bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?
Authors: Marzolini Susan , Fong Karen , Jagroop David , Neirinckx Jennifer , Liu Jean , Reyes Rina , Grace Sherry L , Oh Paul , Colella Tracey J F 
Published: October 2019

AbstractBackgroundPeople after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use.ObjectiveThe aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use.DesignThis was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada.MethodsQuestionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators.ResultsOf 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%).LimitationsGeneralizability to other programs is limited, and other, unmeasured factors may have affected outcomes.ConclusionsAn OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.
Physical Activity and Sedentary Behavior 6 Months After Musculoskeletal Trauma: What Factors Predict Recovery?
Authors: Ekegren Christina L , Climie Rachel E , Simpson Pamela M , Owen Neville , Dunstan David W , Veitch William , Gabbe Belinda J 
Published: October 2019

Abstract

Background
Physical activity is increasingly recognized as an important marker of functional recovery following fracture.

Objective
The objectives of this study were to measure sedentary behavior and physical activity 2 weeks and 6 months following fracture and to determine associated demographic and injury factors.

Design
This was an observational study.

Methods
Two weeks and 6 months following fracture, 83 adults who were 18 to 69 years old and had upper limb (UL) or lower limb (LL) fractures wore an accelerometer and an inclinometer for 10 days. We calculated sitting time, steps, moderate-intensity physical activity (MPA), and vigorous-intensity physical activity and conducted linear mixed-effects multivariable regression analyses to determine factors associated with temporal changes in activity.

Results
At 6 months versus 2 weeks after fracture, participants sat less, took more steps, and engaged in more MPA. Participants with LL fractures sat 2 hours more, took 66% fewer steps, and engaged in 77% less MPA than participants with UL fractures. Greater reductions in sitting time were observed for participants in the youngest age group and with LL fractures, participants with high preinjury activity, and participants who were overweight or obese. For steps, greater improvement was observed for participants in the youngest and middle-aged groups and those with LL fractures. For MPA, greater improvement was observed for middle-aged participants and those with LL fractures.

Limitations
Although this study was sufficiently powered for the analysis of major categories, a convenience sample that may not be representative of all people with musculoskeletal trauma was used.

Conclusions
Working-age adults with LL fractures had lower levels of physical activity 6 months after fracture than those with UL fractures. Older adults showed less improvement over time, suggesting that they are an important target group for interventions aimed at regaining preinjury activity levels.
The impact of threat of shock-induced anxiety on the neural substrates of memory encoding and retrieval
Authors: Garibbo Michele , Aylward Jessica , Robinson Oliver J 
Published: October 2019

AbstractDysfunctional memory processes are widely reported in anxiety disorders, but the underlying neurocognitive mechanisms are unclear. Recent work shows that the impact of anxiety on memory depends on the context and memory modality. For instance, threat of shock, a translational within-subject anxiety induction, has been shown to impair the encoding of facial stimuli, while improving spatial working memory (WM) accuracy. The present study aimed to delineate the neural circuitry regulating these opposing behavioural effects. Thirty-three healthy volunteers performed the previously assessed facial recognition and a spatial WM tasks inside an fMRI scanner, under alternating within-subject conditions of threat or safe from shock across encoding and retrieval. Facial recognition impairments were replicated when threat was selectively induced at encoding. Neuroimaging results suggest that this effect was driven by increased competition for attentional resources within the anterior cingulate cortex, in which activation correlated positively with stress levels. The impact of threat on spatial WM performance did not, however, replicate in the fMRI environment. Nevertheless, state-dependent hippocampal activation was observed in both tasks. These findings suggest a neurocognitive mechanism by which anxiety impairs facial recognition as well as a state-dependent hippocampal activation pattern, which may putatively underline retrieval of negative experiences in anxiety.
Development and Application of a Life-Stage Physiologically Based Pharmacokinetic (PBPK) Model to the Assessment of Internal Dose of Pyrethroids in Humans
Authors: Mallick Pankajini , Moreau Marjory , Song Gina , Efremenko Alina Y , Pendse Salil N , Creek Moire R , Osimitz Thomas G , Hines Ronald N , Hinderliter Paul , Clewell Harvey J , Lake Brian G , Yoon Miyoung 
Published: October 2019

Abstract
To address concerns around age-related sensitivity to pyrethroids, a life-stage physiologically based pharmacokinetic (PBPK) model, supported by in vitro to in vivo extrapolation (IVIVE) was developed. The model was used to predict age-dependent changes in target tissue exposure of 8 pyrethroids; deltamethrin (DLM), cis-permethrin (CPM), trans-permethrin, esfenvalerate, cyphenothrin, cyhalothrin, cyfluthrin, and bifenthrin. A single model structure was used based on previous work in the rat. Intrinsic clearance (CLint) of each individual cytochrome P450 or carboxylesterase (CES) enzyme that are active for a given pyrethroid were measured in vitro, then biologically scaled to obtain in vivo age-specific total hepatic CLint. These IVIVE results indicate that, except for bifenthrin, CES enzymes are largely responsible for human hepatic metabolism (&gt;50% contribution). Given the high efficiency and rapid maturation of CESs, clearance of the pyrethroids is very efficient across ages, leading to a blood flow-limited metabolism. Together with age-specific physiological parameters, in particular liver blood flow, the efficient metabolic clearance of pyrethroids across ages results in comparable to or even lower internal exposure in the target tissue (brain) in children than that in adults in response to the same level of exposure to a given pyrethroid (Cmax ratio in brain between 1- and 25-year old = 0.69, 0.93, and 0.94 for DLM, bifenthrin, and CPM, respectively). Our study demonstrated that a life-stage PBPK modeling approach, coupled with IVIVE, provides a robust framework for evaluating age-related differences in pharmacokinetics and internal target tissue exposure in humans for the pyrethroid class of chemicals.
Evaluating a Center for Interprofessional Education via Social Network Analysis
Authors: Dow Alan W. , Sewell Daniel K. , Lockeman Kelly S. , Micalizzi Elizabeth A. 
Published: October 2019

Centers and institutes are created to support interdisciplinary collaboration. However, all centers and institutes face the challenge of how best to evaluate their impact since traditional counts of productivity may not fully capture the interdisciplinary nature of this work. The authors applied techniques from social network analysis (SNA) to evaluate the impact of a center for interprofessional education (IPE), a growing area for centers because of the global emphasis on IPE.
The authors created networks based on the connections between faculty involved in programs supported by an IPE center at Virginia Commonwealth University from 2014 to 2017. They used mathematical techniques to describe these networks and the change in the networks over time. The results of these analyses demonstrated that, while the number of programs and involved faculty grew, the faculty maintained a similar amount of connection between members. Additional faculty clusters emerged, and certain key faculty were important connectors between clusters. The analysis also confirmed the interprofessional nature of faculty collaboration within the network.
SNA added important evaluation data beyond typical metrics such as counts of learners or faculty. This approach demonstrated how a center was evolving and what strategies might be needed to support further growth. With further development of benchmarks, SNA could be used to evaluate the effectiveness of centers and institutes relative to each other. SNA should guide strategic decisions about the future of centers and institutes as they strive to meet their overarching goal of tackling a social challenge through interdisciplinary collaboration.
Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students’ Feedback Experiences With Longitudinal Coaches
Authors: Bakke Brian M. , Sheu Leslie , Hauer Karen E. 
Published: October 2019

Purpose
Feedback is important for medical students’ development. Recent conceptualizations of feedback as a dialogue between feedback provider and recipient point to longitudinal relationships as a facilitator of effective feedback discussions. This study illuminates how medical students experience feedback within a longitudinal relationship with a physician coach.

Method
In this qualitative study, second-year medical students from the University of California, San Francisco, School of Medicine participated in semistructured interviews that explored their experiences discussing feedback within longitudinal, nonevaluative coaching relationships. Interviews occurred between May and October 2018. Interview questions addressed students’ experiences receiving feedback from their coach, how and when they used this feedback, and how their relationship with their coach influenced engagement in feedback discussions. Interviews were analyzed using constructivist grounded theory.

Results
Seventeen students participated. The authors identified 3 major themes. First, students’ development of a feedback mindset: Over time, students came to view feedback as an invaluable component of their training. Second, setting the stage for feedback: Establishing feedback routines and a low-stakes environment for developing clinical skills were important facilitators of effective feedback discussions. Third, interpreting and acting upon feedback: Students described identifying, receiving, and implementing tailored and individualized feedback in an iterative fashion. As students gained comfort and trust in their coaches’ feedback, they reported increasingly engaging in feedback conversations for learning.

Conclusions
Through recurring feedback opportunities and iterative feedback discussions with coaches, students came to view feedback as essential for growth and learning. Longitudinal coaching relationships can positively influence how students conceptualize and engage in feedback discussions.
Using Team Census Caps to Optimize Education, Patient Care, and Wellness: A Survey of Internal Medicine Residency Program Directors
Authors: Catalanotti Jillian S. , Amin Alpesh N. , Vinciguerra Steve F. , Walsh Katherine , Gilden Janice , Kisielewski Michael , Laird-Fick Heather S. 
Published: October 2019

Purpose
To discover whether internal medicine (IM) residency program directors use lower-than-required caps on general medicine wards, critical care units, and inpatient subspecialty wards; describe justifications for lower-than-required general medicine ward caps and strategies for when caps have been exceeded or the number of patients is a detriment to critical thinking or education; and assess whether caps were associated with program characteristics.

Method
From August to December 2016, the Association of Program Directors in Internal Medicine surveyed all member program directors about team caps and their effects on the learning environment. Responses were appended with publicly available or licensed third-party data. Programs were categorized by type, size, and region.

Results
Overall response rate was 65.7% (251/382 programs). Nearly all (244/248; 98.4%) reported caps for general medicine ward teams (mean = 17.0 [standard deviation (SD) = 4.2]). Fewer (171/247; 69.2%) had caps for critical care teams (mean = 13.8 [SD = 5.4]). Fewer still (131/225; 58.2%) had caps for inpatient subspecialty ward teams (mean = 14.8 [SD = 6.0]). Fewer first-quartile programs (0–28 residents) reported having caps on inpatient subspecialty teams (P < .001). Directors reported higher caps compromised education (109/130; 83.8%), patient care (89/130; 68.5%), and/or resident wellness (77/130; 59.2%). Nonteaching services (181/249; 72.7%), patient transfers (110/249; 44.2%), or “backup” residents (67/249; 26.9%) were used when caps are reached or the number of patients is detrimental to critical thinking or education.

Conclusions
IM program directors frequently exercise discretion when setting caps. Accrediting bodies should explicitly encourage such adjustments and allow differentiation by setting.
Electrocatheter-mediated High-voltage Pulsed Radiofrequency of the Dorsal Root Ganglion in the Treatment of Chronic Lumbosacral Neuropathic Pain
Authors: Vigneri Simone , Sindaco Gianfranco , La Grua Marco , Zanella Matteo , Lo Bianco Giuliano , Paci Valentina , Vinci Francesca M. , Sciacca Chiara , Ravaioli Laura , Pari Gilberto 
Published: October 2019

Objectives:
Despite the interest in scientific community, there is still poor evidence about pulsed radiofrequency (PRF) efficacy in the treatment of neuropathic pain. In order to determine whether high-voltage PRF and epidural adhesiolysis (PRF-EA) showed better results than epidural adhesiolysis alone (EA), a randomized, double-blind, comparative-effectiveness study was conducted in patients with chronic lumbosacral radiating pain and neuropathic features.

Materials and Methods:
A total of 41 patients were randomly allocated to 2 groups. Twenty-one patients were randomized to receive 2 cycles of 240 seconds high-voltage PRF followed by the injection of local anesthetics, hyaluronidase, and betamethasone, whereas 20 patients underwent sham stimulation followed by adhesiolysis. The treatment was delivered at the affected lumbosacral roots and patients, treating physicians and assessors were blinded to intervention.

Results:
A significant reduction of radiating pain was observed in mean Numeric Rating Scale score at follow-up. A change of −3.43 versus −1.75 (P=0.031) after 1 month and −3.34 versus −0.80 (P=0.005) after 6 months was reported in patients undergoing PRF-EA in comparison with EA, respectively. After 1 month, 57% of patients in the PRF-EA group experienced a pain reduction of ≥50% versus only 25% of patients allocated to EA (P=0.037). Improvement decreased to 48% in the PRF-EA group whereas only 10% of EA reported significant pain relief after 6 months (P=0.008).

Discussion:
High-voltage PRF of dorsal root ganglion delivered through multifunctional electrode provided significant pain relief and may be considered a valuable treatment in chronic lumbosacral radicular pain with neuropathic features.
Plastic Surgeon Closure of Index Spinal Cases
Authors: Weissler Elizabeth H. , Jenkins Arthur L. , Hecht Andrew C. , Taub Peter J. 
Published: October 2019

Purpose:
The role of the plastic surgeon in wound management following complications from prior spinal surgeries is well established. The present study evaluates wound complications following plastic surgeon closure of the primary spinal surgery in a large patient population.

Methods:
Spinal surgeries closed by a single plastic surgeon at a large academic hospital were reviewed. Descriptive statistics were applied and outcomes in this sample were compared with previously published outcomes using 2-sample z tests.

Results:
Nine hundred twenty-eight surgeries were reviewed, of which 782 were included. Seven hundred fifteen operations were for degenerative conditions of the spine, 22 for trauma, 30 for neoplasms, and 14 for congenital conditions. Four hundred twenty-one were lumbosacral procedures (53.8%) and 361 (46.2%) cervical. Fourteen patients (1.8%) required readmission with 30 days. This compares favorably to a pooled analysis of 488049 patients, in which the 30-day readmission rate was found to be 5.5% (z=4.5, P<0.0001). Seven patients (0.89%) had wound infection and 3 (0.38%) wound dehiscence postoperatively, compared with a study of 22,430 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who had an infection incidence of 2.2% (z=2.5, P=0.0132) and 0.3% dehiscence rate (z=0.4, P=0.6889). The combined incidence of wound complications in the present sample, 1.27%, was less than the combined incidence of wound complications in the population of 22,430 patients (z=2.2, P=0.029).

Conclusions:
Thirty-day readmissions and wound complications are intensely scrutinized quality metrics that may lead to reduced reimbursements and other penalties for hospitals. Plastic surgeon closure of index spinal cases decreases these adverse outcomes. Further research must be done to determine whether the increased cost of plastic surgeon involvement in these cases is offset by the savings represented by fewer readmissions and complications.
Ingested Nitrate and Nitrite and Bladder Cancer in Northern New England
Authors: Barry Kathryn Hughes , Jones Rena R. , Cantor Kenneth P. , Beane Freeman Laura E. , Wheeler David C. , Baris Dalsu , Johnson Alison T. , Hosain G. Monawar , Schwenn Molly , Zhang Han , Sinha Rashmi , Koutros Stella , Karagas Margaret R. , Silverman Debra T. , Ward Mary H. 
Published: October 2019

Background:

N-nitroso compounds are hypothesized human bladder carcinogens. We investigated ingestion of N-nitroso compound precursors nitrate and nitrite from drinking water and diet and bladder cancer in the New England Bladder Cancer Study.

Methods:
Using historical nitrate measurements for public water supplies and measured and modeled values for private wells, as well as self-reported water intake, we estimated average nitrate concentrations (mg/L NO3-N) and average daily nitrate intake (mg/d) from 1970 to diagnosis/reference date (987 cases and 1,180 controls). We estimated overall and source-specific dietary nitrate and nitrite intakes using a food frequency questionnaire (1,037 cases and 1,225 controls). We used unconditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). We evaluated interactions with factors that may affect N-nitroso compound formation (i.e., red meat, vitamin C, smoking), and with water intake.

Results:
Average drinking water nitrate concentration above the 95th percentile (>2.07 mg/L) compared with the lowest quartile (≤0.21 mg/L) was associated with bladder cancer (OR = 1.5, 95% CI = 0.97, 2.3; P trend = 0.01); the association was similar for average daily drinking water nitrate intake. We observed positive associations for dietary nitrate and nitrite intakes from processed meat (highest versus lowest quintile OR for nitrate = 1.4, 95% CI = 1.0, 2.0; P trend = 0.04; OR for nitrite = 1.5, 95% CI = 1.0, 2.1; P trend = 0.04, respectively), but not other dietary sources. We observed positive interactions between drinking water nitrate and red meat (P-interaction 0.05) and processed red meat (0.07).

Conclusions:
Our results suggest the importance of both drinking water and dietary nitrate sources as risk factors for bladder cancer.