bluuebunny/crossref_metadata_2025_split huggingface dataset:
Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs
Authors: Klink Kathleen A. , Albanese Anthony P. , Bope Edward T. , Sanders Karen M. 
Published: December 2021

The United States has a well-trained, highly specialized physician workforce yet continues to have care gaps across the nation. Deficiencies in primary care and mental health specialties are most frequently cited, though critical shortages in multiple disciplines exist, particularly in rural areas. Sponsoring institutions of physician graduate medical education (GME) have created rural residency tracks with modest federal funding and minimal incentives, though efforts targeting shortages in these specialties and geographic locations have been limited. In response to access problems in the Veterans Health Administration, Department of Veterans Affairs (VA), the second largest federal funder of GME with the most expansive clinical education platform, Congress passed the Veterans Access, Choice, and Accountability Act of 2014. This act directed the VA and provided funding to establish 1,500 new positions, a 15% expansion of VA-funded positions at the time. Priority for position selection was given to primary care, mental health, and any other specialties the secretary of VA determined appropriate. Importantly, priority was also given to VA facilities with documented physician shortages, those that did not have GME training programs, those in communities with high concentrations of veterans, and those in health profession shortage areas. Many rural facilities match this profile and were targeted for this initiative.
At the conclusion of fiscal year 2021, 1,490 positions had been authorized, and 21 of the 22 VA medical centers previously without GME activity had added residents or were planning to soon. Of the authorized positions, 42% are in primary care, 24% in mental health, and 34% in critically needed additional specialties.
Targeted GME expansion in the VA, the largest integrated health care system in the nation, has been successful in addressing physician GME training that aligns with physician shortages and may serve as a model to address national physician specialty and geographic workforce needs.
More Than 1 in 3 Patients With Chronic Low Back Pain Continue to Use Opioids Long-term After Spinal Fusion
Authors: Vraa Matthew L. , Myers Christina A. , Young Jodi L. , Rhon Daniel I. 
Published: December 2021

Objective:
A common expectation for patients after elective spine surgery is that the procedure will result in pain reduction and minimize the need for pain medication. Most studies report changes in pain and function after spine surgery, but few report the extent of opioid use after surgery. This systematic review aims to identify the rates of opioid use after lumbar spine fusion.

Materials and Methods:
PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Ovid Medline were searched to identify studies published between January 1, 2005 and June 30, 2020 that assessed the effectiveness of lumbar fusion for the management of low back pain.

Results:
Of 6872 abstracts initially identified, 329 studies met the final inclusion criteria, and only 32 (9.7%) reported any postoperative opioid use. Long-term opioid use after surgery persists for more than 1 in 3 patients with usage ranging from 6 to 85.9% and a pooled mean of 35.0% based on data from 21 studies (6.4% of all lumbar fusion studies).

Discussion:
Overall, opioid use is not reported in the majority of lumbar fusion trials. Patients may expect a reduced need for opioid-based pain management after surgery, but the limited data available suggests long-term use is common. Lack of consistent reporting of these outcomes limits definitive conclusions regarding the efficacy of spinal fusion for reducing long-term opioid. Patient decisions about undergoing surgery may be altered if they had realistic expectations about rates of postsurgical opioid use. Spine surgery trials should track opioid utilization out to a minimum of 6 months after surgery as a core outcome.
Cholesteatoma Is Associated With Pediatric Progressive Sensorineural Hearing Loss
Authors: Racca Jordan M. , Lee John , Sikorski Faith , Crenshaw E. Bryan , Hood Linda J. 
Published: December 2021

Objectives:
This study identified an association between cholesteatoma and progressive sensorineural hearing loss using a large pediatric longitudinal audiologic dataset. Cholesteatoma is a potential sequela of chronic otitis media with effusion, a commonly observed auditory pathology that can contribute to hearing loss in children. The purpose of this report is to (i) describe the process of identifying the association between cholesteatoma and progressive sensorineural hearing loss in a large pediatric dataset and (ii) describe the audiologic data acquired over time in patients identified with cholesteatoma-associated progressive sensorineural hearing loss.

Design:
Records of patients included in the Audiologic and Genetics Database (n = 175,215 patients) were examined using specified criteria defining progressive hearing loss. A linear regression model examined the log frequency of all diagnostic codes in the electronic health record assigned to patients for a progressive hearing loss cohort compared with a stable hearing loss group. Based on findings from the linear regression analysis, longitudinal audiometric air (AC) and bone conduction (BC) thresholds were extracted for groups of subjects with cholesteatoma-associated progressive (n = 58 subjects) and stable (n = 55 subjects) hearing loss to further analyze changes in hearing over time.

Results:
The linear regression analyses identified that diagnostic codes for cholesteatoma were associated with progressive sensorineural hearing loss in children. The longitudinal audiometric data demonstrated within-subject changes in masked BC sensitivity consistent with progressive sensorineural hearing loss in children diagnosed with cholesteatoma. Additional analyses showed that mastoidectomy surgeries did not appear to contribute to the observed progressive hearing loss and that a high number of cholesteatoma patients with progressive hearing loss had normal-hearing thresholds at their first test.

Conclusions:
The statistical analyses demonstrated an association between cholesteatoma and pediatric progressive sensorineural hearing loss. These findings inform clinical management by suggesting that children with cholesteatoma diagnoses may be at increased risk for progressive sensorineural hearing loss and should receive continued monitoring even after a normal masked BC baseline has been established.
Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening
Authors: Erdal Ozan A. , Gorgun Baris , Yontar Necip S. , Terzibaşioğlu Ali E. , Sarikaya Ilker A. , Inan Muharrem 
Published: December 2021

Background:
One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI).

Methods:
Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut.

Results:
Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury.

Conclusions:
The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy.

Level of Evidence:
Level III.
Spiritual Well-Being and Use of Spiritual Care Interventions of Undergraduate Nursing Students
Authors: Tomsovic Emily , Bond Loretta , Wyant David 
Published: December 2021

ABSTRACT:
A survey of undergraduate nursing students investigated their personal spiritual well-being (SWB), their spiritual care of patients, and where students felt spiritually challenged. The survey utilized the Spiritual Health and Life-Orientation Measure (SHALOM), the Nursing Spiritual Care Therapeutics Scale (NSCTS), and a qualitative extended response question. Findings revealed a positive correlation between high SWB and the spiritual care of patients and a significant improvement in the use of spiritual care therapeutics through the nursing program.
Celecoxib and Myrtol
Authors: Vierra Mason , Dhiman Ankit , Witmer Hunter D.D. , Ulrich Leah , Hindi Enal , Fenton Emily , Shergill Ardaman , Polite Blase , Eng Oliver S. , Turaga Kiran K. 
Published: December 2021

Background:
Unresectable appendiceal mucinous neoplasms (AMNs) with extensive peritoneal dissemination cause significant morbidity and have limited treatment options. We evaluated a novel combination of Celecoxib and Myrtol in treating such AMNs.

Methods:
Patients with recurrent AMNs with extensive peritoneal disease treated with a daily regimen of 200 mg Celecoxib and 1200 mg Myrtol Standardized were included. Progression-free survival (PFS) and overall survival (OS) were calculated, and carcinoembryonic antigen (CEA) trends were compared pretreatment and post-treatment in terms of percentage change.

Results:
Thirteen patients with extensive, recurrent disease (median peritoneal carcinomatosis index of 36) were included between 2017 and 2020. The median age was 63 years (interquartile range: 55 to 67) and 7 (54%) were male. A total of 85% had undergone prior cytoreductive surgery while 15% underwent cytoreductive surgery >2 times. 54% had received multiple cycles of systemic chemotherapy before starting Celecoxib-Myrtol. After a median follow-up of 8 months, median PFS and OS were 16 months (interquartile range: 5 to 17) and 27 months, respectively. Nine (69.2%) showed improvement in CEA values 3 months after treatment compared with 3-month pretreatment CEA trends. None had adverse events attributable to Celecoxib-Myrtol.

Conclusions:
Our feasibility study suggests that a regimen of Celecoxib-Myrtol is well tolerated and may prolong PFS and OS in patients with recurrent AMNs with peritoneal spread.
Probable lumbar acute noncompressive nucleus pulposus extrusion: a case report of acute pain caused by a hydrated nucleus pulposus and review of the literature
Authors: Chen Changjun , Gao Xianlei , Li Hao , Pan Xin , Wang Songgang 
Published: December 2021

Abstract
Acute noncompressive nucleus pulposus (NP) extrusion has been widely described in veterinary medicine, especially in dogs and cats; however, cases have rarely been reported in humans. We report a rare case of acute pain caused by a hydrated NP. Magnetic resonance imaging revealed an obvious hyperintense signal on T2-weighted images at the L5/S1 segments, while computed tomography imaging and radiography revealed a mildly herniated disc at the L4/5 level and slight lumbar spondylolisthesis at the L5/S1 segments. The operation was performed to confirm the presence of a red and swollen nerve root on the right side of the hydrated L5/S1 segment. The patient's severe pain disappeared, and full recovery was achieved months after surgery. Thus, our case demonstrated a probable lumbar acute noncompressive NP extrusion in humans and reported associated symptoms and imaging characteristics. In such circumstances, surgical management is indicated and may be associated with a good outcome.
Surveillance-to-Diagnostic Testing Program for Asymptomatic SARS-CoV-2 Infections on a Large, Urban Campus in Fall 2020
Authors: Gibson Greg , Weitz Joshua S. , Shannon Michael P. , Holton Benjamin , Bryksin Anton , Liu Brian , Sieglinger Madeline , Coenen Ashley R. , Zhao Conan , Beckett Stephen J. , Bramblett Sandra , Williamson JulieAnne , Farrell Michael , Ortiz Alexander , Abdallah Chaouki T. , García Andrés J. 
Published: December 2021

Background:
Six months into the COVID-19 pandemic, college campuses faced uncertainty regarding the likely prevalence and spread of disease, necessitating large-scale testing to help guide policy following re-entry.

Methods:
A SARS-CoV-2 testing program combining pooled saliva sample surveillance leading to diagnosis and intervention surveyed over 112,000 samples from 18,029 students, staff and faculty, as part of integrative efforts to mitigate transmission at the Georgia Institute of Technology in Fall 2020.

Results:
Cumulatively, we confirmed 1,508 individuals diagnostically, 62% of these through the surveillance program and the remainder through diagnostic tests of symptomatic individuals administered on or off campus. The total strategy, including intensification of testing given case clusters early in the semester, was associated with reduced transmission following rapid case increases upon entry in Fall semester in August 2020, again in early November 2020, and upon re-entry for Spring semester in January 2021. During the Fall semester daily asymptomatic test positivity initially peaked at 4.1% but fell below 0.5% by mid-semester, averaging 0.84% across the Fall semester, with similar levels of control in Spring 2021.

Conclusions:
Owing to broad adoption by the campus community, we estimate that the program protected higher risk staff and faculty while allowing some normalization of education and research activities.
The influence of outdoor PM2.5 concentration at workplace on nonaccidental mortality estimates in a Canadian census-based cohort
Authors: Christidis Tanya , Pinault Lauren L. , Crouse Dan L. , Tjepkema Michael 
Published: December 2021

Background:
Associations between mortality and exposure to ambient air pollution are usually explored using concentrations of residential outdoor fine particulate matter (PM2.5) to estimate individual exposure. Such studies all have an important limitation in that they do not capture data on individual mobility throughout the day to areas where concentrations may be substantially different, leading to possible exposure misclassification. We examine the possible role of outdoor PM2.5 concentrations at work for a large population-based mortality cohort.

Methods:
Using the 2001 Canadian Census Health and Environment Cohort (CanCHEC), we created a time-weighted average that incorporates employment hours worked in the past week and outdoor PM2.5 concentration at work and home. We used a Cox proportional hazard model with a 15-year follow-up (2001 to 2016) to explore whether inclusion of workplace estimates had an impact on hazard ratios for mortality for this cohort.

Results:
Hazard ratios relying on outdoor PM2.5 concentration at home were not significantly different from those using a time-weighted estimate, for the full cohort, nor for those who commute to a regular workplace. When exploring cohort subgroups according to neighborhood type and commute distance, there was a notable but insignificant change in risk of nonaccidental death for those living in car-oriented neighborhoods, and with commutes greater than 10 km.

Conclusions:
Risk analyses performed with large cohorts in low-pollution environments do not seem to be biased if relying solely on outdoor PM2.5 concentrations at home to estimate exposure.
Artificial intelligence in pediatric cardiology: taking baby steps in the big world of data
Authors: Van den Eynde Jef , Kutty Shelby , Danford David A. , Manlhiot Cedric 
Published: December 2021

Purpose of review
Artificial intelligence (AI) has changed virtually every aspect of modern life, and medicine is no exception. Pediatric cardiology is both a perceptual and a cognitive subspecialty that involves complex decision-making, so AI is a particularly attractive tool for this medical discipline. This review summarizes the foundational work and incremental progress made as AI applications have emerged in pediatric cardiology since 2020.

Recent findings
AI-based algorithms can be useful for pediatric cardiology in many areas, including: (1) clinical examination and diagnosis, (2) image processing, (3) planning and management of cardiac interventions, (4) prognosis and risk stratification, (5) omics and precision medicine, and (6) fetal cardiology. Most AI initiatives showcased in medical journals seem to work well in silico, but progress toward implementation in actual clinical practice has been more limited. Several barriers to implementation are identified, some encountered throughout medicine generally, and others specific to pediatric cardiology.

Summary
Despite barriers to acceptance in clinical practice, AI is already establishing a durable role in pediatric cardiology. Its potential remains great, but to fully realize its benefits, substantial investment to develop and refine AI for pediatric cardiology applications will be necessary to overcome the challenges of implementation.
Neuroadrenergic activation in obstructive sleep apnoea syndrome: a new selected meta-analysis - revisited
Authors: Biffi Annalisa , Quarti-Trevano Fosca , Bonzani Matilde , Seravalle Gino , Corrao Giovanni , Mancia Giuseppe , Grassi Guido 
Published: December 2021

Background:
Neuroadrenegic overdrive occurs in obstructive sleep apnoea syndrome (OSAS). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities, represented major weaknesses not allowing to precisely define the main features of the phenomenon, particularly in nonobese patients.

Objective:
This meta-analysis detected 14 microneurographic studies based on muscle sympathetic nerve activity (MSNA) quantification in uncomplicated OSAS of different clinical severity.

Methods:
The evaluation was extended to the relationships of MSNA with heart rate, anthropometric and blood pressure values, metabolic variables, apnoea-hypopnea index and oxygen saturation.

Results:
MSNA is activated markedly and almost homogeneously between studies, showing a progressive increase from the healthy state to mild, moderate and severe OSAS (46.03, 48.32, 71.84, 69.27 bursts/100 heart beats). Of special interest are the findings that MSNA is significantly related to the apnoea-hypopnea index, a marker of OSAS severity (r = 0.55, P
= 0.04) but not to BMI, as it occurs in OSAS associated with obesity, and heart rate is significantly and directly related to MSNA and apnoea-hypopnea index (r = 0.68 and r = 0.60, respectively P = 0.03 and P = 0.02), thus representing a surrogate marker of the sympathetic overdrive.

Conclusion:
OSAS, even when uncomplicated by other cardiometabolic disease, displays a marked sympathetic activation, reflected by the MSNA and heart rate behaviour, becoming a target of therapeutic interventions aimed at exerting sympathomoderating effects, such as continuous positive airway pressure.
A Modification to the Situation-based Scheme for Sorting Exposures Proposed in ICRP Publication 103
Authors: Chi Yun C. 
Published: December 2021

Abstract
The International Commission on Radiological Protection (ICRP) issued its current recommendations in 2007, introducing an evolution from a previously process-based protection approach (practices and interventions) to a situation-based approach (planned, existing, and emergency). In most countries, radiation protection standards are generally in line with the new recommendations by the ICRP. Unfortunately, in many cases, situations involving sources of natural or artificial origin may be in a state of contradiction. Logical incompleteness and unsoundness in the framework of exposure situations can be found in current ICRP recommendations. There are situations that do not readily fall into any category. To contribute to a more reasonable situation-based approach for the radiological protection community, we recommend here a possible framework of exposure situations, i.e., planned, unplanned, and naturally occurring, that forms one coherent system. We believe this system will provide increased clarity that will help resolve possible sorting problems.
Estimation of the Thyroid Equivalent Doses to Residents in Areas Affected by the 2011 Fukushima Nuclear Disaster Due to Inhalation of 131I Based on Their Behavioral Data and the Latest Atmospheric Transport and Dispersion Model Simulation
Authors: Kim Eunjoo , Igarashi Yu , Hashimoto Shozo , Tani Kotaro , Kowatari Munehiko , Ishikawa Tetsuo , Kurihara Osamu 
Published: December 2021

Abstract
It has been challenging to obtain reliable estimates of thyroid equivalent doses (TEDs) to residents involved in the 11 March 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident because of the shortage of direct human measurements associated with 131I, the largest contributor to the dose of concern. The present study attempted to perform the estimation of the TEDs by inhalation of 131I to residents from Namie-town, one of the most radiologically-affected municipalities, by means of the latest atmospheric transport and dispersion model (ATDM) simulations with the Worldwide version of System for Prediction of Environmental Emergency Dose Information (WSPEEDI) ver. 2, coupled with personal behavioral data containing the history of the whereabouts of individuals shortly after the accident. We analyzed 1,637 residents who underwent direct measurements with whole-body counters several months after the accident and provided their personal behavioral data. We divided the subjects into two groups based on whether the distances between their locations and the FDNPP were >20 km as of 15:00 on 12 March in relation to the timepoint of the hydrogen explosion at the Unit 1 Reactor building. As a result, the 90th percentile TEDs of the 1,249 prompt evacuees and 388 late evacuees were 3.9 mSv (adult)–6.8 mSv (10-y-old) and 24.1 mSv (adult)–35.6 mSv (5-y-old), respectively, excluding 16 persons whose TEDs exceeded 50 mSv. The 90th percentile (median) TEDs to 1-y-old children (not included in the subjects) for the prompt and late evacuation groups were 8.1 (1.0) mSv and 36.3 (19.7) mSv, respectively. Additionally, this study provided the evidence to support the view that the explosive event at the Unit 1 Reactor building on the afternoon of 12 March 2011 could have caused the critical group among Namie-town's residents, whereas the largest release event on 15 March gave relatively small doses to the residents because their exposure took place mostly at sites that were distant from the FDNPP. However, the present dose estimation has potentially large uncertainty at the individual level; further validations are thus necessary.