bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal exposure to perfluoroalkyl substances
Authors: Shoaff Jessica , Papandonatos George D. , Calafat Antonia M. , Chen Aimin , Lanphear Bruce P. , Ehrlich Shelley , Kelsey Karl T. , Braun Joseph M. 
Published: April 2018

Background:
Prenatal perfluoroalkyl substance (PFAS) exposure has been associated with reduced birth weight and excess child adiposity, but the relationship between PFAS and early life growth is unknown.

Objective:
To determine if prenatal PFAS exposure was associated with birth weight, body composition, and growth until 2 years of age.

Methods:
In a prospective cohort of women and their children from Cincinnati, OH, we quantified perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) in pregnant women’s serum. We used linear regression to estimate associations of PFAS with birth weight z-scores (n = 345) and linear mixed models to estimate associations with repeated weight and length/height measurements (n = 334) at 4 weeks and 1 and 2 years of age, after adjusting for sociodemographic, perinatal, nutritional, and environmental factors.

Results:
We found nonsignificant inverse associations between PFAS and infant birth weight. For example, each log2 increase in PFOA was associated with a 0.03 SD reduction in birth weight z-score (95% confidence interval [CI] = −0.17, 0.10). Compared to associations with birth weight, we observed stronger associations between PFAS and child anthropometry from 4 weeks to 2 years. For instance, each log2 increase in PFOA was associated with a 0.12 SD decrease in BMI z-score (95% CI = −0.25, 0.01). We did not observe any differences in growth rate associated with PFAS.

Conclusions:
We observed inverse associations between prenatal serum PFAS concentrations and anthropometry until 2 years of age. Prenatal serum PFAS concentrations were not associated with growth rate in the first 2 years of life.
Establishing Radiological Screening Levels for Defense-related Uranium Mine (DRUM) Sites on BLM Land Using a Recreational Future-use Scenario
Authors: Brown Steven H. , Edge Russel , Elmer John , McDonald Michael 
Published: April 2018

Abstract
Thousands of former uranium mining sites in the United States, primarily in the southwestern states of Colorado, Arizona, New Mexico, Arizona, and Utah, are being identified and evaluated to assess their potential for causing public and environmental impacts. The common radiological contaminant of concern that characterizes these sites is naturally occurring uranium ore and associated wastes that may have been left behind postmining. The majority of these sites were abandoned and in general, are referred to as abandoned uranium mines, regardless of the government authority currently managing the land or in some cases, assigned responsibility for the oversight of assessment and remediation. The U.S. Department of Energy has identified over 4,000 defense-related uranium mine sites from which uranium ore was purchased by the U.S. government for nuclear defense programs prior to 1970. U.S. Department of Energy has established a program to inventory and perform environmental screening on defense-related uranium mine sites. The focus of this paper is the approximately 2,400 defense-related uranium mine sites located on federal land managed by the Bureau of Land Management and the U.S. Forest Service. This paper presents the results of an analysis to develop radiological screening criteria for U.S. Department of Energy’s defense-related uranium mine sites that can be used as input to the overall ranking of these sites for prioritization of additional assessment, reclamation, or remedial actions. For these sites managed by Bureau of Land Management, public access is typically limited to short-term use, primarily for recreational purposes. This is a broad category that can cover a range of possible activities, including camping, hiking, hunting, biking, all-terrain vehicle use, and horseback riding. The radiological screening levels were developed by calculating the radiological dose to future recreational users of defense-related uranium mine sites assuming a future camper spends two weeks per year at the site engaged in recreational activities. Although a number of possible exposure pathways were included in this analysis (inhalation and ingestion of dust and soil, radon and progeny inhalation, and gamma radiation exposure from the soil), it is desirable as a practical matter to determine what gamma exposure rate would ensure that the annual acceptable exposure as determined by the regulatory authority will not be exceeded in the future. Because these sites are generally remote and located in semiarid environments, traditional exposure scenarios often applied in these types of analyses (e.g., subsistent farmers and ranchers), including exposure pathways for the ingestion of locally grown food products and water, were not considered relevant to short-term recreational use.
Radiation Protection for Interventional Fluoroscopy: Results of a Survey Among Dutch Hospitals
Authors: Bijwaard Harmen , Valk Doreth , de Waard-Schalkx Ischa 
Published: April 2018

Abstract
A survey was conducted among 20 Dutch hospitals about radiation protection for interventional fluoroscopy. This was a follow-up of a previous study in 2007 that led to several recommendations for radiation protection for interventional fluoroscopy. The results indicate that most recommendations have been followed. However, radiation-induced complications from interventional procedures are still often not recorded in the appropriate register. Furthermore, even though professionals with appropriate training in radiation protection are usually involved in interventional procedures, this often is not the case when these procedures are carried out outside the radiology department. Although this involvement is not required by Dutch law, it is recommended to have radiation protection professionals present more often at interventional procedures. Further improvements in radiation protection for interventional fluoroscopy may come from a comparison of dose-reducing practices among hospitals, the introduction of diagnostic reference levels for interventional procedures, and a more thorough form of screening and follow-up of patients.
Anemia in the Elderly
Authors: Girelli Domenico , Marchi Giacomo , Camaschella Clara 
Published: April 2018

AbstractAnemia affects a substantial fraction of the elderly population, representing a public health problem that is predicted to further increase in coming years because of the demographic drive. Being typically mild, it is falsely perceived as a minor problem, particularly in the elderly with multimorbidity, so that it often remains unrecognized and untreated. Indeed, mounting evidence indicates that anemia in the elderly (AE) is independently associated with disability and other major negative outcomes, including mortality. AE is generally multifactorial, but initial studies suggested that etiology remains unexplained in near one‐third of cases. This proportion is consistently declining due to recent advances highlighting the role of several conditions including clonal hematopoiesis, “inflammaging,” correctable androgen deficiency in men, and under‐recognized iron deficiency. Starting from a real‐world case vignette illustrating a paradigmatic example of anemia in an elderly patient with multimorbidity, we review the main clinical and pathophysiological aspect of AE, giving some practical insights into how to manage similar cases.
CHECKPOINT INHIBITOR IMMUNE THERAPY
Authors: Dalvin Lauren A. , Shields Carol L. , Orloff Marlana , Sato Takami , Shields Jerry A. 
Published: April 2018

Purpose:
To review immune checkpoint inhibitor indications and ophthalmic side effects.

Methods:
A literature review was performed using a PubMed search for publications between 1990 and 2017.

Results:
Immune checkpoint inhibitors are designed to treat system malignancies by targeting one of three ligands, leading to T-cell activation for attack against malignant cells. These ligands (and targeted drug) include cytotoxic T-lymphocyte antigen-4 (CTLA-4, ipilimumab), programmed death protein 1 (PD-1, pembrolizumab, nivolumab), and programmed death ligand-1 (PD-L1, atezolizumab, avelumab, durvalumab). These medications upregulate the immune system and cause autoimmune-like side effects. Ophthalmic side effects most frequently manifest as uveitis (1%) and dry eye (1–24%). Other side effects include myasthenia gravis (n = 19 reports), inflammatory orbitopathy (n = 11), keratitis (n = 3), cranial nerve palsy (n = 3), optic neuropathy (n = 2), serous retinal detachment (n = 2), extraocular muscle myopathy (n = 1), atypical chorioretinal lesions (n = 1), immune retinopathy (n = 1), and neuroretinitis (n = 1). Most inflammatory side effects are managed with topical or periocular corticosteroids, but advanced cases require systemic corticosteroids and cessation of checkpoint inhibitor therapy.

Conclusion:
Checkpoint inhibitors enhance the immune system by releasing inhibition on T cells, with risk of autoimmune-like side effects. Ophthalmologists should include immune-related adverse events in their differential when examining cancer patients with new ocular symptoms.
Interleukin-6 trans-signaling and pathological low back pain in patients with Paget disease of bone
Authors: Rendina Domenico , De Filippo Gianpaolo , Postiglione Loredana , Covelli Bianca , Ricciardone Margherita , Guillaume Séverine , Di Spigna Gaetano , Selleri Carmine , Merlotti Daniela , Bianciardi Simone , Materozzi Maria , Muscariello Riccardo , De Pascale Francesca , D'Elia Lanfranco , Nuti Ranuccio , Strazzullo Pasquale , Gennari Luigi 
Published: April 2018

Abstract
The interleukin (IL)-6 biological system plays a key role in the pathogenesis of Paget disease (PD) of bone and pathological bone pain. Bone pain, particularly in the lower back region, is the most frequent symptom in patients with PD. This case–control study aimed to evaluate the relationship between the IL-6 system and low back pain (LBP) in patients with PD. We evaluated 85 patients with PD, with the disease localized in the lumbar spine, pelvis, and/or sacrum, and classified them based on the presence or absence of LBP, before and after aminobisphosphonate treatment. We also examined 32 healthy controls without LBP. Before treatment, IL-6 levels in patients with PD were higher than those in the controls, without difference between patients with or without LBP. Patients with PD with LBP (35/85) showed higher IL-6-soluble receptor (sIL-6R) and lower soluble glycoprotein (sgp) 130 levels compared with both patients with PD without LBP and controls (sIL-6R: 46.9 ± 7.4 vs 35.4 ± 8.6 vs 29.9 ± 4.2 ng/mL; sgp130: 307.2 ± 35.4 vs 341.4 ± 41.4 vs 417.1 ± 58.5 ng/mL, respectively). Paget disease remission, 6 months after treatment, is associated with LBP improvement. This phenomenon is associated with reduced sIL-6R levels and increased sgp130 levels in patients with PD with LBP at the baseline. Considering the biological properties of IL-6, sIL-6R, and sgp130, the results of the study suggest that the perception of LBP in patients with PD could be linked to an enhanced transmission of IL-6 signal in the specialized neural system activated by nociceptors.
Changes in Heart Failure Symptoms are Associated With Changes in Health-related Quality of Life Over 12 Months in Patients With Heart Failure
Authors: Heo Seongkum , Moser Debra K. , Lennie Terry A. , Fischer Mary , Kim JinShil , Lee Mikyoung , Walsh Mary N. , Ounpraseuth Songthip 
Published: April 2018

Purpose:
Patients with heart failure (HF) have notably poor health-related quality of life (HRQOL). A 5-point improvement in HRQOL is associated with reduction in hospitalization and mortality rates. Heart failure symptoms are associated with poor HRQOL, but little is known about whether changes in HF symptoms lead to changes in HRQOL over time. Therefore, we examined the association of changes in HF symptoms with changes in overall, physical, and emotional aspects of HRQOL over a 12-month period, controlling for typical covariates.

Methods:
Data on HF symptoms and HRQOL (Minnesota Living Heart Failure questionnaire) were collected from 94 patients with HF (mean age, 58 years; 58.5% female) at baseline and 12-month follow-up. Psychosocial factors (depressive symptoms, perceived control, and social support), behavioral factors (medication adherence and sodium intake), sociodemographic and clinical factors (age, comorbidities, and body mass index), and a physical factor (functional status) were collected at baseline. Multiple and logistic regression analyses were used to analyze the data.

Results:
In complete models, changes in HF symptoms were associated with changes in the total HRQOL (P < .001) and the physical (P < .001) and emotional (P < .001) aspects of HRQOL over 12 months, controlling for all the factors. Changes in HF symptoms were significantly associated with the likelihood of at least a 5-point improvement in HRQOL (P = .001), controlling for covariates.

Conclusions:
Improvement in HF symptoms was associated with improvement in HRQOL over 12 months. Thus, development and delivery of interventions that target improvement in HF symptoms may improve HRQOL.
Living With Dementia in Correctional Settings: A Case Report
Authors: Peacock Shelley , Hodson Alexandra , MacRae Rhoda , Peternelj-Taylor Cindy 
Published: April 2018

ABSTRACT
The prison population is aging at an alarming rate and many older persons have the potential to develop dementia while in prison. This case report aims to explore the needs of older people living with dementia in prison and discusses the interventions that exist to address these needs. As the condition progresses, persons with dementia become increasingly reliant on the support of others for their health and well-being because of the increasing complexity of physical healthcare and psychosocial needs. Very few interventions are cited in the research literature regarding the use, acceptability, and/or effectiveness of programming for people living with dementia in prison. To support the unique and complex needs of these persons, research is needed to guide the development of evidence-informed dementia programs and services as well as consideration of interdisciplinary collaboration with community organizations.
The Necessity for Post-Maneuver Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo: An Updated Meta-Analysis of the Literature
Authors: Cromwell Christina , Tyler Jordan , Nobbs Rachael , Hockaday Adam , Donnelly Sean , Clendaniel Richard 
Published: April 2018

Objective:
Many studies have published conflicting results regarding the necessity of post-maneuver postural restrictions following treatment of benign paroxysmal positional vertigo (BPPV). The purpose of this meta-analysis is to complete an updated, comprehensive review to determine best practice following a repositioning maneuver (RM).

Data Sources:
PubMed, CINAHL, and Embase were searched through July 2016. The reference lists of the selected studies were searched for studies that were not identified in the electronic database searches.

Study Selection:
Studies investigating the effect of post-maneuver postural restrictions on RM treatment efficacy were included.

Data Extraction:
The methodology, number of participants, type of RM administered, post-maneuver restrictions implemented, outcome measures, and results for each study were recorded.

Data Synthesis:
Following data extraction, heterogeneity and homogeneity values of included studies were determined. Risk ratios and random effects values were obtained to determine effect size.

Results:
Eleven studies were included in the meta-analysis. The results of 739 total subjects were analyzed, 362 of which received post-maneuver postural restrictions and 377 of which did not. Meta-analysis revealed that there was not a statistically significant difference in treatment success rates between patients who received post-maneuver postural restrictions (90.3%) and those who did not (81.7%) (p = 0.095).

Conclusions:
There was no statistically significant difference found in treatment efficacy between subjects who received post-maneuver postural restrictions and those who did not. Based on the results of this meta-analysis, if there is any benefit from prescribing the postural restrictions, it is likely to be a small marginal improvement in outcomes.
In-hospital cardiac arrest: are we overlooking a key distinction?
Authors: Moskowitz Ari , Holmberg Mathias J. , Donnino Michael W. , Berg Katherine M. 
Published: April 2018

Purpose of review
To review the epidemiology, peri-arrest management, and research priorities related to in-hospital cardiac arrest (IHCA) and explore key distinctions between IHCA and out-of-hospital cardiac arrest (OHCA) as they pertain to the clinician and resuscitation scientist.

Recent findings
IHCA is a common and highly morbid event amongst hospitalized patients in the United States. As compared with patients who experience an OHCA, patients who experience an IHCA tend to have more medical comorbidities, have a witnessed arrest, and be attended to by professional first responders. Further, providers resuscitating patients from IHCA commonly have access to tools and information not readily available to the OHCA responders. Despite these differences, society guidelines for the peri-arrest management of patients with IHCA are often based on data extrapolated from the OHCA population. To advance the care of patients with IHCA, clinicians and investigators should recognize the many important distinctions between OHCA and IHCA.

Summary
IHCA is a unique disease entity with an epidemiology and natural history that are distinct from OHCA. In both research and clinical practice, physicians should recognize these distinctions so as to advance the care of IHCA victims.
Trends in Imaging Findings, Interventions, and Outcomes Among Children With Isolated Head Trauma
Authors: Coon Eric R. , Newman Thomas B. , Hall Matt , Wilkes Jacob , Bratton Susan L. , Schroeder Alan R. 
Published: April 2018

Objective
The aim was to analyze the impact of decreased head computed tomography (CT) imaging on detection of abnormalities and outcomes for children with isolated head trauma.

Methods
The study involves a multicenter retrospective cohort of patients younger than 19 years presenting for isolated head trauma to emergency departments in the Pediatric Health Information System database from 2003 to 2015. Patients directly admitted or transferred to another facility and those with a discharge diagnosis code for child maltreatment were excluded. Outcomes were ascertained from administrative and billing data. Trends were tested using mixed effects logistic regression, accounting for clustering within hospitals and adjusted for age, sex, insurance type, race, presence of a complex chronic condition, and hospital-level case mix index.

Results
Between 2003 and 2015, 306,041 children presented for isolated head trauma. The proportion of children receiving head CT imaging was increasing until 2008, peaking at just under 40%, before declining to 25% by 2015. During the recent period of decreased head CT imaging, the detection of skull fractures (odds ratio [OR]/year, 0.96; 95% confidence interval [CI], 0.95–0.97) and intracranial bleeds (OR/year, 0.96; 95% CI, 0.94–0.97), hospitalization (OR/year, 0.96; 95% CI, 0.95–0.96), neurosurgery (OR/year, 0.91; 95% CI, 0.87–0.95), and revisit (OR/year, 0.98; 95% CI, 0.96–1.00) also decreased, without significant changes in mortality (OR/year, 0.93; 95% CI, 0.84–1.04) or persistent neurologic impairment (OR/year, 1.03; 95% CI, 0.92–1.15).

Conclusions
The recent decline in CT scanning in children with isolated head trauma was associated with a reduction in detection of intracranial abnormalities, and a concomitant decrease in interventions, without measurable patient harm.
Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners
Authors: Soon Aun Woon , Toney Amanda Greene , Stidham Timothy , Kendall John , Roosevelt Genie 
Published: April 2018

Objective
To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS).

Methods
We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills.

Results
There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, −2.5; 95% confidence interval [CI], −12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, −1.4, 5.3), and postcourse 2-month retention test (absolute difference, −0.8; 95% CI, −9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, −4.7 to 8.5) and 2-month retention (absolute difference, −0.6; 95% CI, −10.7 to 9.5).

Conclusions
Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.
Quantitation of Perfused Lung Volume Using Hybrid SPECT/CT Allows Refining the Assessment of Lung Perfusion and Estimating Disease Extent in Chronic Thromboembolic Pulmonary Hypertension
Authors: Derlin Thorsten , Kelting Catharina , Hueper Katja , Weiberg Desiree , Meyer Katrin , Olsson Karen M. , Thackeray James T. , Welte Tobias , Bengel Frank M. , Hoeper Marius M. 
Published: April 2018

Background
We evaluated the feasibility of perfusion SPECT/CT for providing quantitative data for estimation of perfusion defect extent in chronic thromboembolic pulmonary hypertension (CTEPH).

Methods
Thirty patients with CTEPH underwent 99mTc–human serum albumin lung perfusion SPECT/CT. Perfusion defects were quantified using 3 different methods: (1) visual, semiquantitative scoring of perfusion defect extent in each lung segment, (2) threshold-based segmentation of perfused lung volumes, and (3) threshold-based segmentation of perfused lung volumes divided by segmented lung volumes at CT (perfusion index). Imaging findings were correlated with right-sided heart catheterization results and N-terminal pro–B-type natriuretic peptide. Receiver operating characteristic analysis was performed to identify SPECT thresholds for mean pulmonary arterial pressure (PAPm) greater than 50 mm Hg.

Results
Assessment of lung perfusion provided similar results using all 3 methods. The perfusion defect score correlated with PAPm (r
s = 0.60, P = 0.0005) and was associated with serum levels of N-terminal pro–B-type natriuretic peptide (r
s = 0.37, P = 0.04). Perfused lung volume (40% threshold, r
s = −0.48, P = 0.007) and perfusion index (40% threshold, r
s = −0.50, P = 0.005) decreased as PAPm increased. Receiver operating characteristic analysis showed that perfusion defect score (sensitivity, 88%; specificity, 77%; area under the curve [AUC] = 0.89, P = 0.001), perfused lung volume (sensitivity, 88%; specificity, 64%; AUC = 0.80, P = 0.01), and perfusion index (sensitivity, 88%; specificity, 64%; AUC = 0.82, P = 0.009) could identify patients with PAPm of greater than 50 mm Hg.

Conclusions
Quantitative analysis of perfusion defects at SPECT is feasible, provides a measure of disease severity, and correlates with established clinical parameters. Quantitation of perfusion SPECT may refine the diagnostic approach in CTEPH providing a quantitative imaging biomarker, for example, for therapy monitoring.