bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXTRACOLONIC FINDINGS—IDENTIFICATION AT LOW-DOSE CTC
Authors: Thorén Fredrik , Johnsson Åse A , Hellström Mikael , Båth Magnus 
Published: March 2021

Abstract
In contrast to optical colonoscopy, computed tomography colonography (CTC) has the ability to reveal pathology outside of the colon. While identification of colorectal lesions at CTC requires only limited radiation dose, the detection of abnormalities in extracolonic soft tissue requires more radiation. The purpose of this study was to investigate the influence of ultra-low-dose (ULD) CTC on the detection and characterisation of extracolonic findings. In a prospective study 49 patients with colorectal symptoms were examined with CTC adding a ULD series (mean effective dose 0.9 ± 0.4 mSv) to the normal unenhanced standard dose (SD) series (mean effective dose 3.6 ± 1.2 mSv). Five radiologists individually and blindly evaluated the ULD, followed by evaluation of the SD after ≥9 weeks (median 35 weeks). A ViewDEX-based examination protocol was used, including a confidence scale and a graded assessment of need for follow-up according to the CTC Reporting and Data System (C-RADS E0–E4). The reference findings comprised the combined information from CTC (ULD, SD and contrast-enhanced CTC series) and a 4-year radiological and clinical follow-up. For the overall detection of reference findings (E2–E4) we found a statistically significant difference in favour of SD. This, however, was not the case when looking at classification of possibly important/important reference findings (E3–E4). Our results suggest that CTC with ULD (0.9 mSv) is comparable to SD (3.6 mSv) for identification of clinically relevant extracolonic pathology, but there is a large inter-observer variability.
EVALUATION OF THE SPATIAL RESOLUTION IN MONTE CARLO-BASED SPECT/CT RECONSTRUCTION OF 111IN-OCTREOTIDE IMAGES
Authors: Wikberg Emma , van Essen Martijn , Rydén Tobias , Svensson Johanna , Gjertsson Peter , Bernhardt Peter 
Published: March 2021

Abstract
The purpose was to evaluate the spatial resolution in 111In-octreotide single-photom emission computed tomography (SPECT)/computed tomography (CT) imaging following reconstructions with three different ordered subset expectation maximizations (OSEM) reconstruction algorithms; attenuation corrected (AC) OSEM, AC OSEM with resolution recovery (ACRR OSEM) and Monte Carlo-based OSEM reconstruction (MC OSEM). SPECT/CT imaging of a triple line phantom containing 111In in air and water was performed. The spatial resolution, represented by the full width at half maximum (FWHM) of a line profile, was determined for each line, for X and Y direction and for all reconstructions. The mean FWHM was 12.2 mm (±standard deviation [SD] 3.7 mm) for AC OSEM, 9.3 mm (±SD 2.5 mm) for ACRR OSEM and 8.2 mm (±SD 2.0 mm) for MC OSEM. MC-based SPECT/CT reconstruction clearly improves the spatial resolution in 111In-octreotide imaging and since MC simulations can be performed for all photon energies MC OSEM has the potential to improve SPECT/CT imaging overall.
Cognitive Behavioral Therapy for Prodromal Stage of Psychosis—Outcomes for Transition, Functioning, Distress, and Quality of Life: A Systematic Review and Meta-analysis
Authors: Zheng Yuchen , Xu Tingting , Zhu Yikang , Li Chunbo , Wang Jijun , Livingstone Steven , Zhang Tianhong 
Published: March 2021

AbstractObjectiveThis study aimed to provide insight into the efficacy of cognitive-behavioral therapy for psychosis (CBTp) in patients with “clinical high risk of psychosis (CHR-P)”.MethodsMajor scientific databases were searched up to April 17, 2020. Randomized controlled trials in CHR-P individuals, comparing CBTp with needs-based interventions (NBI, including treatment as usual or nonspecific control treatment) were included, following PRISMA guidelines. The primary outcome (efficacy) was transition to psychosis by 6 months, 12 months, 24 months, and over 24 months. Secondary outcomes were change in attenuated psychotic symptoms, depression, distress, improvements in functioning, and quality of life.ResultsTen randomized controlled studies met inclusion criteria. The comparisons included 1128 participants. CBTp was significantly more efficacious in reducing rate of transition to psychosis by 6 months (after post-hoc sensitivity analysis) (relative risk [RR] = 0.44, 95% confidence interval [CI]: 0.26, 0.73), 12 months (RR = 0.44, 95% CI: 0.30, 0.64), 12 months (RR = 0.46, 95%CI: 0.30, 0.69), and over 24 months (RR = 0.58, 95% CI: 0.35, 0.95) after treatment, compared with those receiving NBI. CBTp was also associated with more reduced attenuated psychotic symptoms by 12 months (SMD = −0.17, 95% CI: −0.33, −0.02) and by 24 months (SMD = −0.24, 95% CI: −0.43, −0.06). No beneficial effects on functioning, depression, quality of life, or distress were observed favoring CBTp.ConclusionsCBTp is effective in reducing both psychosis transition rates and attenuated psychotic symptoms for the prodromal stage of psychosis. It is a promising intervention at the preventative stage.
Reconstructing Squamate Biogeography in Afro-Arabia Reveals the Influence of a Complex and Dynamic Geologic Past
Authors: Tejero-Cicuéndez Héctor , Patton Austin H , Caetano Daniel S , Šmíd Jiří , Harmon Luke J , Carranza Salvador 
Published: March 2021

Abstract
The geographic distribution of biodiversity is central to understanding evolutionary biology. Paleogeographic and paleoclimatic histories often help to explain how biogeographic patterns unfold through time. However, such patterns are also influenced by a variety of other factors, such as lineage diversification, that may affect the probability of certain types of biogeographic events. The complex and well-known geologic and climatic history of Afro-Arabia, together with the extensive research on reptile systematics in the region, makes Afro-Arabian squamate communities an ideal system to investigate biogeographic patterns and their drivers. Here, we reconstruct the phylogenetic relationships and the ancestral geographic distributions of several Afro-Arabian reptile clades (totaling 430 species) to estimate the number of dispersal, vicariance and range contraction events. We then compare the observed biogeographic history to a distribution of simulated biogeographic events based on the empirical phylogeny and the best-fit model. This allows us to identify periods in the past where the observed biogeographic history was likely shaped by forces beyond the ones included in the model. We find an increase in vicariance following the Oligocene, most likely caused by the fragmentation of the Afro-Arabian plate. In contrast, we did not find differences between observed and expected dispersal and range contraction levels. This is consistent with diversification enhanced by environmental processes and with the establishment of a dispersal corridor connecting Africa, Arabia and Eurasia since the middle Miocene. Finally, here we show that our novel approach is useful to pinpoint events in the evolutionary history of lineages that might reflect external forces not predicted by the underlying biogeographic model. [Dispersal; diversification; model adequacy; paleogeography; reptiles; simulations; vicariance.]
Effects of Spaceflight Stressors on Brain Volume, Microstructure, and Intracranial Fluid Distribution
Authors: Lee Jessica K , Koppelmans Vincent , Pasternak Ofer , Beltran Nichole E , Kofman Igor S , De Dios Yiri E , Mulder Edwin R , Mulavara Ajitkumar P , Bloomberg Jacob J , Seidler Rachael D 
Published: March 2021

Abstract
Astronauts are exposed to elevated CO2 levels onboard the International Space Station. Here, we investigated structural brain changes in 11 participants following 30-days of head-down tilt bed rest (HDBR) combined with 0.5% ambient CO2 (HDBR + CO2) as a spaceflight analog. We contrasted brain changes observed in the HDBR + CO2 group with those of a previous HDBR sample not exposed to elevated CO2. Both groups exhibited a global upward shift of the brain and concomitant intracranial free water (FW) redistribution. Greater gray matter changes were seen in the HDBR + CO2 group in some regions. The HDBR + CO2 group showed significantly greater FW decrements in the posterior cerebellum and the cerebrum than the HDBR group. In comparison to the HDBR group, the HDBR + CO2 group exhibited greater diffusivity increases. In half of the participants, the HDBR + CO2 intervention resulted in signs of Spaceflight Associated Neuro-ocular Syndrome (SANS), a constellation of ocular structural and functional changes seen in astronauts. We therefore conducted an exploratory comparison compared between subjects that did and did not develop SANS and found asymmetric lateral ventricle enlargement in the SANS group. These results enhance our understanding of the underlying mechanisms of spaceflight-induced brain changes, which is critical for promoting astronaut health and performance.
Improvements in Sleep Correlate With Improvements in Clinical Outcomes Among Adolescents Undergoing Intensive Interdisciplinary Pain Treatment
Authors: Boggero Ian A. , Krietsch Kendra N. , Pickerill Hannah M. , Byars Kelly C. , Homan Kendra J. , Williams Sara E. , King Christopher D. 
Published: March 2021

Objectives:
Intensive interdisciplinary pain treatment (IIPT) programs have been shown to restore function, improve coping, and reduce pain in adolescents with chronic pain. Yet, little is known about patients’ sleep during IIPT and whether or not improvements in pain treatment outcomes are associated with changes in sleep pre-to-post IIPT treatment. The objectives of the current study were to describe sleep among adolescents entering IIPT and examine associations between sleep parameters and IIPT treatment effects.

Materials and Methods:
Self-reported sleep measures and clinical outcomes (eg, functional disability, coping, average pain), were collected from 44 adolescents (mean age=14.57, 68.2% female) at admission and discharge from an inpatient IIPT program. Wrist-worn actigraphy data and sleep diaries from participants’ first week and last week in the program were analyzed to characterize sleep parameters.

Results:
Participants self-reported poor sleep/wake patterns, high levels of insomnia symptoms, and subclinical problems with daytime sleepiness upon admission into IIPT, although actigraphic indices of sleep from the first week of IIPT admission were only just under clinical guidelines for healthy adolescent sleep. Better self-reported sleep quality assessed via aggregated sleep diaries from the first week was associated with improvement in average pain and disability over the course of the program. Furthermore, improvements in insomnia symptoms and daytime sleepiness throughout the program were positively correlated with concurrent improvements in functional disability and coping.

Discussion:
Taken together, results suggest that sleep may be associated with IIPT treatment effects and pave the way for future research to continue examining these relationships.
Wellbeing of Frontline Health Care Workers After the First SARS-CoV-2 Pandemic Surge at a Neuroscience Centre: A Cross-sectional Survey
Authors: Douglas Deborah R. , Choi David , Marcus Hani J. , Muirhead Will , Reddy Ugan , Stewart Trudy , Luoma Astri M.V. 
Published: March 2021

Background:
The coronavirus disease 2019 (COVID-19) pandemic has affected people of all ages, races, and socioeconomic groups, and placed extraordinary stress on health care workers (HCWs). We measured the prevalence of burnout and assessed wellbeing and quality of life (QoL) in HCWs at a single UK neuroscience center after the first pandemic surge.

Methods:
A 38-item electronic questionnaire was disseminated through local team email lists between May 22 and June 7, 2020, to HCWs in a university neurosciences center. Burnout was measured using the single-item Emotional Exhaustion and Depersonalization scales, and wellbeing and QoL assessed using the Linear Analogue Self-Assessment Scale and the EuroQol-5 Dimension instrument.

Results:
The response rate was 57.4% (n=234); 58.2% of respondents were nurses, 69.4% were women and 40.1% were aged 25 to 34 years. Overall, 21.4% of respondents reported burnout assessed by the Emotional Exhaustion scale; burnout was higher for nurses (23.5%) and allied health care professionals (22.5%) compared with doctors (16.4%). HCWs from ethnic minority groups reported a higher rate of burnout (24.5%) compared with white HCWs (15.0%). There were no differences in reported wellbeing or QoL between professional groups, or HCW age, sex, or race. Nurses (36.8%) and staff from ethnic minority groups (34.6%) were more fearful for their health than others.

Conclusions:
Our findings highlight the prevalence of HCW burnout after the first surge of the pandemic, with an increased risk of burnout among nurses and staff from ethnic minority groups. Both nursing and staff from ethnic minority groups were also more fearful for their health. With ongoing pandemic surges, the impact on HCW wellbeing should be continuously assessed to ensure that local strategies to support staff wellbeing are diverse and inclusive.
Parental Participation in NICU-Based Occupational Therapy, Physiotherapy, and Speech and Language Therapy
Authors: Edney Sarah K. , McHugh Gretl 
Published: March 2021

Background:
Parent involvement in neonatal care is beneficial to families and infant outcomes. Few studies have explored parental experiences of neonatal therapy participation.

Purpose:
This study had 2 purposes: (1) to explore parental attitudes and beliefs about participating in neonatal therapies and (2) to identify barriers and facilitators to parental involvement and suggest ways to optimize neonatal therapy services.

Methods:
The study design and data analysis were informed by constructivist grounded theory methods. Semistructured telephone interviews were conducted with 9 mothers of children who had received neonatal therapy.

Findings:
After an early period of fear and powerlessness, a transition point occurred where the survival of their infant became more certain and parents were able to consider the future. At this point, participation in therapies was perceived to be more relevant. Therapy participation was experienced as a means of regaining autonomy and control in a context of trauma, but parents encountered barriers related to accessing therapists and external demands on their time.

Implications for Practice:
Parental participation is best facilitated by frequent and flexible access to neonatal therapists and staffing levels should reflect this. On commencing therapy, parents should be given therapists' contact details to maximize opportunities for face-to-face encounters.

Implications for Research:
Future research is needed to explore parental readiness to participate in therapies in the neonatal intensive care unit. Research exploring the impact of parental involvement in therapies over a longer time frame would be beneficial. Finally, there is a need to determine efficacy and effectiveness of parent-delivered neonatal therapies.
Impact of a Care Bundle on Cost Saving for Noninvasive Respiratory Support for Neonates
Authors: Shetty Sandeep , Evans Katie , Kulkarni Anay , Greenough Anne 
Published: March 2021

Background:
Neonates often receive noninvasive respiratory support via continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygen (HHFNC). The decision to change from one mode to the other, however, is not evidence based, hence not standardized and does not consider cost implications.

Purpose:
To assess the introduction of a care bundle for the medical and nursing staff in a tertiary medical and surgical neonatal center with regard to any financial savings or adverse outcomes.

Methods:
An education package and written guidelines were used to increase the awareness of the durations for which CPAP and HHFNC Vapotherm (VT) circuits could be used and the costs of the circuits.

Results:
This resulted in a cost saving of £17,000 ($22,254) for the year without adverse outcomes.

Implications for Practice:
Introduction of a care bundle involving an education package and written guidelines to increase the awareness of the durations that circuits could be used and the costs of CPAP and HHFNC circuits among the medical and nursing staff can lead to cost savings when incorporated into clinical practice.

Implications for Research:
Strategies, particularly during weaning, which involve changing from one form of noninvasive respiratory support to another, need a greater evidence base. Future research should include awareness of the duration different circuits could be used and the cost implications of changes between modes and hence circuits.
Variability in Antibiotic Treatment of Pediatric Surgical Site Infection After Spinal Fusion at A Single Institution
Authors: Cohen Lara L. , Birch Craig M. , Cook Danielle L. , Hedequist Daniel J. , Karlin Lawrence I. , Emans John B. , Hresko Michael T. , Snyder Brian D. , Glotzbecker Michael P. 
Published: March 2021

Background:
Recent focus on surgical site infections (SSIs) after posterior spine fusion (PSF) has lowered infection rates by standardizing perioperative antibiotic prophylaxis. However, efforts have neglected to detail antibiotic treatment of SSIs. Our aim was to document variability in antibiotic regimens prescribed for acute and latent SSIs following PSF in children with idiopathic, neuromuscular, and syndromic scoliosis.

Methods:
This study included patients who developed a SSI after PSF for scoliosis at a pediatric tertiary care hospital between 2004 and 2019. Patients had to be 21 years or younger at surgery. Exclusion criteria included growing rods, staged surgery, and revision or removal before SSI diagnosis. Infection was classified as acute (within 90 d) or latent. Clinical resolution of SSI was measured by return to normal lab values. Each antibiotic was categorized as empiric or tailored.

Results:
Eighty subjects were identified. The average age at fusion was 14.7 years and 40% of the cohort was male. Most diagnoses were neuromuscular (53%) or idiopathic (41%).
Sixty-three percent of patients had an acute infection and 88% had a deep infection. The majority (54%) of subjects began on tailored antibiotic therapy versus empiric (46%). Patients with a neuromuscular diagnosis had 4.0 times the odds of receiving initial empiric treatment compared with patients with an idiopathic diagnosis, controlling for infection type and time (P=0.01). Ninety-two percent of patients with acute SSI retained implants at the time of infection and 76% retained them as of August 2020. In the latent cohort, 27% retained implants at infection and 17% retained them as of August 2020.

Conclusions:
Patients with acute infections were on antibiotics longer than patients with latent infections. Those with retained implants were on antibiotics longer than those who underwent removal. By providing averages of antibiotic duration and lab normalization, we hope to standardize regimens moving forward and develop SSI-reducing pathways encompassing low-risk patients.

Level of Evidence:
Level III.
Analysis of Hidden Blood Loss and its Risk Factors in Oblique Lateral Interbody Fusion Surgery
Authors: Zhu Lei , Zhang Liang , Shan Yuzhou , Feng Xinmin , Zhang Wenjie 
Published: March 2021

Study Design:
This was a retrospective study.

Objective:
The objective of this study was to evaluate the volume of hidden blood loss (HBL) and analyze its influential factors in single level oblique lateral interbody fusion (OLIF) surgery.

Summary of Background Data:
OLIF is a minimally invasive spine surgery and is increasingly used to treat lumbar degenerative disk diseases. It is generally believed that there is less bleeding during OLIF. However, HBL during the perioperative period is commonly ignored.

Materials and Methods:
From January 2018 to December 2019, a total of 70 patients underwent single level OLIF surgery were retrospectively reviewed. The values of preoperative and postoperative hematocrit (Hct) were recorded to reckon HBL in accordance with Gross formula. The influential factors included sex, age, height, weight, body mass index, hypertension, diabetes mellitus, American Society of Anesthesiologists classification, disease etiology, surgery type, operative time, surgical corridor distance, psoas cross-sectional area, thickness of abdominal wall soft tissue, coagulation panel value, platelet count, values of Hct and hemoglobin, and intraoperative blood loss. Independent sample t test, Pearson correlation, Spearman correlation, and multivariate linear regression analysis were performed to investigate the risk factors related to HBL.

Results:
The average volume of HBL was 809 mL and the average hemoglobin loss was 27.1 g/L in OLIF procedure. Multiple linear regression analysis revealed that thickness of abdominal wall soft tissue was the independent risk factor for HBL (P=0.008). Whereas age (P=0.414), activated partial thromboplastin time (P=0.314), preoperative value of Hct (P=0.854), disease etiology (P=0.362), operative time (P=0.389), and intraoperative blood loss (P=0.912) were not statistically associated with HBL.

Conclusions:
HBL was substantial and the average volume of HBL was 809 mL in single level OLIF surgery. The thickness of abdominal wall soft tissue was the risk factor of HBL. Accurate assessment of HBL can prevent perioperative complications and ensure patients’ safety.
Impact of Radiation on Cardiovascular Outcomes in Older Resectable Esophageal Cancer Patients With Medicare
Authors: Sarkar Reith R. , Hatamipour Ahmadreza , Panjwani Neil , Courtney P. Travis , Cherry Daniel R. , Salans Mia A. , Yip Anthony T. , Rose Brent S. , Simpson Daniel R. , Banegas Matthew P. , Murphy James D. 
Published: March 2021

Objectives:
Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients.

Materials and Methods:
We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease.

Results:
Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007).

Conclusions:
This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.