bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting Recovery Trajectories in Pediatric Female Concussion
Authors: Desai Natasha , Wiebe Douglas J. , Corwin Daniel J. , Lockyer Julia E. , Grady Matthew F. , Master Christina L. 
Published: August 2019

Objective:Up to one-third of children with concussion have persistent postconcussion symptoms lasting beyond 4 weeks. Females have been shown to have prolonged concussion recovery compared with males. This study examined characteristics in pediatric athletes with concussion to investigate the underlying factors that may contribute to this difference and their relation to recovery trajectories in females compared with males.Design:A retrospective cohort study of pediatric patients with sports-related concussion (SRC).Setting:A subspecialty pediatric concussion program.Subjects:One hundred ninety-two records were reviewed, 75 females and 117 males, ages 7 to 18 years old.Assessment of Risk Factors:Sex of patient, time to presentation to specialty care after injury, presence of vision, and vestibular deficits on initial clinical examination.Main Outcome Measures:The main outcome of interest was time to clinical recovery, defined by resolution of symptoms, recovery of physical examination deficits, including vision and vestibular examination, recovery of neurocognitive function, and return to school, exercise, and sport.Results:Pediatric females, on average, presented later to specialty care for evaluation after SRC than males. Females also took longer to recover on 5 markers of recovery: time to return to school without accommodations, time to return to noncontact exercise, time to return to full sport, time to recovery of neurocognitive function on computerized testing, and time to clinical recovery of vision and vestibular deficits on examination including smooth pursuits, saccades, gaze stability, near point of convergence, and balance. These sex-based differences in recovery disappeared when controlling for time to presentation to specialty care.Conclusions:In this cohort of pediatric patients, ages 7 to 18 years old with SRC, females took longer to recover than males. Our results indicate, however, that a modifiable extrinsic factor, time to presentation to specialty care, may contribute to this difference in recovery between the sexes.
Implementation of Safety Standards for Youth Sports Leagues: The “Safe Stars” Example in Tennessee
Authors: Diamond Alex B. , Dickinson Rebecca , Fiscus Michelle D. , Heitmann Rachel , Radman Meghan 
Published: August 2019

Objective:
Discuss the implementation of the nation's first statewide standardized youth sports safety program and review the current culture and status of youth sports which led to its development.

Design:
Descriptive.

Setting:
State of Tennessee.

Interventions:
The “Safe Stars” Initiative.

Main Outcome Measures:
Provide a summary of the process of devising, developing, and deploying a set of evidence-based and best practice criteria to improve the health, safety, and well-being of youth athletes.

Conclusions:
Safe Stars provides a structured opportunity for every child to play sports and develop successful habits and skills for life while safely doing so. We intend for this to serve as a roadmap for others to adopt and institute a statewide philosophy that emphasizes the importance of a safe, positive, and high-quality experience for children while holding their respective youth sports communities accountable for its achievement. Currently, very few leagues meet the recommended minimum standards of safety. Continued advancement of strategic partnerships as well as research into the program's impact on sports participation, health, and safety will be some of the critical next steps in realizing the full value of this program.
State-of-the-art methods in clinical intracochlear drug delivery
Authors: Chin Oliver Y. , Diaz Rodney C. 
Published: August 2019

Purpose of review
Increasing awareness and prevalence of disorders in hearing and balance have placed emphasis on treatment strategies. With the rapid evolution in molecular, gene, and nanotechnology, alternate delivery methods have advanced intracochlear drug delivery. This review aims to raise awareness of recent developments in technologies to augment current clinical practices.

Recent findings
Intracochlear drug delivery research has expanded with the familiarity and accessibility to cochlear implantation. Various therapeutics are closely studied for both safety and efficacy as well as biologic effect. Agents including neurotrophins, antiapoptotics, cell therapy, gene therapy, and anti-inflammatory drugs are on the forefront of preclinical research. Cochlear implant electrode modification and drug administration at the time of implantation is a major focus of research. Improvements in study design have focused on overcoming barriers including elucidating the role of the blood–perilymph barrier.

Summary
Inner ear drug delivery methods include systemic, intratympanic, and intracochlear administration. Therapeutic technologies aim to overcome delivery barriers and to improve overall biologic effect while minimizing toxicity. Precision of drug application through intratympanic and intracochlear administration with minimal trauma is the future of inner ear drug development.
Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain
Authors: Kubiak Carrie A. , Kemp Stephen W. P. , Cederna Paul S. , Kung Theodore A. 
Published: August 2019

Background:
Postamputation pain affects a large number of individuals living with major limb loss. Regenerative peripheral nerve interfaces are constructs composed of a transected peripheral nerve implanted into an autologous free muscle graft. The authors have previously shown that regenerative peripheral nerve interfaces can be used to treat symptomatic end neuromas that develop after major limb amputation. In this study, they investigated the potential of prophylactic interfaces to prevent the formation of symptomatic neuromas and mitigate phantom limb pain.

Methods:
Patients who underwent limb amputation with and without prophylactic regenerative peripheral nerve interface implantation were identified. A retrospective review was performed to ascertain patient demographics, level of amputation, and postoperative complications. Documentation of symptomatic neuromas and phantom limb pain was noted.

Results:
Postoperative outcomes were evaluated in a total of 90 patients. Forty-five patients underwent interface implantation at the time of primary amputation, and 45 control patients underwent amputation without interfaces. Six control patients (13.3 percent) developed symptomatic neuromas in the postoperative period compared with zero (0.0 percent) in the prophylactic interface group (p = 0.026). Twenty-three interface patients (51.1 percent) reported phantom limb pain, compared with 41 control patients (91.1 percent; p < 0.0001).

Conclusions:
Prophylactic regenerative peripheral nerve interfaces in major limb amputees resulted in a lower incidence of both symptomatic neuromas and phantom limb pain compared with control patients undergoing amputation without regenerative peripheral nerve interfaces, suggesting that prevention of peripheral neuromas following amputation may diminish the central pain mechanisms that lead to phantom limb pain.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Outcomes and Complications of Pediatric Cranioplasty: A Systematic Review
Authors: Abu-Ghname Amjed , Banuelos Joseph , Oliver Jeremie D. , Vyas Krishna , Daniels David , Sharaf Basel 
Published: August 2019

Background:
Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used.

Methods:
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome data comparing fresh bone, banked bone, titanium, poly(methyl methacrylate), and polyetheretherketone were abstracted.

Results:
Twenty studies met the authors’ selection criteria. The mean patient age ranged from 4 to 17.4 years. Autologous cranioplasty was performed in 439 patients, and 201 patients underwent alloplastic reconstruction. Fresh bone grafts and titanium mesh were associated with the lowest infection rates (0.4 percent and 3.3 percent, respectively; p < 0.001), graft failures (2.9 percent and 3.3 percent, respectively; p < 0.001), and surgical-site occurrence rates (8.8 percent and 6.7 percent, respectively; p < 0.001). Banked bone flaps had the highest overall complication rates (51 percent; p < 0.001), bone resorption (39.7 percent; p < 0.001), and failure rates (40.2 percent; p < 0.001), whereas polyetherether ketone had the highest rates of infection (16.1 percent; p < 0.001).

Conclusions:
Based on the available evidence to date, fresh bone grafts and titanium mesh demonstrated the lowest surgical-site infection, surgical-site occurrence, and graft failure rates. Banked bone flaps had the highest overall surgical-site complications and graft failures. Pediatric cranioplasty outcomes studies are needed to evaluate current and novel cranioplasty materials.
Where Is the Value in Ambulatory Versus Inpatient Surgery?
Authors: Friedlander David F. , Krimphove Marieke J. , Cole Alexander P. , Marchese Maya , Lipsitz Stuart R. , Weissman Joel S. , Schoenfeld Andrew J. , Ortega Gezzer , Trinh Quoc-Dien 
Published: August 2019

Objective:
The aim of this study was to estimate the effect of index surgical care setting on perioperative costs and readmission rates across 4 common elective general surgery procedures.

Summary Background Data:
Facility fees seem to be a driving force behind rising US healthcare costs, and inpatient-based fees are significantly higher than those associated with ambulatory services. Little is known about factors influencing where patients undergo elective surgery.

Methods:
All-payer claims data from the 2014 New York and Florida Healthcare Cost and Utilization Project were used to identify 73,724 individuals undergoing an index hernia repair, primary total or partial thyroidectomy, laparoscopic cholecystectomy, or laparoscopic appendectomy in either the inpatient or ambulatory care setting. Inverse probability of treatment weighting-adjusted gamma generalized linear and logistic regression was employed to compare costs and 30-day readmission between inpatient and ambulatory-based surgery, respectively.

Results:
Approximately 87% of index surgical cases were performed in the ambulatory setting. Adjusted mean index surgical costs were significantly lower among ambulatory versus inpatient cases for all 4 procedures (P < 0.001 for all). Adjusted odds of experiencing a 30-day readmission after thyroidectomy [odds ratio (OR) 0.70, 95% confidence interval (CI), 0.53–0.93; P = 0.03], hernia repair (OR 0.28, 95% CI, 0.20–0.40; P < 0.001), and laparoscopic cholecystectomy (OR 0.37, 95% CI, 0.32–0.43; P < 0.001) were lower in the ambulatory versus inpatient setting. Readmission rates among ambulatory versus inpatient-based laparoscopic appendectomy were comparable (OR 0.63, 95% CI, 0.31–1.26; P = 0.19).

Conclusions:
Ambulatory surgery offers significant costs savings and generally superior 30-day outcomes relative to inpatient-based care for appropriately selected patients across 4 common elective general surgery procedures.
Increased serological response against human herpesvirus 6A is associated with risk for multiple sclerosis
Authors: Engdahl Elin , Gustafsson Rasmus , Huang Jesse , Biström Martin , Bomfim Izaura Lima , Stridh Pernilla , Khademi Mohsen , Brenner Nicole , Butt Julia , Michel Angelika , Jons Daniel , Hortlund Maria , Alonso-Magdalena Lucia , Hedström Anna Karin , Flamand Louis , Ihira Masaru , Yoshikawa Tetsushi , Andersen Oluf , Hillert Jan A. , Alfredsson Lars , Waterboer Tim , Sundström Peter , Olsson Tomas , Kockum Ingrid , Fogdell-Hahn Anna 
Published: August 2019

ABSTRACTHuman herpesvirus (HHV)-6A or HHV-6B involvement in multiple sclerosis (MS) etiology has remained controversial mainly due to the lack of serological methods that can distinguish the two viruses.A novel multiplex serological assay measuring IgG reactivity against the immediate-early protein 1 from HHV-6A (IE1A) and HHV-6B (IE1B) was used in a MS cohort (8742 persons with MS and 7215 matched controls), and a pre-MS cohort (478 individuals and 476 matched controls) to investigate this further.The IgG response against IE1A was positively associated with MS (OR = 1.55, p = 9×10−22), and increased risk of future MS (OR = 2.22, p = 2×10−5). An interaction was observed between IE1A and Epstein-Barr virus (EBV) antibody responses for MS risk (attributable proportion = 0.24, p = 6×10−6). In contrast, the IgG response against IE1B was negatively associated with MS (OR = 0.74, p = 6×10−11). The association did not differ between MS subtypes or vary with severity of disease. The genetic control of HHV-6A/B antibody responses were located to the Human Leukocyte Antigen(HLA) region and the strongest association for IE1A was the DRB1*13:01-DQA1*01:03-DQB1*06:03 haplotype while the main association for IE1B was DRB1*13:02-DQA1*01:02-DQB1*06:04.In conclusion a role for HHV-6A in MS etiology is supported by an increased serological response against HHV-6A IE1 protein, an interaction with EBV, and an association to HLA genes.
Detection of H3N8 influenza A virus with multiple mammalian-adaptive mutations in a rescued Grey seal (Halichoerus grypus) pup
Authors: Venkatesh Divya , Bianco Carlo , Núñez Alejandro , Collins Rachael , Thorpe Darryl , Reid Scott M. , Brookes Sharon M. , Essen Steve , McGinn Natalie , Seekings James , Cooper Jayne , Brown Ian H. , Lewis Nicola S. 
Published: August 2019

ABSTRACTAvian Influenza A Viruses (IAV) in different species of seals display a spectrum of pathogenicity, from subclinical infection to mass mortality events. Here we present an investigation of avian IAV infection in a 3-4 month old Grey seal (Halichoerus grypus) pup, rescued from St Michael’s Mount, Cornwall in 2017. The pup underwent medical treatment but died after two weeks; post-mortem examination and histology indicated sepsis as the cause of death. IAV NP antigen was detected by immunohistochemistry in the nasal mucosa, and sensitive real-time reverse transcription polymerase chain reaction assays detected trace amounts of viral RNA within the lower respiratory tract, suggesting that the infection may have been cleared naturally. IAV prevalence among Grey seals may therefore be underestimated. Moreover, contact with humans during the rescue raised concerns about potential zoonotic risk. Nucleotide sequencing revealed the virus to be of subtype H3N8. Combining a GISAID database BLAST search and time-scaled phylogenetic analyses, we inferred that the seal virus originated from an unsampled, locally circulating (in Northern Europe) viruses, likely from wild Anseriformes. From examining the protein alignments, we found several residue changes in the seal virus that did not occur in the bird viruses, including D701N in the PB2 segment, a rare mutation, and a hallmark of mammalian adaptation of bird viruses. IAVs of H3N8 subtype have been noted for their particular ability to cross the species barrier and cause productive infections, including historical records suggesting that they may have caused the 1889 pandemic. Therefore, infections such as the one we report here may be of interest to pandemic surveillance and risk and may help us better understand the determinants and drivers of mammalian adaptation in influenza.
Relative growth of invasive and indigenous tilapiine cichlid fishes in Tanzania
Authors: Bradbeer SJ , Ngatunga BP , Turner GF , Genner MJ 
Published: August 2019

AbstractNon-native species have been widely distributed across Africa for the enhancement of capture fisheries, but it can be unclear what benefits in terms of fisheries production the non-native species bring over native species. Here we compared the relative growth rate of sympatric populations of introducedOreochromis niloticus(Nile tilapia) to indigenousOreochromis jipe(Jipe tilapia) at three impoundments in Northern Tanzania. Using scale increments as a proxy for growth, we found thatO. niloticushad an elevated growth rate relative toO. jipe, with the greatestO. niloticusgrowth rates being evident in the Nyumba ya Mungu reservoir. These results help explain whyO. niloticusmay be a superior competitor to native species in some circumstances. However, further introductions of this non-native species should be undertaken with caution given potential for negative ecological impacts on threatened indigenous tilapia species.
Plasma non-esterified fatty acids contribute to increased coagulability in type-2 diabetes through altered plasma zinc speciation
Authors: Sobczak Amélie I. S. , Katundu Kondwani G. H. , Phoenix Fladia A. , Khazaipoul Siavash , Yu Ruitao , Lampiao Fanuel , Stefanowicz Fiona , Blindauer Claudia A. , Pitt Samantha J. , Smith Terry K. , Ajjan Ramzi A. , Stewart Alan J. 
Published: August 2019

AbstractZn2+ is an essential regulator of coagulation and its availability in plasma is fine-tuned through buffering by human serum albumin (HSA). Non-esterified fatty acids (NEFAs) transported by HSA reduce its ability to bind/buffer Zn2+. This is important as plasma NEFA levels are elevated in type-2 diabetes mellitus (T2DM) and other diseases with an increased risk of developing thrombotic complications. The presence of 5 mol. eq. of myristate, palmitate, stearate, palmitoleate and palmitelaidate reduced Zn2+ binding to HSA. Addition of myristate and Zn2+ increased thrombin-induced platelet aggregation in platelet-rich plasma and increased fibrin clot density and clot time in a purified protein system. The concentrations of key saturated (myristate, palmitate, stearate) and monounsaturated (oleate, vaccinate) NEFAs positively correlated with clot density in subjects with T2DM (and controls). Collectively, these data strongly support the concept that elevated NEFA levels contribute to an increased thrombotic risk in T2DM through dysregulation of plasma zinc speciation.
Neural signatures of disordered multi-talker speech perception in adults with normal hearing
Authors: Parthasarathy Aravindakshan , Hancock Kenneth E , Bennett Kara , DeGruttola Victor , Polley Daniel B 
Published: August 2019

AbstractIn social settings, speech waveforms from nearby speakers mix together in our ear canals. The brain unmixes the attended speech stream from the chorus of background speakers using a combination of fast temporal processing and cognitive active listening mechanisms. Multi-talker speech perception is vulnerable to aging or auditory abuse. We found that ∼10% of adult visitors to our clinic have no measurable hearing loss, yet offer a primary complaint of poor hearing. Multi-talker speech intelligibility in these adults was strongly correlated with neural phase locking to frequency modulation (FM) cues, as determined from ear canal EEG recordings. Combining neural temporal fine structure (TFS) processing with pupil-indexed measures of cognitive listening effort could predict most of the individual variance in speech intelligibility thresholds. These findings identify a confluence of disordered bottom-up and top-down processes that predict poor multi-talker speech perception and could be useful in next-generation tests of hidden hearing disorders.
Metabolic profiling suggests two sources of organic matter shape microbial activity, but not community composition, in New Zealand fjords
Authors: Tobias-Hünefeldt Sven P. , Wing Stephen R. , Baltar Federico , Morales Sergio E. 
Published: August 2019

AbstractFjords are semi-enclosed marine systems with unique physical conditions that influence microbial communities structure. Pronounced organic matter and physical condition gradients within fjords provide a natural laboratory for the study of changes in microbial phylogeny and metabolic potential in response to environmental conditions (e.g. depth). In the open ocean new production from photosynthesis supplies organic matter to deeper aphotic layers, sustaining microbial activity. We measured the metabolic diversity and activity of microbial communities in fjords to determine patterns in metabolic potential across and within fjords, and whether these patterns could be explained by community composition modifications. We demonstrated that metabolic potential and activity are shaped by similar parameters as total (prokaryotic and eukaryotic) microbial communities. However, we identified increases in metabolic diversity and potential (but not in community composition) at near bottom (aphotic) sites consistent with the influence of sediments in deeper waters. Thus, while composition and function of the microbial community in the upper water column was likely shaped by marine snow and sinking POM generated by new production, deeper sites were strongly influenced by sediment resuspension of benthic organic matter generated from this or other sources (terrestrial, chemoautotrophic, microbial carbon loop), uncoupling the community composition and function dynamics.
Proliferative behavior of hematopoietic stem cells revisited: No evidence for mitotic memory
Authors: Morcos Mina N. F. , Zerjatke Thomas , Glauche Ingmar , Munz Clara M. , Ge Yan , Petzold Andreas , Reinhardt Susanne , Dahl Andreas , Anstee Natasha , Bogeska Ruzhica , Milsom Michael , Säwén Petter , Wan Haixia , Bryder David , Roers Axel , Gerbaulet Alexander 
Published: August 2019

AbstractThe proliferative activity of adult hematopoietic stem cells (HSCs) is controversially discussed. Inducible fluorescent histone 2B fusion protein (H2B-FP) transgenic mice are important tools for tracking the mitotic history of murine HSCs in label dilution experiments. A recent study proposed that the most primitive HSCs divide only four times, to then enter permanent quiescence. We observed that background fluorescence due to leaky H2B-FP expression, occurring in all H2B-FP transgenes independent of label induction, accumulated with age in primitive HSCs with high repopulation potential. We argue that this background had been misinterpreted as retention of induced label and permanent quiescence. We found cell division-independent half-lives of H2B-FPs to be short, which had led to overestimation of HSC divisional activity. Our data do not support HSC mitotic memory and entry into permanent quiescence after few divisions, but show that primitive HSCs of adult mice continue to cycle rarely.