bluuebunny/crossref_metadata_2025_split huggingface dataset:
Charcot Neuroarthropathy Is Associated With Higher Rates of Phantom Limb After Lower Extremity Amputation
Authors: Nam Hannah H. , Martinazzi Brandon J. , Lorenz F. Jeffrey , Kirchner Gregory J. , Bonaddio Vincenzo , Adeyemo Adeshina , Walley Kempland C. , Aynardi Michael C. 
Published: February 2024

Background The incidence of phantom limb pain in patients with Charcot neuroarthropathy who undergo major amputation is not well described. The purpose of this study was to determine whether patients with Charcot neuroarthropathy and diabetes who underwent either a below-knee amputation (BKA) or above-knee amputation (AKA) had an increased rate of phantom limb pain compared with those with a diagnosis of diabetes alone. Methods Using international classification of disease (ICD) and common procedural terminology (CPT) codes, the TriNetX research database identified 10 239 patients who underwent BKA and 6122 who underwent AKA between 2012 and 2022. Diabetic patients with and without Charcot neuroarthropathy were compared in terms of demographics and relative risk of developing phantom limb pain after AKA or BKA. Results Age, sex, ethnicity, and race did not significantly differ between groups. Charcot neuroarthropathy was associated with significantly increased risk of phantom limb pain following both BKA (risk ratio [RR]: 1.2, 95% confidence interval [CI]: 1.1-1.3, P < .01) and AKA (RR: 1.6, 95% CI: 1.2-2.3, P < .0068). Conclusion Our results indicate that patients with a coexisting diagnosis of Charcot neuroarthropathy who require BKA or AKA may have an increased risk of developing phantom limb pain. Levels of Evidence: Level III
A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players
Authors: Zeller Anne Marie , Lear Aaron , Post Eric , McNulty Suzanne , Bentley Brett 
Published: February 2024

Background: There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes. Hypothesis: Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes. Study Design: Cross-sectional survey. Level of Evidence: Level 4. Methods: An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups. Results: A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01). Conclusion: While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points). Clinical Relevance: This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.
Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria
Authors: Shekoni Oluwatobi , Iversen Synne , Diaz Gabriela J , Aune Anders , Ubuane Peter Odion , Imam Zainab , André Beate 
Published: February 2024

Background: Mobile health has enormous potential in healthcare due to the increasing use of mobile phones in low- and middle-income countries; its effective deployment, uptake, and utilization may result in improved health outcomes, including a reduction in neonatal deaths. However, there is a suboptimal uptake of mobile health technologies among healthcare workers in low-resource settings like Nigeria, which are often context-specific. Objective: To investigate healthcare workers’ perceptions of mobile health technologies in public health facilities in Lagos, Nigeria. Method: A qualitative study was conducted, and data were collected through six focus group discussions with 26 healthcare workers (doctors, nurses, and community health extension workers) from three public health facilities in Lagos, Nigeria. The collected data were analyzed using a thematic approach, where themes and subthemes were created. Results: Although the participants acknowledged that mobile health enhances patient–provider communication and saves time, they identified altering of healthcare workers’ routine practices, information overload, power and network failure, skepticism, lack of trust, and concerns over diagnostic accuracy as potential barriers to its uptake. Conclusion: Addressing healthcare workers’ perceptions of mobile health technologies may enhance the deployment and uptake of such solutions in Nigeria and similar low-resource settings. Developers and implementers of such can use them to create new or enhance existing mobile health solutions to better meet the needs and requirements of healthcare workers in low- to middle-income health settings, such as Lagos, Nigeria.
Prevalence of goiter and associated factors among adolescent girls in the highland area of Northwest Ethiopia
Authors: Teshome Assefa Agegnehu , Ashagrie Berhanu Kindu , Agmas Atalo Ayenew , Mengstie Misganaw Asmamaw , Molla Yalew Melkamu , Baye Nega Dagnaw , Abate Agmas Wassie , Gebeyehu Asaye Alamneh , Yazie Taklo Simeneh , Chanie Ermias Sisaye , Kassaw Amare Wolie , Admasu Fitalew Tadele , Walle Gashaw Ayehu 
Published: February 2024

Background: Goiter is a common public health issue in Ethiopia; however, there is not much evidence of it among adolescent girls, especially in Northwest Ethiopia. Objective: This study aimed to determine the prevalence and associated factors of goiter in adolescent girls living in the highlands of Northwest Ethiopia. Methods: From 5 January to 15 February 2022, 560 adolescent girls participated in this study. A multistage sampling method was used. Participants were checked for goiter using World Health Organization guidelines. Using a quick test kit, the amount of iodine in samples of table salt was determined. After being entered into Epi Info version 7, the data were exported to the SPSS version 22 for statistical analysis. Binary logistic regression was applied. It was decided to set the statistically significant level at p < 0.05. Results: In this study, the total prevalence of goiter among adolescent girls was 33.4% (95% CI: 26.3%–39.4%). The odds of goiter were 5.3 times higher among adolescents whose families had a history of goiter (AOR = 5.34, 95% CI: 3.65–9.74). The likelihood of developing goiter was 3.7 times greater among adolescent girls who consumed cabbage at least once per week (AOR = 3.74, 95% CI: 2.46–8.31). In addition, adolescent girls who did not consume meat at all were 3.3 times more likely to develop goiter (AOR = 3.32, 95% CI: 1.95–6.78). Similarly, the odds of getting goiter among adolescent girls from families who use salt with inadequate levels of iodine (0–14) were 9.84 times greater compared to their counterparts (AOR = 9.84, 95% CI: 5.61–26.24). Conclusion: In the study area, goiter was very common. Therefore, the district’s health sector should make an effort to raise community knowledge by spreading important messages regarding the proper use of iodized salt and food sources.
Beliefs, experiences and concerns of using artificial intelligence in healthcare: A qualitative synthesis
Authors: Fazakarley Carol-Ann , Breen Maria , Thompson Ben , Leeson Paul , Williamson Victoria 
Published: February 2024

Objective Artificial intelligence (AI) is a developing field in the context of healthcare. As this technology continues to be implemented in patient care, there is a growing need to understand the thoughts and experiences of stakeholders in this area to ensure that future AI development and implementation is successful. The aim of this study was to conduct a literature search of qualitative studies exploring the opinions of stakeholders such as clinicians, patients, and technology experts in order to establish the most common themes and ideas that have been presented in this research. Methods A literature search was conducted of existing qualitative research on stakeholder beliefs about the use of AI use in healthcare. Twenty-one papers were selected and analysed resulting in the development of four key themes relating to patient care, patient–doctor relationships, lack of education and resources, and the need for regulations. Results Overall, patients and healthcare workers are open to the use of AI in care and appear positive about potential benefits. However, concerns were raised relating to the lack of empathy in interactions of AI tools, and potential risks that may arise from the data collection needed for AI use and development. Stakeholders in the healthcare, technology, and business sectors all stressed that there was a lack of appropriate education, funding, and guidelines surrounding AI, and these concerns needed to be addressed to ensure future implementation is safe and suitable for patient care. Conclusion Ultimately, the results found in this study highlighted that there was a need for communication between stakeholder in order for these concerns to be addressed, mitigate potential risks, and maximise benefits for patients and clinicians alike. The results also identified a need for further qualitative research in this area to further understand stakeholder experiences as AI use continues to develop.
Ultrasound imaging in spinal cord injury patients with shoulder pain
Authors: Saengsuwan Jittima , Sirasaporn Patpiya 
Published: February 2024

Objective To examine shoulder ultrasound imaging in both tetraplegic and paraplegic spinal cord injury (SCI) patients with shoulder pain. Methods All 28 individuals with SCI with shoulder pain were enrolled in this study. Fifty-six shoulders were evaluated by ultrasound (US) imaging. Results Fourteen tetraplegics and 14 paraplegics were enrolled (age 45.4 ± 13.8 years [mean ± SD]). Median time post-SCI was 8.6 years. Twenty-three individuals (82.1%) were independent in transfer and four individuals (14.3%) were partially independent in transfer. The prevalence of shoulder pain was 78.6% in manual wheelchair ambulators, 10.7% in gait aids users, 7.1% in wheelchair sitters, and 3.6% in no assistive device individuals. Abnormal US imaging was found in 24/28 (85.7%) individuals. Total shoulder US abnormalities were 38 units. Most common abnormal US imaging was supraspinatous tendinosis (42.1%), biceps tendon effusion (23.7%), positive dynamic supraspinatus impingement (21.1%), and subdeltoid bursitis (18.4%). Conclusions Shoulder ultrasonographic abnormalities were common in the patients with SCI with shoulder pain. The supraspinatus tendinosis is the most common abnormal US imaging in patients with SCI with shoulder pain.
Using the Carers’ Alert Thermometer tool to identify needs and support family caregivers of people with motor neurone disease: moving beyond needs assessments
Authors: Aoun Samar M. , O’Brien Mary R. , Knighting Katherine 
Published: February 2024

Background: Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of this pilot study was to assess the feasibility and relevance of the Carers’ Alert Thermometer (CAT) in home-based care, from the perspective of MND family caregivers. The tool provides a formal structure to facilitate discussions with caregivers to enable needs to be addressed. Methods: This mixed-method study was conducted in Western Australia (2020–2021). Forty-one caregivers and five MND Advisors participated in trialling the CAT intervention which consisted of two encounters with Advisors (6–8 weeks apart) to identify and address support needs through action plans. Caregivers’ feedback was obtained via telephone interviews and a thematic analysis was undertaken. Results: Thirty caregivers completed two CAT assessments. Caregivers identified support priorities of managing their feelings and worries, providing emotional or spiritual care, information about the person’s condition and how their care needs might change. Seventeen caregivers were interviewed and found that this assessment process adequately addressed their needs and it should be continued, it brought the focus onto them to clarify problems and work through solutions. The improvements that were suggested by them, including better information/education in palliative care, led to the development of an online support/information toolkit, which served to empower caregivers and staff by accessing relevant information and resources. Conclusions: The CAT demonstrated utility for triaging caregivers most in need of additional support and those whom signposting to additional information and self-directed access to support was most appropriate. For any tool to become an integrated part of care, service provider support is key for implementation, allowing for the time resource required and an appropriate education and support structure. MND Associations have an important role in building stronger partnerships with supportive community networks, through compassionate communities models of care, to address the identified needs of MND families in a more sustainable and wholistic manner. Needs assessment is a means towards building this capacity between formal and informal networks.
Does the American Foregut Society Endoscopic Classification of Esophago-gastric Junction Integrity Predict Acid Reflux and Esophago-gastric Junction Disruption?
Authors: Siboni Stefano , Sozzi Marco , Kersik Alessia , Lovece Andrea , Milito Pamela , Menikou Fedra , Bonavina Luigi , Froiio Caterina , Bernardi Daniele , Asti Emanuele 
Published: February 2024

Background: Gastroesophageal reflux disease (GERD) is usually associated with disruption of the esophagogastric junction (EGJ). The endoscopic Hill classification has proven to be inadequate to assess EGJ integrity. Recently, the American Foregut Society (AFS) developed an endoscopic classification focused on hiatal hernia (L), hiatal opening (D), and the flap valve (F). While pH-monitoring remains the gold standard for the diagnosis of GERD, high-resolution manometry (HRM) can assess EGJ anatomy and competency. Aim of this study is to validate the AFS classification in patients with suspected GERD assessing its accuracy in predicting EGJ disruption and pathologic reflux. Methods: We prospectively enrolled patients with suspected GERD who underwent upper endoscopy, HRM and pH-study between November 2022 and March 2023. Demographic and clinical data were analyzed. The efficacy of the AFS classification in predicting GERD (acid exposure time, AET > 6%) was assessed. Each component of the classification was compared with the corresponding HRM variable. Results: Among 56 patients (48% men, BMI 23.5 kg/m2, age 43 years), an AET > 6% was found in 22 (39%), and in 0% of patients with AFS grade I, 5.9% with grade II, 52% with grade III and 77.8% with grade IV ( P < .001). The L component effectively predicted the EGJ type, the D the EGJ-Contractile Integral, while the absence of the flap valve was related to a positive Straight Leg Raise maneuver. Conclusions: The new grading system is able to stratify patients with pathologic GERD. Moreover, the single components of the AFS classification are associated with manometric markers of EGJ disruption.
Influence of metabolic state and body composition on the action of pharmacological treatment of migraine
Authors: Bruijn Noor , van Lohuizen Romy , Boron Malgorzata , Fitzek Mira , Gabriele Francesca , Giuliani Giada , Melgarejo Laura , Řehulka Pavel , Sebastianelli Gabriele , Triller Paul , Vigneri Simone , Özcan Behiye , van den Brink Antoinette Maassen ,   the European Headache Federation School of Advanced Studies (EHF‐SAS)
Published: February 2024

AbstractMigraine is a disabling neurovascular disorder among people of all ages, with the highest prevalence in the fertile years, and in women. Migraine impacts the quality of life of affected individuals tremendously and, in addition, it is associated with highly prevalent metabolic diseases, such as obesity, diabetes mellitus and thyroid dysfunction. Also, the clinical response to drugs might be affected in patients with metabolic disease due to body composition and metabolic change. Therefore, the efficacy of antimigraine drugs could be altered in patients with both migraine and metabolic disease. However, knowledge of the pharmacology and the related clinical effects of antimigraine drugs in patients with metabolic disease are limited. Therefore, and given the clinical relevance, this article provides a comprehensive overview of the current research and hypotheses related to the influence of metabolic state and body composition on the action of antimigraine drugs. In addition, the influence of antimigraine drugs on metabolic functioning and, vice versa, the influence of metabolic diseases and its hormonal modulating medication on migraine activity is outlined. Future exploration on personalizing migraine treatment to individual characteristics is necessary to enhance therapeutic strategies, especially given its increasing significance in recent decades.
Risk factors for early septic failure after two-stage exchange total knee arthroplasty for treatment of periprosthetic joint infection
Authors: Lee Woo-Suk , Park Kwan Kyu , Cho Byung-Woo , Park Jun Young , Kim Inuk , Kwon Hyuck Min 
Published: February 2024

Abstract
Background
The cause of early septic failure after two-stage exchange revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) and the factors affecting it are not well known. The purpose of this study was to determine the surgical outcomes and the risk factors for early septic failure after two-stage revision TKA for chronic PJI.

Methods
We identified a total of 246 adult patients who met the Musculoskeletal Infection Society (MSIS) diagnostic criteria for chronic PJI at two academic tertiary hospitals from March 2012 to December 2018. Finally, 151 patients who consecutively received two-stage exchange revision TKA for chronic PJI and who had a minimum 3-year follow-up were enrolled and retrospectively reviewed. Successful surgical treatment was evaluated for two-stage revision TKA and risk factors for early septic failure were identified.

Results
Early septic failures occurred within 3 years after reimplantation in 48 patients (31.8%). After accounting for potentially confounding variables, we found that male patient [odds ratio (OR): 2.753, 95% confidence interval (CI) 1.099–6.893, p = 0.031], fungus or mycobacterial infection (OR: 5.224, 95% CI 1.481–18.433, p = 0.01), and positive culture at reimplantation (OR: 4.407, 95% CI 1.255–15.480, p = 0.021) were independently associated with early septic failure after two-stage exchange revision TKA.

Conclusion
Male patients, fungus or mycobacterial infection, and positive culture at reimplantation were independently associated with an increased risk of early septic failure after two-stage exchange revision TKA despite normal C-reactive protein values prior to reimplantation. Further prospective and high-quality studies are needed to determine the risk factors of two-stage exchange revision TKA for chronic PJI.
Level of evidence: level IV; retrospective comparison; treatment study.
VOC emissions from Euro 6 vehicles
Authors: Ferrarese Christian , Franzetti Jacopo , Selleri Tommaso , Suarez-Bertoa Ricardo 
Published: February 2024

Abstract
Background
Air pollution is a major health concern in worldwide. Non-methane volatile organic compounds (NMVOCs) are precursors of secondary air pollutants, with road transport being responsible of ~ 90% for the EU-27’s NMVOCs transport emissions in 2021. A series of VOC emissions from 17 modern gasoline, Diesel and Plug-in hybrid (PHEV) vehicles were investigated under various driving conditions and temperatures. All tested vehicles meet the latest European emission standard (Euro 6d and Euro 6d-TEMP). The different VOC species were measured with a Fourier-Transform Infrared Analyzer (FTIR).

Results
Diesel vehicles presented the lowest VOC emissions, while PHEVs operating in charge sustaining mode, with a depleted battery, exhibited very similar behavior to conventional gasoline. Among the VOCs, C5 compounds were the primary contributors to total NMVOCs over WLTC at 23 °C for gasoline and PHEV vehicles. A proportional increase in VOC emissions at colder temperatures, affecting all the studied species, was observed. Significant increases were observed for Aromatics, with an important contribution of < C5 as well. On the other hand, VOC emissions from Diesel vehicles were consistently low and little affected by temperature, except for Aldehydes in tests at − 7 °C. VOC emissions primarily occurred during cold starts, with urban cycle showing higher emission factors due to its shorter distance. VOC emissions remained consistently low during the highway cycle, highlighting a significant reduction in VOC emissions once the after-treatment system (ATS) was warmed up, even under demanding conditions. In Diesel vehicles, total VOCs measured with the FTIR exhibited a slight tendency to exceed Total Hydrocarbons (THC) measured with a Flame Ionization Detector (FID), while for gasoline vehicles and PHEVs, the trend was temperature-dependent.

Conclusions
In summary, the study shows that VOC emissions from Diesel vehicles are significantly lower compared to modern gasoline and PHEV vehicles. Moreover, gasoline and PHEV vehicles exhibit similar levels and emission profiles of VOC emissions. Additionally, ambient temperatures and driving conditions have a significant impact on VOC emissions for all the powertrain technologies investigated.