hospitals
Authors: Morse Keith E. , Chadwick Whitney A. , Paul Wendy , Haaland Wren , Pageler Natalie M. , Tarrago Rod 
Published: July 2021

Introduction:
Medication reconciliation errors (MREs) are common and can lead to significant patient harm. Quality improvement efforts to identify and reduce these errors typically rely on resource-intensive chart reviews or adverse event reporting. Quantifying these errors hospital-wide is complicated and rarely done. The purpose of this study is to define a set of 6 MREs that can be easily identified across an entire healthcare organization and report their prevalence at 2 pediatric hospitals.

Methods:
An algorithmic analysis of discharge medication lists and confirmation by clinician reviewers was used to find the prevalence of the 6 discharge MREs at 2 pediatric hospitals. These errors represent deviations from the standards for medication instruction completeness, clarity, and safety. The 6 error types are Duplication, Missing Route, Missing Dose, Missing Frequency, Unlisted Medication, and See Instructions errors.

Results:
This study analyzed 67,339 discharge medications and detected MREs commonly at both hospitals. For Institution A, a total of 4,234 errors were identified, with 29.9% of discharges containing at least one error and an average of 0.7 errors per discharge. For Institution B, a total of 5,942 errors were identified, with 42.2% of discharges containing at least 1 error and an average of 1.6 errors per discharge. The most common error types were Duplication and See Instructions errors.

Conclusion:
The presented method shows these MREs to be a common finding in pediatric care. This work offers a tool to strengthen hospital-wide quality improvement efforts to reduce pediatric medication errors.
A Quality Improvement Approach to Influence Value-based Mucolytic Use in the PICU
Authors: Gillis Holly Catherine , Dolan Kevin , Sargel Cheryl L. , Thompson R. Zachary , Lutmer Jeffrey E. 
Published: July 2021

Introduction:
High-cost medication administration, despite lacking evidence for use, results in poor healthcare value. This work aimed to reduce dornase-alfa utilization in critically ill mechanically ventilated children.

Methods:
The project employed an observational pre-post design to develop a value-based clinical pathway to guide provider choice in mucolytic utilization in a quaternary pediatric intensive care unit. This pathway was designed to continue using low-cost mucolytic aerosols (hypertonic saline, N-acetylcysteine) but decrease new starts and total doses per 100 patient days (P100PD) dornase-alfa among patients for whom there is little to no supporting evidence. Interventions included a departmental journal club for fellow and attending physicians and a rolling introduction of the pathway to residents and respiratory therapists. Control charts serially tracked ordering changes and location-specific dornase alfa orders.

Results:
New dornase-alfa starts P100PD decreased by 53% (1.17–0.55), and total doses P100PD decreased by 75% (16–4). N-acetylcysteine ordering more than doubled; however, total doses of P100PD remained unchanged after the intervention. The use of 3% sodium chloride increased significantly from 0.28 to 4.15 new starts and 4.37 to 38.84 total doses P100PD. Mechanical ventilation days P100PD decreased, suggesting there were no measured adverse effects of pathway implementation. The reduction in dornase-alfa utilization resulted in a cumulative and sustained 59% mucolytic cost reduction ($2183.08–$885.77 P100PD).

Conclusion:
A clinical pathway prioritizing pharmacoeconomics when evidence for use is lacking can improve health care value without adversely affecting patient outcomes.
Standardized Neurodevelopmental Surveillance of High-risk Infants Using Telehealth: Implementation Study during COVID-19
Authors: Maitre Nathalie L. , Benninger Kristen L. , Neel Mary Lauren , Haase Jennifer A. , Pietruszewski Lindsay , Levengood Katelyn , Adderley Kathleen , Batterson Nancy , Hague Kaleigh , Lightfoot Megan , Weiss Sarah , Lewandowski Dennis J. , Larson Heather 
Published: July 2021

Introduction:
Neurodevelopmental surveillance is critical for high-risk infants following neonatal intensive care discharge and is traditionally performed in-person. COVID-19 interruption of regular surveillance necessitated a rapid development of telehealth models for effective and standardized care.

Methods:
We used implementation science and lean methodologies to develop an effective telehealth neurodevelopmental surveillance program for high-risk infants. Interventions included reorganization of visit flow processes and a telehealth toolkit for standardized neurological and developmental assessments. We tested and improved our intervention through plan-do-study-act cycles, value-added analysis, and parent- and provider-satisfaction questionnaires. Process metrics (standard elements, subspecialty referrals, diagnostic tests, and prescriptions ordered) were compared in group-level analyses between telehealth patients (N = 97) March 16, 2020–July 1, 2020 and a matched in-person cohort at the same period the previous year. Run charts examined shifts in balancing measures (provider efficiency and missed visits) over 8 weeks before and after implementation.

Results:
Primary outcomes were visit completion (100%), patient parent satisfaction (>90% strongly agreed or agreed telehealth procedures were valuable and easy to use) and ability to accurately diagnose cerebral palsy (no statistical difference with comparison visits). Providers (N = 6) rated telehealth experiences favorably. Process metrics indicated no differences between telehealth and in-person visits (all P > 0.05). Following telehealth implementation, provider efficiency increased to near baseline (median 88.9% versus 91.7%) and median missed visits decreased to 0% from 20% (in-person).

Conclusions:
Implementation of telehealth for neurodevelopmental surveillance in a tertiary high-risk infant follow-up clinic successfully provided standardized and timely care during stay-at-home orders; broader telehealth applications may overcome access barriers in this field.