bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in Gender and Race Among Physician–Scientists: A Call to Action and Strategic Recommendations
Authors: Ward Heather Burrell , Levin Frances R. , Greenfield Shelly F. 
Published: June 2021

The size of the physician–scientist workforce has declined for the past 3 decades, which raises significant concerns for the future of biomedical research. There is also a considerable gender disparity among physician–scientists. This disparity is exacerbated by race, resulting in a compounding effect for women of color. Proposed reasons for this disparity include the time and expense physicians must devote to obtaining specialized research training after residency while at the same time burdened with mounting medical school debt and domestic and caretaking responsibilities, which are disproportionately shouldered by women. These circumstances may contribute to the overall gender disparity in research funded by the National Institutes of Health (NIH). Women apply for NIH grants less often than men and are therefore less likely to receive an NIH grant. However, when women do apply for NIH grants, their funding success is comparable with that of men.
Increasing representation of women and groups underrepresented in medicine (UIM) requires not only improving the pipeline (e.g., through training) but also assisting early- and midcareer women—and especially women who are UIM—to advance. In this article, the authors propose the following solutions to address the challenges women and other UIM individuals face at each of these career stages: developing specific NIH research training programs targeted to women and UIM individuals in medical school and residency; creating institutional and individual grant initiatives; increasing student loan forgiveness; setting up robust institutional mentorship programs for individuals seeking to obtain independent funding; providing childcare stipends as part of NIH grants; and instituting an NIH requirement that funded investigators participate in efforts to increase diversity in the physician–scientist workforce. Enabling more women and UIM individuals to enter and thrive in the physician–scientist workforce will increase the size and diversity of this critical component of biomedical research.
Optimizing Safety for the Postradiation Face Lift
Authors: Boustany Ashley N. , Laikhter Elizabeth , Shiah Eric , Lin Samuel J. , Slavin Sumner A. 
Published: June 2021

Background:
The growing population of aging patients who have received head or neck radiation has brought attention to the unique considerations for surgical face lifts. Tissue fibrosis and impaired microcirculation can compromise wound healing and increase overall complication rates. Our review of the literature identified few reported cases of postradiation face lifts.

Methods:
Three patients who underwent postradiation face lift procedures were identified within two senior surgeons’ practices. Patient demographics, medical history, surgical technique, postoperative course, and photographs were obtained. Complications were analyzed, including infections, hematomas, seromas, wound dehiscence, delayed healing, necrosis, nerve injuries, poor scarring, and systemic events.

Results:
None of the patients experienced immediate or major complications. All patients reported satisfaction with the procedure. One patient required a revision of the earlobe.

Conclusions:
Our limited series suggests that with a comprehensive approach and a deliberate surgical technique, safe and desirable outcomes may be achieved in the appropriately selected patient. We outline perioperative considerations to assist surgeons in caring for these patients. Additional research is necessary to assess the impact of patient and therapeutic variables.
Value-Based Healthcare Initiatives in Practice: A Systematic Review
Authors: Zanotto Bruna Stella , Etges Ana Paula Beck da Silva , Marcolino Miriam Allein Zago , Polanczyk Carisi Anne 
Published: June 2021

EXECUTIVE SUMMARY
Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.
Persistent Postural-Perceptual Dizziness in Children and Adolescents
Authors: Wang Alicia , Fleischman Katie M. , Kawai Kosuke , Corcoran Meghan , Brodsky Jacob R. 
Published: June 2021

Objective:
Persistent postural-perceptual dizziness (PPPD) is a recently defined diagnostic syndrome characterized by chronic symptoms of dizziness, unsteadiness, and/or non-spinning vertigo. Although PPPD has been studied in adults, reports in the pediatric population are few. The goal of this study was to describe the presentation and treatment of PPPD in a group of pediatric patients.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
≤21 years old, who met Bárány Society consensus criteria for a diagnosis of PPPD and were followed for ≥6 months or until symptom resolution.

Main Outcome Measures(s):
Patient demographics, comorbidities, symptom chronicity, and response to treatment(s).

Results:
Of the 53 patients identified, 44 (83.0%) were women. Mean age at the time of initial evaluation was 14.6 years old. Common diagnoses in addition to PPPD included benign paroxysmal positional vertigo (64.2%), vestibular migraine (56.6%), and anxiety (28.3%). A high proportion of patients (43.4%) reported initially missing school or work due to their symptoms. Eighteen patients (34.0%) reported symptom resolution ranging from 2 to 48 months after diagnosis (median 9 mo). Of these patients, 15 of 18 attended physical therapy (PT), 11 of 18 attended cognitive behavioral therapy (CBT) and/or biofeedback therapy, and 10 of 18 took selective serotonin reuptake inhibitor (SSRI) medications, and 7 of 18 (40%) did a combination of all three therapies.

Conclusion:
PPPD can impact patients at a young age, and prolonged symptoms present a significant burden to children and adolescents, many of whom are unable to attend school. Treatments such as PT, CBT, and SSRI medication may be effective.
Surgical Experience and Early Audiological Outcomes With New Active Transcutaneous Bone Conduction Implant
Authors: Sprinzl Georg Mathias , Schoerg Philipp , Ploder Marlene , Edlinger Stefan Herwig , Magele Astrid 
Published: June 2021

Objectives:
Our objective was to report the very first surgical experiences, audiologic benefits, and satisfaction with the new active transcutaneous bone conduction implant, generation 602 (BCI602), in patients with mixed/conductive hearing loss (M/CHL) and single-sided deafness.

Methods:
A retrospective chart review from patients who underwent BCI602 surgery was performed.

Results:
Twelve subjects were implanted (mean age 33.17 ± 21.67 yrs). Mean surgery time was 29.89 ± 8.59 minutes, with the longest being a difficult passive-BCI explantation due to excessive osseointegration. No surgical nor post-surgical complications occurred. No pre-operative surgical planning for device placement was necessary, no BCI-lifts were used and complete transmastoid implantation was possible. The mean functional gain in the M/CHL cohort significantly increased after 3 months (ρ < .0001). The mean word recognition score (%) in quiet for the M/CHL group significantly improved at activation and 3 months post-surgery (ρ = .0002; ρ < .0001). At the 3 months follow-up the subjects reported high satisfaction with the device accompanied with a mean wearing time of 10.13 hours per day (range 18–6 h/d) resulting in a reported battery change of every 8.29 ± 0.49 days.

Conclusions:
These early results of the new BCI602 showed significantly improved audiological performance, no limitations during surgery (youngest subject 2 yrs at surgery), no prior surgical planning necessary, accompanied by high patient satisfaction and increased wearing time. Based on these results, the BCI602 can be highly recommended and especially for difficult anatomical and surgical cases and the given indication for children older than 5 years should probably be revaluated.

Level of Evidence: Level 4.
Individual and combined effects of GSTM1, GSTT1, and GSTP1 polymorphisms on lung cancer risk
Authors: Zhang Wen-Ping , Yang Chen , Xu Ling-Jun , Wang Wei , Song Liang , He Xiao-Feng 
Published: June 2021

Abstract
Thirty-five previous meta-analyses have been reported on the individual glutathione S-transferase M1 (GSTM1) present/null, glutathione S-transferase T1 (GSTT1) present/null, and glutathione S-transferase P1 (GSTP1) IIe105Val polymorphisms with lung cancer (LC) risk. However, they did not appraise the credibility and explore the combined effects between the 3 genes and LC risk.
We performed a meta-analysis and re-analysis of systematic previous meta-analyses to solve the above problems.
Meta-analyses of Observational Studies in Epidemiology guidelines were used. Moreover, we employed false-positive report probability (FPRP), Bayesian false discovery probability (BFDP), and the Venice criteria to verify the credibility of current and previous meta-analyses.
Significantly increased LC risk was considered as “highly credible” or “positive” for GSTM1 null genotype in Japanese (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.17–1.44, I
2 = 0.0%, statistical power = 0.997, FPRP = 0.008, BFDP = 0.037, and Venice criteria: AAB), for GSTT1 null genotype in Asians (OR = 1.23, 95% CI = 1.12–1.36, I
2 = 49.1%, statistical power = 1.000, FPRP = 0.051, BFDP = 0.771, and Venice criteria: ABB), especially Chinese populations (OR = 1.31, 95% CI = 1.16–1.49, I
2 = 48.9%, Statistical power = 0.980, FPRP = 0.039, BFDP = 0.673, and Venice criteria: ABB), and for GSTP1 IIe105Val polymorphism in Asians (Val vs IIe: OR = 1.28, 95% CI = 1.17–1.42, I
2 = 30.3%, statistical power = 0.999, FPRP = 0.003, BFDP = 0.183, and Venice criteria: ABB). Significantly increased lung adenocarcinoma (AC) risk was also considered as “highly credible” or “positive” in Asians for the GSTM1 (OR = 1.35, 95% CI = 1.22–1.48, I
2 = 25.5%, statistical power = 0.988, FPRP < 0.001, BFDP < 0.001, and Venice criteria: ABB) and GSTT1 (OR = 1.36, 95% CI = 1.17–1.58, I
2 = 30.2%, statistical power = 0.900, FPRP = 0.061, BFDP = 0.727, and Venice criteria: ABB) null genotype.
This study indicates that GSTM1 null genotype is associated with increased LC risk in Japanese and lung AC risk in Asians; GSTT1 null genotype is associated with increased LC risk in Chinese, and GSTP1 IIe105Val polymorphism is associated with increased LC risk in Asians.
Factors associated with a high-risk return visit to the emergency department: a case-crossover study
Authors: Sung Chih-Wei , Lu Tsung-Chien , Fang Cheng-Chung , Lin Jia-You , Yeh Huang-Fu , Huang Chien-Hua , Tsai Chu-Lin 
Published: June 2021

Background and importance
Although factors related to a return emergency department (ED) visit have been reported, few studies have examined ‘high-risk’ return ED visits with serious adverse outcomes. Understanding factors associated with high-risk return ED visits may help with early recognition and prevention of these catastrophic events.

Objectives
We aimed to (1) estimate the incidence of high-risk return ED visits, and (2) to investigate time-varying factors associated with these revisits.

Design
Case-crossover study.

Settings and participants
We used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 651 815 ED visits over a 6-year period. Patient demographics and computerized triage information were extracted.

Outcome measure and analysis
A high-risk return ED visit was defined as a revisit within 72 h of the index visit with ICU admission, receiving emergency surgery, or with in-hospital cardiac arrest during the return ED visit. Time-varying factors associated with a return visit were identified.

Main results
There were 440 281 adult index visits, of which 19 675 (4.5%) return visits occurred within 72 h. Of them, 417 (0.1%) were high-risk revisits. Multivariable analysis showed that time-varying factors associated with an increased risk of high-risk revisits included the following: arrival by ambulance, dyspnea, or chest pain on ED presentation, triage level 1 or 2, acute change in levels of consciousness, tachycardia (>90/min), and high fever (>39°C).

Conclusions
We found a relatively small fraction of discharges (0.1%) developed serious adverse events during the return ED visits. We identified symptom-based and vital sign-based warning signs that may be used for patient self-monitoring at home, as well as new-onset signs during the return visit to alert healthcare providers for timely management of these high-risk revisits.
Vasculitis Presenting as Autonomic Failure
Authors: Blech Benzion , Meyer Megan , Goodman Brent , Knox Molly , Aslam Fawad , Schmitt Alessandra , Grill Marie 
Published: June 2021

Introduction:
Granulomatosis with polyangiitis (GPA) is a vasculitic process that can cause neurological dysfunction in addition to characteristic sinus and pulmonary manifestations. This case report highlights the spectrum of nervous system manifestations and includes rarely reported autonomic and pituitary involvement.

Case Report:
A 62-year-old woman presented with orthostatic intolerance, tachycardia, dry mouth, and temperature sensitivity; subsequent autonomic reflex study demonstrated widespread postganglionic sympathetic sudomotor, cardiovagal, and cardiovascular adrenergic impairment reflective of autonomic neuropathy and overall autonomic failure. Additional progressive symptoms included dysarthria, dysphagia, bilateral hearing loss, voice hoarseness, and right-sided facial numbness with multiple cranial neuropathies identified on neurological examination. The diagnosis of central diabetes insipidus was also confirmed. Pachymeningitis was present on brain magnetic resonance imaging. Pathologic review of the dural biopsy specimen revealed necrotizing granulomatous vasculitis consistent with GPA. She was treated with intravenous methylprednisolone and rituximab. Over the next 2 months, she had near-complete resolution of her symptoms with normalization on repeat autonomic testing.

Conclusions:
This is a unique GPA case presenting with autonomic failure and pituitary dysfunction with conclusive objective findings of autonomic dysfunction. Autonomic dysfunction and other disease manifestations were responsive to immunosuppressive therapy.
Hemorrhage Into a Subependymal Giant Cell Astrocytoma in an Adult With Tuberous Sclerosis
Authors: Barbiero Frank J. , Huttner Anita J. , Fulbright Robert K. , Baehring Joachim M. 
Published: June 2021

Background:
We present an uncommon cause of intracranial hemorrhage in a young adult. Tuberous sclerosis complex is a rare genetic disorder characterized by skin changes, benign systemic or central nervous system tumors [subependymal giant cell astrocytoma (SEGA)], mental retardation, or epilepsy. Hemorrhage into SEGA is exceedingly rare.

Case Presentation:
We evaluated a 21-year-old college student with migraine. Biopsy of numerous popular skin lesions on his nose revealed adenoma sebaceum. Magnetic resonance imaging brain showed a subependymal nodule near the foramen of Monro suspected to be SEGA. Genetic analysis identified a tuberous sclerosis complex-1 germ line mutation. Surveillance imaging was recommended for the subependymal tumor. Fourteen months later, he presented with spontaneous hemorrhage into the tumor. Hematoma evacuation and tumor resection revealed SEGA. The college graduate was able to return to full-time work.

Conclusions:
We present an unusual cause of intracranial hemorrhage in a young adult. Thorough work-up and recognition of an underlying genetic predisposition can curtails diagnostic delay when life-threatening complications occur.
Intraosseous Venous Malformation of the Zygomatic Bone: Virtual Surgical Planning and Reconstruction With Customized CAD-CAM Titanium Implant
Authors: Antúnez-Conde Raúl , Salmerón José Ignacio , Navarro Carlos 
Published: June 2021

Abstract
Zygomatic intraosseous vascular anomalies are uncommon. Most cases have been reported without a precise diagnosis. The prevalence is 3:1 women during the fourth decade of life. The study of these lesions includes clinical findings, radiological studies, such as computed tomography and magnetic resonance imaging scans, and a postoperative histological study of the specimen. Biopsy is not recommended because of the risk of bleeding. Complete surgical resection remains the gold standard elective treatment.
The case of a patient with an intraosseous venous malformation of the zygomatic bone is presented, detailing the clinical, histological, and radiological characteristics and the surgical treatment with a primary reconstruction through Computer-Aided Design/Computer-Aided Manufacturing customized titanium implant guided by virtual surgical planning with a reduction of surgical time and morbidity in the donor area with optimal functional and aesthetic results.
Novelty-induced frontal-STN networks in Parkinson’s disease
Authors: Cole Rachel C , Espinoza Arturo I , Singh Arun , Berger Joel I , Cavanagh James F , Wessel Jan R , Greenlee Jeremy D , Narayanan Nandakumar S 
Published: June 2021

AbstractNovelty detection is a primitive subcomponent of cognitive control that is deficient in Parkinson’s disease (PD) patients with cognitive dysfunction. Here, we studied novelty-response mechanisms in PD. In participants with PD, we recorded from cortical circuits with scalp-based electroencephalography (EEG) and from subcortical circuits using intraoperative neurophysiology during surgeries for implantation of deep-brain stimulation (DBS) electrodes. We report three major results. First, novel auditory stimuli triggered midfrontal low-frequency rhythms; of these, 1-4 Hz “delta” rhythms were linked to novelty-associated slowing whereas 4-7 Hz “theta” rhythms were specifically attenuated in PD. Second, 32% of subthalamic nucleus (STN) neurons were response-modulated; nearly all (94%) of these were also modulated by novel stimuli. Third, response-modulated STN neurons were coherent with midfrontal 1-4 Hz activity. These findings link scalp-based measurements of neural activity with neuronal activity in the STN. Our results provide insight into midfrontal cognitive control mechanisms and how purported hyperdirect fronto-basal ganglia circuits evaluate new information.
Racial/ethnic-based spirometry reference equations: Are they accurate for admixed populations?
Authors: Witonsky Jonathan , Elhawary Jennifer R. , Eng Celeste , Rodríguez-Santana José R. , Borrell Luisa N. , Burchard Esteban G. 
Published: June 2021

ABSTRACTBACKGROUNDVariation in genetic ancestry among admixed racial/ethnic groups may influence the fit of guideline-recommended spirometry reference equations, which rely on self-identified race/ethnicity.RESEARCH QUESTIONWhat is the influence of genetic ancestry on the fit of the guideline-recommended racial/ethnic-based spirometry reference equations in populations of genetically admixed children?STUDY DESIGN AND METHODSCross-sectional fit of guideline-recommended racial/ethnic-based spirometry reference equations was evaluated in control subjects from case-control studies of asthma. Anthropometry, blood samples, and spirometric measurements were obtained in 599 healthy admixed children, aged 8 to 21-years. Genetic ancestry was estimated using genome-wide genotype data. Equation fit was determined as a mean z-score between -0.5 and 0.5 and assessed in self-identified African American (N = 275) and Puerto Rican (N = 324) children using the distribution to determine cut points of genetic ancestry.RESULTSFor African American children, African American-derived equations fit for predicting FEV1 and FVC in those with an African ancestry above the median (81-100%), whereas composite equations for “other/mixed” populations fit for predicting FEV1 and FVC in those with an African ancestry below the median (31-81%). Among Puerto Rican children, White-derived equations fit for predicting FEV1, and the composite equations fit for predicting FVC for those with African ancestry above the median (21-88%). In contrast, in Puerto Rican children with African ancestry below the median (6-21%), only equations derived in Whites provide an adequate fit.INTERPRETATIONGuideline-recommended spirometry reference equations yielded biased estimates of lung function in admixed populations with high variation of African ancestry. Spirometry is due for reference equations that incorporate genetic ancestry, either for more precise application of the current equations or the derivation and utilization of new equations.
Imaging cortical multiple sclerosis lesions with ultra-high field MRI
Authors: Madsen Mads A.J. , Wiggermann Vanessa , Bramow Stephan , Christensen Jeppe Romme , Sellebjerg Finn , Siebner Hartwig R. 
Published: June 2021

AbstractBackgroundCortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualizein vivo. Ultra-high field (UHF) MRI at 7T and above provides technological advances suited to optimize the detection of cortical lesions in MS.PurposeTo provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS.MethodsA systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3T and 7T MRI and between 7T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology.Results7T MRI detected on average 52±26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17±6/patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Superiority of one MRI sequence over another could not be established from available data.Post-mortemlesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33±6% and 71±10%, respectively, with the highest sensitivity towards type I and type IV lesions.ConclusionUHF MRI improves cortical lesion detection in MS considerably compared to 3T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.