bluuebunny/crossref_metadata_2025_split huggingface dataset:
School Violence and Bullying
Authors: Mayer Matthew J. 
Published: November 2023

Abstract
School violence and disruption, including bullying, continue to concern parents, educators, community stakeholders, and governmental bodies at the local, state, and national levels. While high-profile school shootings are often at the forefront of media coverage of school safety, schools are among the safest places for students in the community. This chapter unpacks key issues central to the field, providing an overview of recent data trends and measurement approaches, dimensions of the issues, and resultant harm from violence and bullying. Research on prevention approaches is examined, with attention to several types of school-wide approaches for minimizing school violence and disruption and bullying. The chapter closes with a discussion of future challenges across research, policy, and practice.
Coming in Hot: A quality improvement approach to improving care of febrile infants
Authors: Gupta Joel , Zipursky Amy R , Pirie Jonathan , Freire Gabrielle , Karin Amir , Bohn Mary Kathryn , Adeli Khosrow , Ostrow Olivia 
Published: November 2023

Abstract

Background and Objectives
Significant practice variation exists in managing young infants with fever. Quality improvement strategies can aid in risk stratification and standardization of best care practices, along with a reduction of unnecessary interventions. The aim of this initiative was to safely reduce unnecessary admissions, antibiotics, and lumbar punctures (LPs) by 10% in low-risk, febrile infants aged 29 to 90 days presenting to the emergency department (ED) over a 12-month period.

Methods
Using the Model for Improvement, a multidisciplinary team developed a multipronged intervention: an updated clinical decision tool (CDT), procalcitonin (PCT) adoption, education, a feedback tool, and best practice advisory (BPA) banner. Outcome measures included the proportion of low-risk infants that were admitted, received antibiotics, and had LPs. Process measures were adherence to the CDT and percentage of PCT ordered. Missed bacterial infections and return visits were balancing measures. The analysis was completed using descriptive statistics and statistical process control methods.

Results
Five hundred and sixteen patients less than 90 days of age were included in the study, with 403 patients in the 29- to 90-day old subset of primary interest. In the low-risk group, a reduction in hospital admissions from a mean of 24.1% to 12.0% and a reduction in antibiotics from a mean of 15.2% to 1.3% was achieved. The mean proportion of LPs performed decreased in the intervention period from 7.5% to 1.8%, but special cause variation was not detected. Adherence to the CDT increased from 70.4% to 90.9% and PCT was ordered in 92.3% of cases. The proportion of missed bacterial infections was 0.3% at baseline and 0.5% in the intervention period while return visits were 6.7% at baseline and 5.0% in the intervention period.

Conclusions
The implementation of a quality improvement strategy, including an updated evidence-based CDT for young infant fever incorporating PCT, safely reduced unnecessary care in low-risk, febrile infants aged 29 to 90 days in the ED.

Purpose
To develop and implement a multipronged improvement strategy including an evidence-based CDT utilizing PCT to maximize value of care delivered to well-appearing, febrile infants presenting to EDs.
The characteristics of driver lane-changing behaviour in congested road environments
Authors: Wang Wanqi , Cheng Guozhu 
Published: November 2023

Abstract
Lane-changing behaviour is one of the complex driving behaviours. The lane-changing behaviour of drivers may exacerbate congestion, however driver behavioural characteristics are difficult to accurately acquire and quantify, and thus tend to be simplified or ignored in existing lane-changing models. In this paper, the Bik-means clustering algorithm is used to analyse the urban road congestion state discrimination method. Then, simulated driving tests were conducted for different traffic congestion conditions. Through the force feedback system and infrared camera, the data of driver lane-changing behaviours at different traffic congestion levels are obtained separately, and the definitions of the start and end points of a vehicle changing lanes are determined. Furthermore, statistical analysis and discussion of key feature parameters including driver lane-changing behaviour data and visual data under different levels of traffic congestion were conducted. It is found that the average lane-change intention times in each congestion state are 2 s, 4 s, 6 s and 7 s, while the turn-signal duration and the number of rear-view mirror observations have similar patterns of change to the data on lane-changing intention duration. Moreover, drivers’ pupil diameters become smaller during the lane-changing intention phase, and then relatively enlarge during lane-changing; the range of pupil variation is roughly 3.5 mm to 4 mm. The frequency of observing the vehicle in front of the target lane increased as the level of congestion increased, and the frequency of observation in the driver's mirrors while changing lanes approximately doubled compared to driving straight ahead, and this ratio increased as the level of congestion increased.
Comparing the Efficacy of Zinc Oxide Versus Barrier Creams for Pressure Injury Prevention: A Retrospective Cross-sectional Study
Authors: Koc Ferhat , Eren Merve Gulbahar , Sert Havva 
Published: November 2023

ABSTRACT

OBJECTIVE
To compare the efficacy of zinc oxide versus barrier creams for the maintenance of skin integrity in intensive care patients with a risk of pressure injury (PI).

METHODS
This was a retrospective and cross-sectional study. The authors included data from 95 patients treated in the neurology and respiratory ICUs of a training and research hospital between January and June 2022. Patients in the neurology ICU were treated with zinc oxide cream (group 1, n = 48), and patients in the respiratory ICU received classic barrier cream (group 2, n = 47). Sociodemographic characteristics and PI data (Braden Scale score, Pressure Ulcer Healing Assessment Scale [PUSH] score, and PI stage) were obtained from each patient’s file.

RESULTS
The mean PUSH score of the patients who received zinc oxide cream was 3.83 ± 4.39 at discharge versus 6.79 ± 4.40 for the group who received barrier cream. When PUSH scores and PI stages during hospitalization and discharge were compared, the authors found a statistically significant between-group difference in mean discharge scores (P < .05).

CONCLUSIONS
Within the limitations of this retrospective study based on patient records, zinc oxide creams had more positive effects on the prevention of PIs than barrier creams.
A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy
Authors: Sun Xiaofei , Li Fudong , Zhao Baolian , Zhang Bin , Sun Kaiqiang , Sun Jingchuan , Xu Ximing , Wang Yuan , Shi Jiangang 
Published: November 2023

Study Design.
A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings.

Objective.
This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype.

Summary of Background Data.
A practical and reliable classification is needed to guide the treatment of COPLL.

Methods.
This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 in Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal occupying ratio of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen’s kappa.

Results.
A total of 1000 cases were included, which were classified into five types: Focal type (F type), Short-Sequential type (S type), Long-Sequential type (L type), High type (H type), and Mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal occupying ratio. Then each type could be further classified into other subtypes according to the location and morphology. The interobserver reliabilities in the first and second round were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888.

Conclusion.
We classified COPLL into a system comprised of five types and several subtypes according to canal occupying ratio, location and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.
Fourth Generation Hallux Valgus Correction
Authors: Acevedo Jorge I. , Garcia Alexander R. , Queen Joseph D. , McWilliam James R. 
Published: November 2023

Abstract:
The surgical method described in this paper has shown numerous benefits when compared with traditional minimally invasive surgery (MIS) techniques for the correction of hallux valgus. Although modern, third-generation MIS techniques have been widely adopted for this purpose due to perceived improvements in patient outcomes, those can be largely attributed to the incorporation of a novel system of rigid internal fixation allowing for a reduced risk of surgical complications. By incorporating the second-generation MIS technique of transverse osteotomy with third-generation fixation techniques, the authors have been able to devise a hybrid, fourth-generation MIS technique that shows improvements both in terms of patient recovery and ease of surgical operation.

Level of Evidence:
The mechanism-based reasoning used in this study classifies it as diagnostic level V in accordance with the OCEBM 2011 Levels of Evidence. For a complete description of levels of evidence, see Instructions for Authors.
Epstein–Barr Virus–Associated Lymphomatoid Papules: A Sign of Immunosuppression Resembling Lymphomatoid Papulosis
Authors: Hooper Madeline J. , Lee Woo Jin , LeWitt Tessa M. , Nguyen Cuong , Griffin Teresa , Chung Christopher , Zhou Xiaolong A. , Guitart Joan 
Published: November 2023

Abstract:
Epstein–Barr virus (EBV)–positive lymphoproliferative disorders associated with immunodeficiency constitute a spectrum of lymphoid and plasma cell proliferations that vary in cytomorphology, immunophenotype, and clinical behavior. CD30-positive cutaneous lymphocytic infiltrates with EBV expression and lymphomatoid papulosis–like presentations have been rarely reported. This retrospective study assessed the clinical and histopathological characteristics of EBV-positive cases with papulonodular morphologies and CD30 positivity seen by Northwestern Medicine Dermatopathology. Twelve patients (7M:5F, mean age 69 years) were presented with papular cutaneous lesions without antecedent patch/plaque disease. Nine cases were associated with known immunosuppression in the setting of transplant-related therapies (n = 4), hematopoietic malignancy (n = 2), post-transplant hematopoietic malignancy (n = 1), and autoimmune disease treatment (n = 2). Two patients had age-related immunosenescence. Four patients demonstrated EBV viremia; for 2 patients, this finding comprised the first sign of immunosuppression. Workup was negative for systemic lymphoma in all patients. Various treatment strategies were used, including observation (n = 3), discontinuation/reduction of immunosuppression (n = 3), rituximab (n = 4), and steroids (n = 4). At mean 30-month follow-up, 4 patients (33.3%) were alive, 3 with and 1 without disease. Eight patients (67.6%) had died, 3 after lesional resolution and 5 with recurrent disease. Biopsies revealed mixed lymphoid infiltrates composed of atypical CD30-positive T cells (n = 5) or B cells (n = 7) with variable EBV-encoded small RNA expression. These cases suggest clinicopathologic presentations resembling lymphomatoid papulosis with atypical, large CD30-positive, EBV-positive cells could comprise first sign of potentially serious immunodeficiency and should prompt evaluation for EBV viremia. These cases also broaden the current picture of immunodeficiency-associated lymphoproliferative disorders to include lymphomatoid papulosis–like clinical presentations.
The Safety of Abdominal Contouring in the Presence of a Gastric Band
Authors: Bresnick Stephen D. , Lagman Carlito 
Published: November 2023

Background:
Gastric bands, specifically the Lap-Band, have been widely used for weight loss. However, little is known about the complications associated with abdominal contouring procedures in patients with Lap-Bands. This study aimed to determine the complication rates and consent processes for these procedures.

Methods:
We conducted a survey study of 300 members of the American Society of Aesthetic Plastic Surgery. Commonly performed abdominal contouring procedures included abdominal liposuction, abdominoplasty, and combined abdominoplasty with abdominal liposuction.

Results:
The overall infection rate was low (1%) and did not significantly differ between the procedural groups. Abdominoplasty and combined liposuction with abdominoplasty had significantly higher complication rates (4.7% and 10.5%, respectively) than liposuction alone (1%, P = 0.0004). Abdominoplasty procedures also had higher rates of port/tubing malposition (2.3%, P = 0.04) and system leaks (1.6%, P = 0.003). Approximately 59% of plastic surgeons provided written or dictated consent as part of the standard procedural consent to address the presence of the Lap-Band, whereas 8% of plastic surgeons provided a separate written or printed signed consent specifically related to the procedure in the presence of a Lap-Band.

Conclusions:
Our study supports the relative safety of aesthetic abdominal contouring procedures in patients with gastric bands but highlights the increased risk of complications in the presence of a Lap-Band. Surgeons should use careful dissection techniques to minimize complications and consider involving a bariatric surgeon, especially with abdominoplasty procedures. Surgical consent should explicitly outline the risks identified in this study to ensure that patients are fully informed.
An Atypical Presentation of Disseminated Varicella Infection
Authors: Ferguson Derrick , Aguilar-Aragon Javier Antonio , Obeid Imad 
Published: November 2023

Abstract
We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.
A Red Swollen Leg
Authors: Narayanan Shivakumar , Traver Edward C. , Greenblatt Aaron David 
Published: November 2023

Abstract
We present a case of pseudocellulitis in a patient with chronic wounds from active injection drug use and edema and edema from secondary amyloidosis and highlight diagnostic challenges and approaches to differentiate infection from vascular and other noninfectious causes as well as the opportunity to intervene at a reachable moment to try to mitigate risk related to injection drug use.
Outcomes of Pleural Space Infections in Patients With Indwelling Pleural Catheters for Active Malignancies
Authors: Chang Christopher H. , Ost David E. , Jimenez Carlos A. , Saltijeral Sahara N. , Eapen Georgie A. , Casal Roberto F. , Sabath Bruce F. , Lin Julie , Cerrillos Eben , Nevarez Tinoco Tamara , Grosu Horiana B. 
Published: November 2023

Background:
Pleural infections related to indwelling pleural catheters (IPCs) are an uncommon clinical problem. However, management decisions can be complex for patients with active malignancies due to their comorbidities and limited life expectancies. There are limited studies on the management of IPC-related infections, including whether to remove the IPC or use intrapleural fibrinolytics.

Methods:
We conducted a retrospective cohort study of patients with active malignancies and IPC-related empyemas at our institution between January 1, 2005 and May 31, 2021. The primary outcome was to evaluate clinical outcomes in patients with malignant pleural effusions and IPC-related empyemas treated with intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) compared with those treated with tPA alone or no intrapleural fibrinolytic therapy. The secondary outcome evaluated was the incidence of bleeding complications.

Results:
We identified 69 patients with a malignant pleural effusion and an IPC-related empyema. Twenty patients received tPA/DNase, 9 received tPA alone, and 40 were managed without fibrinolytics. Those treated with fibrinolytics were more likely to have their IPCs removed as part of the initial management strategy (P=0.004). The rate of surgical intervention and mortality attributable to the empyema were not significantly different between treatment groups. There were no bleeding events in any group.

Conclusion:
In patients with IPC-related empyemas, we did not find significant differences in the rates of surgical intervention, empyema-related mortality, or bleeding complications in those treated with intrapleural tPA/DNase, tPA alone, or no fibrinolytics. More patients who received intrapleural fibrinolytics had their IPCs removed, which may have been due to selection bias.
Performance of OC-Auto Micro 80 Fecal Immunochemical Test in an Integrated Academic-Community Health System
Authors: Durowoju Lindsey , Mathias Patrick C. , Bell-Brown Ari , Breit Nathan , Liao Hsuan-Chieh , Burke Wynn , Issaka Rachel B. 
Published: November 2023

Goals:
We aimed to determine the performance of the OC-Auto Micro 80 fecal immunochemical test (FIT) in an average-risk population receiving care in an integrated, academic-community health system.

Background:
The FIT is the most used colorectal cancer (CRC) screening test worldwide. However, many Food and Drug Administration–cleared FIT products have not been evaluated in clinical settings.

Study:
We performed a retrospective cohort study of patients (50 to 75 y old) in the University of Washington Medicine health care system who were screened for CRC by OC-Auto Micro 80 FIT between March 2016 and September 2021. We used electronic health records to extract patient-level and clinic-level factors, FIT use, colonoscopy, and pathology findings. The primary outcomes were the FIT positivity rate and neoplasms detected at colonoscopy. Secondary outcomes were FIT positivity by sex and safety-net versus non–safety-net clinical settings.

Results:
We identified 39,984 FITs completed by 26,384 patients; 2411 (6.0%) had a positive FIT result (>100 ng/mL of hemoglobin in buffer), and 1246 (51.7%) completed a follow-up colonoscopy. The FIT positive rate was 7.0% in men and 5.2% in women (P <0.01). Among those who completed a colonoscopy after an abnormal FIT result, the positive predictive value for CRC, advanced adenoma, and advanced neoplasia was 3.0%, 20.9%, and 23.9%, respectively.

Conclusions:
In a retrospective analysis of a large heterogeneous population, the OC-Auto Micro 80 FIT for CRC screening demonstrated a positivity rate of 6.0% and a positive predictive value for CRC of 3.0%.
Health economics of detection and treatment of children with familial hypercholesterolemia: to screen or not to screen is no longer the question
Authors: Marquina Clara , Morton Jedidiah I. , Ademi Zanfina 
Published: November 2023

Purpose of review
Heterozygous familial hypercholesterolemia (HeFH) is one of the most common monogenic disorders and is safely treatable with lipid-lowering medication. However, most individuals with HeFH remain untreated and undetected, especially in paediatric populations where the potential for long-term therapeutic benefit is higher. Here, we review the recent literature on health economic outcomes for the detection and management of FH in children.

Recent findings
A targeted literature review identified eight studies evaluating detection and management strategies for paediatric FH populations in the last 25 years. Most studies conducted modelled cost-effectiveness analyses to understand the long-term impact of these strategies on health outcomes and the financial impact on the healthcare system. All studies reported that detection and management of HeFH in paediatric populations was cost-effective, regardless of the age of the children. However, cost-effectiveness varied depending on the method of case ascertainment – targeted screening was generally cheaper overall, but less effective, than whole-of-population screening, although both methods were generally cost-effective.

Summary
Detection and management of HeFH in paediatric populations is a cost-effective way to significantly lower the burden of disease later in life for these individuals. These strategies should be implemented across healthcare systems.