bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Blast- and Impact-Related Concussion on Persistent Sleep Problems
Authors: Chung Samuel Y. , Harrison Elizabeth M. , Englert Robyn M. , Belding Jennifer N. 
Published: June 2024

Objective:
Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population.

Setting:
Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later.

Participants:
Active duty enlisted US Marines who completed both assessments (N = 64 464).

Design:
This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment.

Main Measures:
Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade.

Results:
With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression.

Conclusion:
mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.
Outcomes of Six Specific Types of Post-Hospital Brain Injury Rehabilitation Programs
Authors: Salisbury David B. , Parrott Devan , Walters G. Joseph , McGrath Claire , Logan Daniel M. , Altman Irwin M. , Malec James F. 
Published: June 2024

Objective:
Evaluate outcomes of intensive posthospital brain injury rehabilitation programs compared to supported living (SL) programs; explore variations in outcome by diagnostic category (traumatic brain injury, stroke, and other acquired brain injury [ABI]) and specific program type.

Setting:
Data were obtained from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and SL programs serving individuals with ABI.

Participants:
A total of 2120 individuals with traumatic brain injury, stroke, or other ABI participated in this study.

Main Measures:
The main measures are sex, age, time since injury, and Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).

Design:
Retrospective analyses of demographic variables and MPAI-4 Total, index, and subscale Rasch-derived T-scores on admission and discharge.

Results:
Gains on MPAI-4 Total T-scores were significantly greater for the intensive rehabilitation (IR) group in comparison to stable functioning in the SL group (F = 236.69, P < .001, partial η2 = .101) while controlling for admission/time 1 scores; similar results were found for MPAI-4 indices and subscales. For the IR cohort, discharge scores differed by diagnostic category after controlling for admission scores for the Total MPAI-4 T-score (F = 22.65, P < .001, partial η2 = .025), as well as all indices and subscales. A statistically significant interaction between program type and diagnostic group on discharge MPAI-4 Total T-scores (F = 2.55, P = .018, partial η2 = .01) after controlling for admission scores indicated that differing outcomes across diagnoses also varied by program type. Varying significant main effects and interactions were apparent for MPAI-4 indices and subscales with generally small effect sizes.

Conclusions:
Significant gains on MPAI-4 variables across IR program types compared to no change over a comparable period of time for SL programs supports the effectiveness of posthospital brain injury rehabilitation. This finding in the presence of small effect sizes on outcome variables for program type and for significant interactions between program type and diagnostic category suggests that participants generally were appropriately matched to program type and benefited from interventions provided through specific program types.
Invasive Fungal Sinusitis and Its Orbital Morbidity in Pediatric Population: A Strategic Treatment Algorithm and Outcomes
Authors: Das K. Nidhin , Sharma Vidhu , Shakrawal Jyoti , Tiwari Sarbesh , Soni Kapil , Choudhury Bikram , Goyal Amit 
Published: June 2024

Background:
Invasive fungal sinusitis, particularly mucormycosis, presents a significant clinical challenge, especially in pediatric populations. This retrospective epidemiologic study aimed to investigate the clinical characteristics, risk factors and outcomes associated with this rare but severe condition, with a focus on orbital morbidity.

Methods:
Clinical data of 12 pediatric patients diagnosed with invasive fungal sinusitis between 2021 and 2023 were retrospectively analyzed. Diagnosis involved microbiological and histopathologic examinations, alongside radiologic imaging. Treatment comprised surgical intervention and antifungal therapy, with a detailed evaluation of orbital involvement. Statistical analysis included descriptive statistics and logistic regression.

Results:
Predominantly affecting males, the median age of the patients was 8 years. Common symptoms included orbital swelling and impaired vision. Imaging revealed characteristic features of invasive fungal sinusitis, including fat stranding and bone erosions. Orbital involvement was extensive, with poor visual outcomes observed in several cases. Surgical debridement and antifungal therapy, including transcutaneous retrobulbar Amphotericin B, were administered. Risk factors associated with poor orbital outcomes included duration of diabetes and glycated hemoglobin levels. Mortality rate stood at 22.2%.

Conclusions:
Early diagnosis, aggressive surgical intervention and combined antifungal therapy are essential for improving outcomes. Timely intervention showed stabilization of the orbital disease and better outcomes in pediatric patients. Further research with larger sample sizes is warranted to better understand and address this serious condition.
Antifungal Drug Usage in European Neonatal Units: A Multicenter Weekly Point Prevalence Study
Authors: Chorafa Elisavet , Iosifidis Elias , Oletto Andrea , Warris Adilia , Castagnola Elio , Bruggemann Roger , Groll Andreas H. , Lehrnbecher Thomas , Ferreras Antolin Laura , Mesini Alessio , Agakidou Eleni , Controzzi Tiziana , De Luca Maia , Dimitriou Gabriel , Emonts Marieke , Esposito Susanna , Fernàndez-Polo Aurora , Ghimenton-Walters Elisabetta , Gkentzi Despoina , Grasa Carlos , Hatzidaki Eleftheria , Jõgi Piia , Kildonaviciute Kornelija , Kontou Angeliki , Leibold-Aguinarte Alessa , Manzanares Angela , Mendoza-Palomar Natalia , Metsvaht Tuuli , Noni Maria , Paulus Stéphane , Perrone Serafina , Rincón-López Elena , Romani Lorenza , Sánchez Laura , Cetin Benhur Sirvan , Spoulou Vana , Strenger Volker , Vergadi Eleni , Villaverde Serena , Vuerich Marco , Zamora-Flores Elena , Roilides Emmanuel 
Published: June 2024

Background:
Data on antifungal prescribing in neonatal patients are limited to either single-center or single-country studies or to 1-day recording. Therefore, we assessed antifungal longitudinal usage in neonatal units (NUs) within Europe.

Methods:
CALYPSO, a prospective weekly point prevalence study on antifungal drug usage in NUs in 18 hospitals (8 European countries), was conducted in 2020 during a 12-week period. All patients receiving systemic antifungals were included. Ward demographics were collected at the beginning; ward and patient data including indication, risk factors and antifungal regimen were weekly collected prospectively.

Results:
Among 27 participating NUs, 15 (56%) practiced antifungal prophylaxis for neonates with birth weight <1000 g or <1500 g and additional risk factors. In total, 174 patients received antifungals with a median frequency per week of 10.5% ranging from 6.9% to 12.6%. Indication for antifungal prescribing was prophylaxis in 135/174 (78%) courses and treatment in 22% [39 courses (69% empirical, 10% preemptive, 21% targeted)]. Fluconazole was the most frequent systemic agent used both for prophylaxis (133/135) and treatment (15/39, 39%). Among neonates receiving prophylaxis, the most common risk factors were prematurity (119/135, 88%), mechanical ventilation (109/135, 81%) and central vascular catheters (89/135, 66%). However, gestational age <28 weeks was only recorded in 55/135 (41%) courses and birth weight <1000 g in 48/135 (35%). Most common reason for empirical treatment was late-onset sepsis; all 8 targeted courses were prescribed for invasive candidiasis.

Conclusion:
Antifungal usage in European NUs is driven by prophylaxis and empirical treatment with fluconazole being the most prescribed agent for both indications.
The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials
Authors: Wilson Monique V. , Braithwaite Felicity A. , Arnold John B. , Crouch Sophie M. , Moore Emily , Heil Alrun , Cooper Kay , Stanton Tasha R. 
Published: June 2024

Abstract
This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception—January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD −3.48, 95% CI −6.61, −0.35; long-term: MD −1.97, 95% CI −3.53, −0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD −0.10, 95% CI −0.19, −0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD −0.41, 95% CI −0.77, −0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.
Telehealth in Urology Beyond COVID-19
Authors: Strup Sydney , Modi Parth , Finkelstein Lisa , Kraft Kate , North Amanda , Spitz Aaron , Thatcher Jacob , Rhee Eugene , Harris Andrew 
Published: June 2024

Introduction:
Implementation of telehealth (TH) accelerated during the COVID-19 pandemic and has become a vital part of health care delivery. As we move toward the post-COVID-19 era, clinical practice has demonstrated a need for updated policies and quality improvement to solidify the role of TH in the urology care setting. The AUA Census data were used to explore trends, benefits, and barriers to urology TH implementation.

Methods:
The AUA Workforce Workgroup and Telehealth Taskforce analyzed data from the 2019-2022 AUA Census. Pertinent variables included utilization, patient satisfaction, care settings, quality, and diagnoses amenable to TH.

Results:
Pre-COVID-19 TH utilization increased from 11.9% to 81% during and after the COVID-19 pandemic. TH is predominately used in metropolitan academic centers, with usage increasing from 12.8% to 83% in these areas during the pandemic. Usage also increased in non-metropolitan areas from 3.8% to 61.2%. Overall, 76.7% reported increased ease of scheduling follow-ups, 62% ease of ordering tests, and 69.5% ease of accessing patient data in favor of audio visits vs in-person visits. TH utilization increased from 42.4% to 65% for initial visits and 66.8% to 82% for follow-up visits. Over 80% of practicing urologists younger than 54 years desire the use of telemedicine for follow-up visits. TH increased patient access to care by 51.6%, and 54% of urologists expressed desire to continue using or increase utilization of TH. The top 3 barriers of patient’s ability to receive telemedicine were 67.6% noting lack of knowledge in using patient portal/software needed for telemedicine visits, 49.6% had lack of adequate conferencing tools, and 43.9% lacked high-speed internet service to enable video visits. In total, 53.4% of urologists would absolutely or probably increase usage if payment parity of TH was comparable with that of in-office E/M services.

Conclusion:
TH implementation accelerated during the COVID-19 era. In the post-COVID-19 era, TH continues to be important across multiple areas including patient and physician satisfaction and increasing access to care, particularly in rural areas. Barriers exist, especially concerning payment parity, and could be eliminated through advocacy for policy updates and standardization of technology.
Learning styles, approaches and academic performance of second and third-year medical students of a medical college of Kathmandu: a descriptive cross-sectional study
Authors: Khadka Anjan , Basnet Anuj , Jaiswal Riya , Karki Sudha , Magar Sonali Shrees 
Published: June 2024

Background:
The research is based on a questionnaire to study the different learning styles among medical students, and their approach to intellectual development.

Methods:
This is an observational, cross-sectional study conducted on 140 participants. Initially after the informed consent process, the second-year and third-year medical students were requested to respond to the questionnaire without consulting friends. Data were analyzed descriptively and comparison was made.

Results:
In this study, the students were mostly visual learners, followed by solo learners, audio learners, verbal learners, and social learners. The majority of the students in our study (84.56%) studied less than 4 h per day beyond normal lecture hours. Similarly, 45.71% of students studied continuously for 30–60 min. During break, 63.57% of students used social media, watched television, and videos, and listened to music. Most students (75%) preferred to study in a hostel room and only 12.85% used the library as their study place. The majority of the students (65.71%) of students slept between six to eight hours. The University’s suggested medical textbooks and reference materials were consulted by 94.3% of the students. The 47.85% of students favored self-directed learning with 56.42% preferring to read and write to retain the learned materials. Self-prepared notes were commonly used by the majority of students (60.7%).

Conclusions:
This research evaluates the preferred learning preferences of medical students and their relationship to academic performance, which will improve the effectiveness of teaching and learning between teachers and medical students.
Venous Thromboembolism Prevention in Rehabilitation
Authors: Geerts William H. , Jeong Eric , Robinson Lawrence R. , Khosravani Houman 
Published: June 2024

Abstract
Venous thromboembolism is a frequent complication of acute hospital care, and this extends to inpatient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important venous thromboembolism, associated mortality and costs of care. While there has been extensive research on optimal approaches to venous thromboembolism prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of venous thromboembolism and its prevention related to inpatient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of venous thromboembolism after another thrombotic insult. Low molecular weight heparins and direct oral anticoagulants are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for venous thromboembolism prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.
Brief Report: Characterizing HIV Drug Resistance in Cases of Vertical Transmission in the VESTED Randomized Antiretroviral Treatment Trial
Authors: Bishop Marley D. , Korutaro Violet , Boyce Ceejay L. , Beck Ingrid A. , Styrchak Sheila M. , Knowles Kevin , Ziemba Lauren , Brummel Sean S. , Coletti Anne , Jean-Philippe Patrick , Chakhtoura Nahida , Vhembo Tichaona , Cassim Haseena , Owor Maxensia , Fairlie Lee , Moyo Sikhulile , Chinula Lameck , Lockman Shahin , Frenkel Lisa M. 
Published: June 2024

Introduction:
VESTED (Virologic Efficacy and Safety of ART combinations with tenofovir alafenamide fumarate (TAF)/tenofovir disoproxil fumarate (TDF), efavirenz, and dolutegravir)(NCT03048422) compared the safety and efficacy of 3 antiretroviral treatment (ART) regimens in pregnant and postpartum women: dolutegravir + emtricitabine/TAF, dolutegravir + emtricitabine/TDF, and efavirenz/emtricitabine/TDF. Vertical HIV transmission (VT) occurred in 4 of 617 live-born infants (0.60%), who were evaluated for HIV drug resistance (HIVDR) and other risk factors.

Setting:
In 2018–2020, pregnant women (weeks 14–28) living with HIV underwent ≤14 days of ART were enrolled at 22 international sites and followed with their infants through 50 weeks postpartum.

Methods:
HIV sequences derived by single-genome amplification from longitudinally collected specimens were assessed from VT cases for HIVDR in protease, reverse transcriptase, integrase, and the nef 3′polypurine tract (3′PPT).

Results:
The 4 case mothers were prescribed efavirenz-based ART for 1–7 days before randomization to study ART. Their infants received postnatal nevirapine ± zidovudine prophylaxis and were breastfed. A total of 833 single-genome amplification sequences were derived. The “major” (Stanford HIVDR Score ≥60) non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation (K103N) was detected persistently in 1 viremic mother and likely contributed to VT of HIVDR. Major NNRTI HIVDR mutations were detected in all 3 surviving infants. Neither integrase nor high frequencies of 3′PPT mutations conferring dolutegravir HIVDR were detected. The timing of HIV infant diagnosis, plasma HIV RNA levels, and HIVDR suggests 1 in utero, 1 peripartum, 1 early, and 1 late breastfeeding transmission.

Conclusions:
VT was rare. New-onset NNRTI HIVDR in case mothers was likely from efavirenz ART or dolutegravir ART prescribed before study, and in 1 case, it seemed transmitted to the infant despite nevirapine prophylaxis.

NCBI GenBank Accession Numbers:
OQ911992-OQ912874.
18F-FDG PET/CT Unveils Coexistent Myelomatous Hepatosplenic and Thyroid Cartilage Involvement
Authors: Abdlkadir Ahmed Saad , Almasri Nidal , Estrada Enrique , Fani Bozkurt Murat , Al-Ibraheem Akram 
Published: June 2024

Abstract
Extramedullary myelomatous disease is an aggressive condition where clonal plasma cells proliferate outside the bone marrow, allowing independent survival. This state is generally associated with negative outcomes. A 65-year-old woman presented with progressive bilateral hypochondrial pain, was initially misattributed to an inflammatory etiology, and was consequently managed with corticosteroid therapy. A bone marrow biopsy was offered after further deterioration confirming plasma cell myeloma. Afterward, 18F-FDG PET/CT revealed medullary and extramedullary hepatosplenic and thyroid cartilage involvement, concluding an overall picture of an atypical and extensive extramedullary myelomatous disease.
Patient Handoff Practices at the Epilepsy Centers in the United States: A Survey of the Medical Directors
Authors: Selioutski Olga , Herman Susan , Ritzl Eva Katharina , Garlinghouse Matthew , Taraschenko Olga 
Published: June 2024

Purpose:
Communication failure is one of the most significant causes of medical errors. Providing care to patients with seizures at comprehensive epilepsy centers requires uninterrupted coverage and a multidisciplinary approach. However, handoff practices in these settings have not been comprehensively assessed, and recommendations for their standardization are currently lacking. The aim of this observational study was to define the scope of existing practices for patient handoffs across epilepsy centers in the United States and provide relevant recommendations.

Methods:
A 79-question survey was developed to establish the patterns of transition of care for patients undergoing continuous EEG recording, including the periodicity of handoffs and specifics of the relevant workflow. With permission from the National Association of Epilepsy Centers (NAEC), the survey was distributed to the medical directors of all Level 3 and 4 NAEC-accredited epilepsy centers in the United States.

Results:
The responses were obtained from 70 institutions yielding a survey response rate of 26%. Of these, more than 77% had established weekly handoff processes for both the epilepsy monitoring unit and continuous EEG (cEEG) monitoring services. However, only 53% and 43% of centers had procedures for daily service transfers for the patients admitted to the epilepsy monitoring unit or the patients undergoing cEEG, respectively. The patterns of handoffs were complex and utilized group handoffs in <50% of institutions. In most centers (>70%), patient data transmitted through handoffs included history, clinical information, and EEG findings. However, templates were not applied to standardize this information. All participants agreed or strongly agreed that a culture of patient safety was maintained in their place of practice; however, 12% of participants felt that insufficient time was allowed to discuss these patients or carry out the handoffs without interruptions.

Conclusions:
Existing handoff practices are not uniform or fully established across epilepsy centers in the United States. This study recommends that guidelines for formal handoff procedures be developed and introduced as a quality metric for all NAEC–accredited epilepsy centers.