bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Sagittal Alignment Matter? A Biomechanical Look at Pinning Pediatric Supracondylar Humerus Fractures
Authors: Serbin Ryan , Duemmler Marc , Bonvillain Kirby , Coe Kelsie , Habet Nahir A. , Odum Susan , Paloski Michael 
Published: September 2024

Objective:
Closed manipulation and percutaneous pinning is standard of care for displaced supracondylar humerus fractures, yet the optimal pin configuration, particularly in the sagittal plane, is not well defined. This study evaluates how sagittal plane pin variations affect construct strength biomechanically.

Methods:
One hundred synthetic pediatric humerus models were used to emulate supracondylar humerus fracture. The models were pinned using 4 different configurations uniformly divergent in the coronal plane with variations in the sagittal plane: (1) 2 diverging pins with the lateral pin anterior (n = 25), (2) 2 diverging pins with the lateral pin posterior (n = 25), (3) 2 parallel pins (n = 25), and (4) 3 parallel pins (n = 25). The models were tested under bending (flexion, extension, and varus) and rotational (internal and external) forces, measuring stiffness and torque. Statistical analyses identified significant differences across configurations.

Results:
The 2-pin parallel configuration (9.68 N/mm in extension, 8.76 N/mm in flexion, 0.14 N-m/deg in internal rotation, and 0.14 N-m/deg in external rotation) performed similarly to the 3-pin parallel setup (10.77 N/mm in extension, 7.78 N/mm in flexion, 0.16 N-m/deg in internal rotation, and 0.14 N-m/deg in external rotation), with no significant differences in stiffness. In contrast, both parallel configurations significantly outperformed the 2-pin anterior (5.22 N/mm in extension, 5.7 N/mm in flexion, 0.11 N-m/deg in internal rotation and 0.10 N-m/deg in external rotation) and posterior (9.86 N/mm in extension, 8.31 N/mm in flexion, 0.12N-m/deg in internal rotation, and 0.11 N-m/deg in external rotation) configurations in resisting deformation. No notable disparities were observed in varus loading among any configurations.

Conclusions:
This study illuminates the sagittal plane’s role in construct stability. It suggests that, when utilizing 2-pins, parallel configurations in the sagittal plane improve biomechanical stability. In addition, it suggests avoiding the lateral anterior pin configuration due to its biomechanical inferiority. Further research should assess ultimate strength and compare various 3-pin configurations to better delineate differences between 2-pin and 3-pin configurations regarding sagittal plane alignment.

Level of Evidence:
Level III—biomechanical study.
Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery
Authors: Mohamed Ayman , Sheehan Connor , Kaur Paramveer , Schwab Frank , Butler Alexander 
Published: September 2024

Study Design:
Narrative review.

Purpose:
To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery.

Methods:
Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery.

Summary of Background Data:
Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications.

Results:
Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery.

Conclusions:
Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.
Pre-operative triAge proCedure to streaMline elective surgicAl patieNts (PACMAN) improves efficiency by selecting patients eligible for phone consultation
Authors: Di Biase Manuela , van der Zwaard Babette , Aarts Fenne , Pieters Barbe 
Published: September 2024

BACKGROUND
Pre-operative screening is a high volume task consuming time and resource. Streamlining patient flow by gathering information in advance reduces costs, optimises resources and diminishes patient burden whilst maintaining safety of care.

OBJECTIVE
To evaluate whether ‘Pre-operative triAge proCedure to streaMline elective surgicAl patieNts’ (PACMAN) is able to improve pre-operative screening by selecting patients eligible for evaluation by telephone.

DESIGN
A single-centre, retrospective, observational cohort analysis.

SETTING
A tertiary medical teaching hospital in ‘s-Hertogenbosch, The Netherlands.

PATIENTS AND METHODS
Adults scheduled for clinical interventions under procedural sedation and all types of elective medium or low risk surgery with anaesthetic guidance were eligible. Patients answered a questionnaire to calculate the PACMAN score. This score combined with risk factors related to surgery determines suitability for phone consultation (PhC) or the need for an in-person consultation (in-PC).

INTERVENTION
Evaluation of standard care.

MAIN OUTCOME MEASURES
Primary outcome was the reduction in number of in-PCs. Secondary outcomes included reliability of PACMAN, peri-operative patient outcomes and cost-effectiveness.

RESULTS
Of 965 patients triaged by PACMAN, 705 (73.1%) were identified as suitable for a PhC. Of those, 688 (97.6%) were classified American Society of Anesthesiologists Physical Status (ASA-PS) I to II or III with stable comorbidities. Of the 260 in-PC patients, 47.4% were classified ASA-PS III with unstable comorbidities or ASA-PS IV. The overall incidence of unanticipated adverse peri-operative events was 1.3%. Finally, implementation of PACMAN led to a 20% increase in pre-operative department efficiency due to better deployment of personnel and resources.

CONCLUSION
Implementation of PACMAN resulted in a 73.1% reduction in pre-operative in-PCs at our hospital. Given the increasing pressure on healthcare systems globally, we suggest developing further optimisation and integration of smart triage solutions into the pre-operative process.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT06148701
The development and evaluation of a fact sheet resource for women managing menopausal-related cognitive complaints
Authors: Zhu Chen , Arunogiri Shalini , Thomas Elizabeth H. X. , Li Qi , Kulkarni Jayashri , Gurvich Caroline 
Published: September 2024

Abstract

Objectives
Cognitive symptoms are frequently reported by women during the menopause transition years. The aim of this research was to codesign and evaluate a fact sheet resource to help women understand and manage cognitive symptoms that may occur during menopause.

Methods
This study adopted a codesign approach involving women during the menopause transition years as well as professionals to develop and evaluate a fact sheet, with a focus on acceptability and safety. Four phases (discover, define, develop, deliver) were conducted to develop, refine, and evaluate the fact sheet using a mixed-methods approach of focus groups, interviews, and surveys.

Results
The discover phase identified a need for online educational resources for women in premenopause, perimenopause, and postmenopause to learn about menopause-related topics. The define and develop phases, relying on focus group sessions with perimenopausal and postmenopausal women, revealed common themes related to the experience of cognitive symptoms and a desire for management tips to optimize cognitive functioning. Structured interviews with professionals highlighted a desire for more concrete examples of cognitive symptoms. The results of the deliver phase found strong acceptability for the fact sheet, alongside requests for additional information on menopausal hormone therapy from premenopausal, perimenopausal, and postmenopausal women.

Conclusions
The study reported a wide range of cognitive symptoms among women during the menopause transition years. This study showed broad agreement on the fact sheet's acceptability and safety in addressing menopausal cognitive symptoms. Feedback on menopausal hormone therapy and management tips underscores the demand for more research on effective interventions.
Effects of Yoga on Stress in Pregnant Women
Authors: Pais Maria , Pai Muralidhar , Kamath Asha , Lewis Leslie , Nambiar Jayaraman 
Published: September 2024

During pregnancy, a woman’s body undergoes physiological and metabolic changes to nourish the developing fetus. Every woman experiences pregnancy-related stress differently, with symptoms and difficulties ranging from mild to severe. However, various therapies are available to help reduce stress levels. The purpose of this study is to assess the impact of integrated yoga, which includes asanas and pranayama, on stress levels and physiological markers in pregnant women. The study is a prospective, randomized, controlled, single-blind trial with 2 parallel groups. The intervention group was provided with integrated yoga therapy, while the control group was given routine standard care from 18 to 22 weeks to 33-35 weeks of gestation. To measure the stress level, a standardized perceived stress scale was used, which has 10 items with stress scores ranging from 0 to 4, with a maximum score of 40. The average stress score was significantly lower in the intervention group (P < .001) as well as normal physiological parameters when compared to the control group. Findings suggest that practicing yoga during pregnancy is safe and effective in reducing stress and preventing complications. Women who began yoga therapy during their second trimester reported a significant decrease in physiological parameters from baseline to post-intervention. However, further randomized controlled trials are necessary to determine the validity and usefulness of yoga therapy during pregnancy.
The Effect of Face Mask Wear on the Ocular Surface and Contact Lens Microbiome
Authors: Ozkan Jerome , Majzoub Marwan E. , Khan Mahjabeen , Coroneo Minas , Thomas Torsten , Willcox Mark 
Published: September 2024

Objectives:
As face mask wear can result in the redirection of nasal and oral exhalation toward the ocular region, this study investigated the impact of face mask wear on the conjunctiva, eyelid margin, and contact lens (CL) surface microbiome.

Methods:
In this prospective, cross-over study, experienced CL wearers (N=20) were randomized to wear a face mask for 6 hr/day (minimum) for a week or no mask for a week. The conjunctiva, eyelid, and CLs were then sampled. After a 1-week washout period, participants were crossed over into the alternate treatment for 1 week and sampling was repeated. Sampling was bilateral and randomly assigned to be processed for culturing or 16S ribosomal(r) RNA gene sequencing.

Results:
Culturing showed no effect of mask wear on the average number of bacterial colonies isolated on the conjunctiva, eyelid, or CL, but there was increased isolation of Staphylococcus capitis on CL samples with mask wear (P=0.040). Culture-independent sequencing found differences in the taxonomic complexity and bacterial composition between the three sites (P<0.001), but there was no effect of bacterial diversity within and between sites. Mask wear did not impact dry eye or CL discomfort, but increased ocular surface staining was reported (P=0.035).

Conclusions:
Mask wear did not substantially alter the microbiome of the conjunctiva, eyelid margin, or CL surfaces in uncompromised healthy eyes.
Objective quantification of posterior capsule opacification using swept-source AS-OCT
Authors: Tao Shuya , Liang Feiyan , Fan Shuxin , Wang Mingwei , Zhang Yimeng , Liu Xialin , He Chang 
Published: September 2024

Purpose:
To objectively quantify posterior capsule opacification (PCO) using swept-source anterior segment optical coherence tomography (SS-AS–OCT) in pseudophakic eyes.

Setting:
Zhongshan Ophthalmic Center, Guangzhou, China.

Design:
Prospective cross-sectional study.

Methods:
180 eyes with PCO (37 multifocal intraocular lenses [mfIOLs] and 143 monofocal intraocular lenses [moIOLs]) were enrolled. The PCO irregular degree (PID), defined to evaluate the surface irregularity of PCO, the average and maximum thickness of PCO (AT-PCO, MT-PCO) were applied to quantify PCO based on SS-AS–OCT (CASIA2) images. Corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), modulation transfer function, and Strehl ratio were recorded. The associations between SS-AS–OCT parameters and visual function parameters were assessed by Spearman correlation analysis.

Results:
PID, AT-PCO, and MT-PCO showed significant correlations with CDVA, Strehl ratio, and HOAs (CDVA: r = 0.702, 0.741, and 0.736; Strehl ratio: r = −0.746, −0.719, and −0.740; HOAs: r = 0.762, 0.734, and 0.752). The correlations of these 3 parameters with Strehl ratio and HOAs were significantly higher than those of clinical PCO grading with Strehl ratio and HOAs (all P < .05). Particularly, PID demonstrated notable correlations with Strehl ratio and HOAs. In addition, patients with mfIOLs presented worse Strehl ratio and HOAs than those with moIOLs after matching age, PID, AT-PCO, and MT-PCO.

Conclusions:
This study provides a new method for objectively quantifying PCO using successive cross-sectional SS-AS–OCT images. AT-PCO, MT-PCO, and PID are presented as new indicators to document PCO severity, with PID offering a unique perspective by considering the irregularity aspect of PCO.
Heat-related illness and sun safety strategies for pediatric populations
Authors: Krishna Shruthi , Kim Rachel , Pochtar Emily , Papaioannou Helen 
Published: September 2024

Purpose of review
The ongoing rise in temperature poses significant public health concerns such as exposure to extreme heat and increased prevalence of heat-related illnesses. Given that pediatric populations are particularly vulnerable to heat-related risks, pediatricians need to be prepared to counsel caregivers and patients on heat protective strategies and treatment recommendations.

Recent findings
Children are physiologically susceptible to heat-related complications. Heat-related illness is a spectrum of illnesses ranging from mild heat rash to potentially life-threatening heatstroke. Prevention is key to protecting children from heat-related illness and hazards. Recommended prevention strategies include clothing, sun avoidance, hydration, acclimatization, and sunscreen.

Summary
It is important that pediatricians provide anticipatory guidance on summer sun safety practices to parents and patients. Should prevention fail, pediatricians must be aware of how to effectively distinguish and treat heat-related illness and harms.
Pearls for practice from the 2023 joint task force anaphylaxis practice parameter
Authors: Maddukuri Chaitanya , Kartha Navya , Conway Alexandra E. , Shaker Marcus S. 
Published: September 2024

Purpose of review
To share important highlights on the management of anaphylaxis from the latest 2023 practice parameter.

Recent findings
The 2023 Allergy Immunology Joint Task Force on Practice Parameters (JTFPP) anaphylaxis practice parameter provides updated anaphylaxis guidance. Criteria for the diagnosis of anaphylaxis are reviewed. The parameter highlights that while anaphylaxis is not more severe in younger children, age-specific symptoms can vary. Activation of emergency medical services may not be required in patients who experience prompt resolution of symptoms following epinephrine use and caregivers are comfortable with observation. For children weighing <15 kg, the anaphylaxis parameter suggests the clinician may prescribe either the 0.1 mg or the 0.15 mg epinephrine autoinjector, with the 0.3 mg autoinjector prescribed for those weighing 25 kg or greater. In patients with heart disease, discontinuing or changing beta blockers and/or angiotensin converting enzyme inhibitors may pose a larger risk for worsened cardiovascular disease compared with risk for severe anaphylaxis with medication continuation. Furthermore, in patients with a history of perioperative anaphylaxis, shared decision-making based on diagnostic testing and clinical history is recommended prior to repeat anesthesia use. Beyond the recent parameter update, novel contemporary therapies can decrease risk of community anaphylaxis.

Summary
The 2023 JTFPP Anaphylaxis Guidelines offer up-to-date guidance for the diagnosis and management of anaphylaxis in infants, children, and adults.
Cystic dysplasia of the rete testis in adulthood: a case report and review of the literature
Authors: Nasrallah Oussama G. , El Mir Mohammad W. , Fawaz Mohammad W. , Mahdi Jana H. , Khouzami Riad A. , Bachir Bassel G. 
Published: September 2024

Background:
Rete testis dysplasia is a cystic anomaly arising from the rete testis presenting normally in the pediatric population. These cases usually regress spontaneously without the need for surgical intervention. There are rare, reported cases of rete testis dysplasia in adulthood, which have been managed surgically.

Case presentation:
A 58-year-old man presented with lower urinary tracts symptoms and found to have a slightly larger right testicle namely in the lower pole near the epididymis. Investigation was done using ultrasound of the testicles with Doppler showing an 8 mm cyst contained in 16.5×12.1 mm cystic dysplasia near the rete testis. MRI of the testicles revealed a small intratesticular cyst with adjacent band-like signals, in keeping with rete testis dysplasia. This patient was placed under surveillance and the rete testis dysplasia is stable after 6 months and will not be operated on unless progression on ultrasound is encountered.

Clinical discussion:
The management of cystic dysplasia of the rete testis has been evolving with time. While there have never been clear-cut guidelines on the treatment of this condition, a radical orchiectomy of the affected testicle had traditionally been the preferred treatment option. There have only been three case reports of cystic dysplasia of the rete testis in adults, none of which are known to have been managed by observation.

Conclusion:
In conclusion, the authors report a unique case of rete testis dysplasia being managed conservatively showing the benign features of such a pathology, which may be actively surveyed through sequential imaging.
Point-of-Care Ultrasound Diagnosis of Early Pyomyositis in a Pediatric Patient
Authors: Ciurria Julia A. , Grither Allie 
Published: September 2024

Abstract
Skin and soft tissue infections are common in the pediatric emergency department. Because pyomyositis occurs deep to the fascial plane, it is often difficult to appreciate on physical examination. The utility of point-of-care ultrasound for identifying pyomyositis is of great value to the pediatric emergency physician as this diagnosis has a different expected clinical course and requires different management than other skin and soft tissue infections. This case report describes a child who presented to the pediatric emergency department with leg pain and redness, initially concerning for an abscess based on clinical findings. Point-of-care ultrasound diagnosed early pyomyositis, prompting early involvement of the pediatric surgical service and urgent computed tomography imaging, which confirmed the diagnosis.
Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods
Authors: Cowger Tori L. , Link Nicholas B. , Hart Justin D. , Sharp Madeline T. , Nair Shoba , Balasubramanian Ruchita , Moallef Soroush , Chen Jarvis , Hanage William P. , Tabb Loni Philip , Hall Kathryn T. , Ojikutu Bisola O. , Krieger Nancy , Bassett Mary T. 
Published: September 2024

Context:
Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention’s (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level “wastewater viral activity levels.”

Program:
In October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.

Approach and Implementation:
To produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.

Evaluation:
COVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with “Very High” wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for “High” or “Low,” obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.

Discussion:
Our methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.