bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telehealth, Wearable Sensors, and the Internet: Will They Improve Stroke Outcomes Through Increased Intensity of Therapy, Motivation, and Adherence to Rehabilitation Programs?
Authors: Burridge Jane H. , Lee Alan Chong W. , Turk Ruth , Stokes Maria , Whitall Jill , Vaidyanathan Ravi , Clatworthy Phil , Hughes Ann-Marie , Meagher Claire , Franco Enrico , Yardley Lucy 
Published: June 2017

Background and Purpose:
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points:
We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, “LifeCIT,” is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice:
We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.
Activity-Based Therapy: From Basic Science to Clinical Application for Recovery After Spinal Cord Injury
Authors: Behrman Andrea L. , Ardolino Elizabeth M. , Harkema Susan J. 
Published: June 2017

Background and Purpose:
Collaboration between scientists and clinicians effectively accelerated translation of scientific evidence for activity-based therapies (ABTs) into rehabilitation. This article addresses the basic scientific findings of activity-dependent plasticity that led to locomotor training, an ABT, and its principles to advance recovery in adult and pediatric populations with spinal cord injury (SCI). Expansion to new therapies based on these common principles is highlighted, for example, epidural stimulation. The article also describes a recently developed measure, the Neuromuscular Recovery Scale (NRS), and its psychometric properties.

Summary of Key Points:
Locomotor training has led to recovery of walking in some individuals with motor-incomplete SCI even years after injury. Recent studies resulted in individuals with motor-complete SCI regaining some voluntary movements and standing in the presence of epidural stimulation. The level of success for locomotor training and epidural stimulation appears dependent on spinal networks maintaining the appropriate central state of excitability for the desired task. As these new advances in restorative therapies required an outcome measure that measured performance without compensation, the NRS was developed. The NRS has strong psychometric properties in adults, and a pediatric version is under development. Application of locomotor training in children is still novel. Preliminary evidence suggests that locomotor training can improve trunk control and also foster participation in children with chronic SCI.

Recommendations for Clinical Practice:
ABTs may effectively promote neuromuscular recovery and improve function and participation in adults and children post-SCI. Evaluation of outcomes with valid measures, such as the NRS, is necessary to document the ability to perform functional tasks and to assess progress as function improves.
Menstrual Hygiene Management in Resource-Poor Countries
Authors: Kuhlmann Anne Sebert , Henry Kaysha , Wall L. Lewis 
Published: June 2017

Importance
Adequate management of menstrual hygiene is taken for granted in affluent countries; however, inadequate menstrual hygiene is a major problem for girls and women in resource-poor countries, which adversely affects the health and development of adolescent girls.

Objective
The aim of this article is to review the current evidence concerning menstrual hygiene management in these settings.

Evidence Acquisition
A PubMed search using MeSH terms was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized.

Results
Most research to date has described menstrual hygiene knowledge, attitudes, and practices, mainly in sub-Saharan Africa and South Asia. Many school-based studies indicate poorer menstrual hygiene among girls in rural areas and those attending public schools. The few studies that have tried to improve or change menstrual hygiene practices provide moderate to strong evidence that targeted interventions do improve menstrual hygiene knowledge and awareness.

Conclusion and Relevance
Challenges to improving menstrual hygiene management include lack of support from teachers (who are frequently male); teasing by peers when accidental menstrual soiling of clothes occurs; poor familial support; lack of cultural acceptance of alternative menstrual products; limited economic resources to purchase supplies; inadequate water and sanitation facilities at school; menstrual cramps, pain, and discomfort; and lengthy travel to and from school, which increases the likelihood of leaks/stains. Areas for future research include the relationship between menarche and school dropout, the relationship between menstrual hygiene management and other health outcomes, and how to increase awareness of menstrual hygiene management among household decision makers including husbands/fathers and in-laws.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completion of this educational activity, the obstetrician/gynecologist should be able to define what is meant by “adequate menstrual hygiene management,” identify the challenges to adequate menstrual hygiene management that exist in resource-poor countries, and describe some of the intervention strategies that have been proposed to improve menstrual hygiene management for girls and women in those countries.
Uterine Malformations: An Update of Diagnosis, Management, and Outcomes
Authors: Bhagavath Bala , Greiner Ellie , Griffiths Kara M. , Winter Tom , Alur-Gupta Snigdha , Richardson Carter , Lindheim Steven R. 
Published: June 2017

Importance
The prevalence of uterine malformations has been reported in up to 7% of the general population and 18% of those with recurrent pregnancy loss. The diagnosis, classification, management, and outcome of the management have been subject to debate for decades.

Objective
The aim of this article is to summarize the current knowledge regarding the genetics of müllerian anomalies, the varied classification schemes, the appropriate diagnostic modalities, the surgical methods, and the obstetric outcomes related to these surgical methods.

Evidence Acquisition
An extensive literature review using the key words uterine anomaly, classification, mullerian, agenesis, unicornuate, didelphys, bicornuate, septate, arcuate, DES, and diethyl stilbestrol was conducted using PubMed. Only English-language publications were reviewed. Relevant references within these publications were also obtained and reviewed in preparing this article.

Results
Only 4 genes have been clearly linked to müllerian anomalies in humans. All these have been described only in syndromic patients. Four different classification schemes have been proposed including the American Society of Reproductive Medicine classification. There is accumulating evidence that 3-dimensional ultrasonography is an effective and less expensive diagnostic tool. Many innovative surgical methods have been developed for the various categories of anomalies, particularly for müllerian agenesis. Although there is accumulating evidence for the improved obstetric outcomes after surgical repairs, robust evidence from randomized trials is lacking.

Conclusions
Current evidence favors continued use of the American Society of Reproductive Medicine classification. Three-dimensional sonography, especially when combined with saline infusion, can be very helpful in accurately classifying müllerian anomalies.

Relevance
Müllerian anomalies are relatively common. Accurate knowledge of the advantages and limitations of various diagnostic modalities, the limitations of the classification systems, the surgical options available where appropriate, and the obstetric outcomes after these surgeries will help in the optimal management of these patients.

Target Audience
Obstetrician and gynecologists.

Learning Objectives
After completion of this educational activity, the obstetrician/gynecologist should be better able to discuss the current controversies and new classifications of müllerian anomalies, describe the prevalence and pathogenesis of each müllerian anomaly, illustrate the various modalities for the diagnosis of müllerian anomalies, and outline the appropriate counseling and clinical practice for surgical management and obstetric outcomes for each anomaly.
Reducing Health Disparities by Removing Cost, Access, and Knowledge Barriers
Authors: Goodman Melody , Onwumere Ojiugo , Milam Laurel , Peipert Jeffrey F. 
Published: June 2017

(Abstracted from Am J Obstet Gynecol 2017;216(4):382.e1–382.e5)
In the United States, black women are thrice more likely and Hispanic women twice as likely to have an unintended pregnancy as white women. The high rates of unintended pregnancy among black and Hispanic women are largely due to incorrect, inconsistent, and nonuse of contraception, as well as health care disparities.
Do Patient Characteristics Impact the Relationship Between Anatomic Prolapse and Vaginal Bulge Symptoms?
Authors: Kowalski Joseph T. , Melero Gerardo Heredia , Mahal Amandeep , Genadry Rene , Bradley Catherine S. 
Published: June 2017

(Abstracted from Int Urogynecol J 2017; 28:391–396)
Previous studies have shown that seeing or feeling a vaginal bulge is the most specific symptom for identifying pelvic organ prolapse (POP). It has been suggested that the critical point at which bulge symptoms appear in most women is prolapse to or beyond the level of the hymen.
Urinary Microbiome and Cytokine Levels in Women With Interstitial Cystitis
Authors: Abernethy Melinda G. , Rosenfeld Amy , White James R. , Mueller Margaret G. , Lewicky-Gaupp Christina , Kenton Kimberly 
Published: June 2017

(Abstracted from Obstet Gynecol 2017;129:500–506)
Evidence for the existence of a biodiverse urinary microbiome that cannot be isolated by conventional culture has significant clinical implications for the diagnosis and treatment of several urinary tract conditions. Interstitial cystitis is a debilitating chronic condition characterized by suprapubic pain and urinary frequency.
Factors Associated With Deciding Between Risk-Reducing Salpingo-oophorectomy and Ovarian Cancer Screening Among High-Risk Women Enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group Study
Authors: Mai Phuong L. , Piedmonte Marion , Han Paul K. , Moser Richard P. , Walker Joan L. , Rodriguez Gustavo , Boggess John , Rutherford Thomas J. , Zivanovic Oliver , Cohn David E. , Thigpen J. Tate , Wenham Robert M. , Friedlander Michael L. , Hamilton Chad A. , Bakkum-Gamez Jamie , Olawaiye Alexander B. , Hensley Martee L. , Greene Mark H. , Huang Helen Q. , Wenzel Lari 
Published: June 2017

(Abstracted from Gynecol Oncol 2017;145(1):122–129)
Currently, there is no safe and effective ovarian cancer screening (OCS) test, and novel screening modalities are being investigated. Recently, the Risk of Ovarian Cancer Algorithm (ROCA), a novel screening strategy, has shown promise among average-risk and high-risk women.
Use of MRI in the Diagnosis of Fetal Brain Abnormalities in Utero (MERIDIAN): A Multicentre, Prospective Cohort Study
Authors: Griffiths Paul D. , Bradburn Michael , Campbell Michael J. , Cooper Cindy L. , Graham Ruth , Jarvis Deborah , Kilby Mark D. , Mason Gerald , Mooney Cara , Robson Stephen C. , Wailoo Allan 
Published: June 2017

(Abstracted from Lancet 2017;389:538–546)
Ultrasound is routinely used for antenatal screening. One role of antenatal sonography is in the detection of fetal anomalies; among these, fetal brain anomalies occur in almost 3 of every 1000 pregnancies and lead to significant rates of morbidity and mortality.
The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites
Authors: Zou Yaming , Liao Yu , Liu Fengying , Chen Lei , Shen Hongcheng , Huang Shujie , Zheng Heping , Yang Bin , Hao Yuantao 
Published: June 2017

Background
Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective.

Methods
Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method.

Results
Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54.

Conclusions
Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.
Improving Hypertension Control Population-wide in Minnesota
Authors: Foti Kathryn , Auerbach John , Magnan Sanne 
Published: June 2017

Context:
Hypertension is a common and costly risk factor for cardiovascular disease, but just over half of all adults with hypertension have their blood pressure controlled nationally. In Minneapolis–St Paul, Minnesota, the rate of hypertension control is approximately 70% despite a rate of hypertension control similar to the national average as recently as the first half of the 1990s.

Objective:
The purposes of this study were to identify factors in Minneapolis–St Paul and state-level policies and programs in Minnesota that may have contributed to the more rapid increase in blood pressure control there than that in the rest of the nation and to identify factors that can potentially be replicated in other jurisdictions.

Design, Setting, Participants:
The study included analysis of trends in hypertension control since 1980 based on the Minnesota Heart Survey and the National Health and Nutrition Examination Survey, as well as interviews with health care and public health leaders in Minnesota.

Main Outcome Measure:
Prevalence of hypertension control.

Results:
Probable contributing factors identified include a focus on collaborative and continuous quality improvement; a forum for setting statewide clinical guidelines and measures; the willing participation from the largest health systems, purchasers, and nonprofit health plans; and the use of widely accepted mechanisms for providing feedback to clinicians and reporting performance. The relatively high rate of insurance coverage and socioeconomic status may have contributed but do not fully explain the difference in hypertension control as compared with the rest of the United States.

Conclusions:
The experience in Minnesota demonstrates that it is possible to dramatically increase hypertension control at the population level, across health systems, and health plans in a relatively short period of time. Lessons learned may be helpful to informing local, state, and national efforts to improve hypertension control.
Revolving Loan Fund: A Novel Approach to Increasing Access to Long-Acting Reversible Contraception Methods in Community Health Centers
Authors: Evans Megan L. , Breeze Janis L. , Paulus Jessica K. , Meadows Audra 
Published: June 2017

Objective:
The aim of this study was to assess the impact of a revolving loan fund (RLF) on timing of device insertion and long-acting reversible contraception (LARC) access among a high-risk urban population at 3 Boston community health centers.

Design:
Three health centers were identified to implement a RLF. Each clinic received $5000 from the RLF to purchase LARC devices. Data collected through medical record review retrospectively 1 year prior to start of the RLF and prospectively for 1 year thereafter included patient demographics, type of LARC selected, patient's date of documented interest in a LARC device, and date of insertion. The effect of a RLF on delay to LARC insertion was tested using negative binomial regression, controlling for site and potential confounding variables between the pre- and post-RLF periods.

Setting:
Three urban community health centers.

Participants:
Reproductive-aged women who received family planning services at the 3 participating health centers.

Main Outcome Measures:
Increasing access to LARC and decreasing wait times to LARC insertion after implementation of the RLF.

Results:
Data on 133 patients in the pre-RLF group and 205 in the post-RLF group were collected. There were no statistically significant differences in demographic or clinical characteristics between the 2 time periods. LARC uptake increased significantly from the pre- to post-RLF period, specifically among implant users. There was a statistically significant decrease in the mean number of days in delay from interest to insertion from the pre- to post-RLF period (pre-RLF: 31.3 ± 50.6 days; post-RLF: 13.6 ± 16.7 days, adjusted P < .001). The reasons for the delay did not differ significantly between the 2 time periods.

Conclusion:
The RLF decreased wait time for the devices and increased overall insertion rates. This may serve as a promising solution to improve LARC access in community health centers. This project could be expanded to include more health centers, creating a city wide RLF. This expansion could allow for further data analysis, including unintended pregnancy rates with LARC delay, LARC continuation rates, and sustainability of a RLF.
Distributed Data Networks That Support Public Health Information Needs
Authors: Tabano David C. , Cole Elizabeth , Holve Erin , Davidson Arthur J. 
Published: June 2017

Introduction:
Data networks, consisting of pooled electronic health data assets from health care providers serving different patient populations, promote data sharing, population and disease monitoring, and methods to assess interventions. Better understanding of data networks, and their capacity to support public health objectives, will help foster partnerships, expand resources, and grow learning health systems.

Methods:
We conducted semistructured interviews with 16 key informants across the United States, identified as network stakeholders based on their respective experience in advancing health information technology and network functionality. Key informants were asked about their experience with and infrastructure used to develop data networks, including each network's utility to identify and characterize populations, usage, and sustainability.

Results:
Among 11 identified data networks representing hundreds of thousands of patients, key informants described aggregated health care clinical data contributing to population health measures. Key informant interview responses were thematically grouped to illustrate how networks support public health, including (1) infrastructure and information sharing; (2) population health measures; and (3) network sustainability.

Conclusion:
Collaboration between clinical data networks and public health entities presents an opportunity to leverage infrastructure investments to support public health. Data networks can provide resources to enhance population health information and infrastructure.
Determinants of HIV-1 CD4-Independent Brain Adaptation
Authors: Shakirzyanova Madina , Kong Xiang-Peng , Cheng-Mayer Cecilia 
Published: June 2017

Background:
HIV-1 is known to adapt to the local environment in its usage of receptors, and it can become CD4 independent in the brain where the receptor is scarce. This adaptation is through amino acid variations, but the patterns of such variation are not yet well understood. Given that infection of long-lived CD4-low and CD4-negative cells in anatomical compartments such as the brain expands cell tropism in vivo and may serve as potential viral reservoirs that pose challenge for HIV eradication, understanding the evolution to CD4 independence and envelope conformation associated with infection in the absence of CD4 will not only broaden our insights into HIV pathogenesis but may guide functional cure strategies as well.

Methods:
We characterize, by site-directed mutagenesis, neutralization assay, and structural analysis, a pair of CD4-dependent (cl2) and CD4-independent (cl20) envelopes concurrently isolated from the cerebral spinal fluid of an SHIV-infected macaque with neurological AIDS and with minimum sequence differences.

Results:
Residues different between cl2 and cl20 are mapped to the V1V2 and surrounding regions. Mutations of these residues in cl2 increased its CD4 independence in infection, and the effects are cumulative and likely structural.

Conclusions:
Our data suggested that the determinants of CD4 independence in vivo mapped principally to V1V2 of gp120 that can destabilize the apex of the envelope spike, with an additional change in V4 that abrogated a potential N-linked glycan to facilitate movement of the V1V2 domain and further expose the coreceptor-binding site.