bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffusion-weighted magnetic resonance imaging for the diagnosis of giant cell arteritis: a comparison with T1-weighted black-blood imaging
Authors: Seitz Luca , Bucher Susana , Bütikofer Lukas , Maurer Britta , Bonel Harald M , Wagner Franca , Lötscher Fabian , Seitz Pascal 
Published: August 2023

Abstract

Objectives
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA.

Methods
Retrospectively, 156 patients with clinically suspected GCA were included. A new 4-point ordinal DWI rating scale was developed. A post-contrast, fat-suppressed, T1-weighted ‘black-blood’ sequence (T1-BB) was rated for comparison. Ten arterial segments were assessed: common superficial temporal arteries, temporal and parietal branches, occipital and posterior auricular arteries bilaterally. The expert clinical diagnosis after ≥6 months of follow-up was the diagnostic reference standard. Diagnostic accuracy was evaluated for different rating methods.

Results
The study cohort consisted of 87 patients with and 69 without GCA. For DWI, the area under the curve was 0.90. For a cut-off of ≥2 consecutive pathological slices, DWI showed a sensitivity of 75.9%, a specificity of 94.2% and a positive likelihood ratio of 13.09. With a cut-off of ≥3 consecutive pathological slices, sensitivity was 70.1%, specificity was 98.6% and the positive likelihood ratio was 48.38. For the T1-BB, values were 88.5%, 88.4% and 7.63, respectively. The inter-rater analysis for DWI with a cut-off of ≥2 pathological slices showed a kappa of 1.00 on the patient level and 0.85 on the arterial segment level. For the T1-BB the kappa was 0.78 and 0.79, respectively.

Conclusion
DWI of the superficial cranial arteries demonstrates a good diagnostic accuracy and reliability for the diagnosis of GCA. DWI is widely available and can be used immediately in clinical practice for patients with suspected GCA.
The effect of contact radiation shielding on breast dose during CT abdomen–pelvis: a phantom study
Authors: Long Maria , Albeshan Salman , Alashban Yazeed , England Andrew , Moore Niamh , Young Rena , Bezzina Paul , McEntee Mark F 
Published: August 2023

Abstract
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen–pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92–1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53–1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91–1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92–1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen–pelvis.
In control or along for the ride? Lessons for anesthesiologists from air traffic control
Authors: Ruskin Keith J. , Dutton Richard P. , Ruskin Anna Clebone 
Published: August 2023

Purpose of review
Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways.

Recent findings
The increasing complexity of the healthcare environment suggests that the complete elimination of human error is not possible. Complex clinical situations predispose to errors that are the result of high workload, decision making under stress, and poor team coordination. The theory behind complex adaptive systems differs from medicine's traditional approach to safety and highlights the importance of an institutional safety culture that encourages flexibility, adaptability, reporting and learning from errors. Instead of focusing on standardization and strict adherence to procedures, clinicians can improve safety by recognizing that unpredictable changes routinely occur in the work environment and learning how resilience can prevent adverse events.

Summary
A better understanding of automation, complexity, and resilience in a changing environment are essential steps toward the safe practice of anesthesia.
Obesity Paradox for Postoperative Mortality in Young Chinese Patients Undergoing Craniotomy for Brain Tumor Resection
Authors: He Jialing , Jia Lu , Zhang Yu , Tian Yixin , Hao Pengfei , Li Tiangui , Xiao Yangchun , Peng Liyuan , Feng Yuning , Cheng Xin , Deng Haidong , Wang Peng , Chong Weelic , Hai Yang , Chen Lvlin , You Chao , Fang Fang 
Published: August 2023

Background:
There is little evidence regarding the association of body mass index (BMI) with postoperative mortality after craniotomy, especially in the Asian population. Our study aimed to explore the association between BMI and postoperative 30-day mortality in Chinese patients undergoing craniotomy for brain tumor resection.

Methods:
This large retrospective cohort study, Supplemental Digital Content 9, http://links.lww.com/JNA/A634 collected data from 7519 patients who underwent craniotomy for brain tumor resection. On the basis of the World Health Organization obesity criteria for Asians, included patients were categorized as underweight (<18.5 kg/m2), normal weight (18.5 to 22.9 kg/m2), overweight (23to 24.9 kg/m2), obese I (25 to 29.9 kg/m2), and obese II (≥30 kg/m2). We used a multivariable logistic regression model to explore the association between different BMI categories and 30-day postoperative mortality. In addition, we also conducted stratified analyses based on age and sex.

Results:
Overweight (adjusted odds ratio 0.63, 95% CI 0.40-0.99) and obese I (adjusted odds ratio 0.44, 95% CI 0.28-0.72) were associated with decreased 30-day postoperative mortality compared with normal-weight counterparts. Such associations were prominent among younger (age younger than 65 y) patients but not older patients, and there was an interaction between age and overweight versus normal weight on mortality (P for interaction=0.04).

Conclusions:
We found that among Chinese patients undergoing craniotomy for brain tumors, there was a J-shaped association between BMI and postoperative 30-day mortality, with lowest mortality at 27 kg/m². Moreover, in young patients, overweight and obese I were both associated with decreased risk of 30-day mortality.
Fragile X Syndrome and Fetal Alcohol Syndrome: Occurrence of Dual Diagnosis in a Set of Triplets
Authors: Aishworiya Ramkumar , Biag Hazel Maridith Barlahan , Salcedo-Arellano Maria Jimena , Musa Zayan , Schneider Andrea , Clark Courtney , Santos Ellery , Tassone Flora , Hagerman Randi 
Published: August 2023

Abstract:

Background:
Fragile X syndrome (FXS) and fetal alcohol syndrome disorders are both common causes of intellectual disability in children. When both conditions are present in the same individual, the resultant phenotype may make identification of clinical issues and management challenging.

Case presentation:
In this case report, we present a case of triplets who had significant in utero alcohol exposure; 2 of whom also have FXS and the other not having the fragile X mutation. The siblings with FXS have subtle differences in the physical phenotype compared with the other one, who has prominent features of partial fetal alcohol syndrome instead. However, all 3 siblings have intellectual impairment (although this is more severe in the 2 with FXS), meet diagnostic criteria for autism spectrum disorder, and present with severe behavioral challenges. The clinical presentation of the 2 siblings with FXS is much more severe as compared to a child with FXS alone, and this is likely due to the additive effect of in utero alcohol exposure and environmental factors. We discuss the combination of these 2 pathologies and how this can affect the overall clinical presentation.

Conclusion:
In the management of children with FXS, evaluation for other risk factors that can have neurobehavioral sequelae is important, and these can affect clinical presentation and prognosis.
“She Is Stand-Offish Like That”: Black Adults' Recognition of Child Behaviors Associated with Autism Spectrum Disorder
Authors: Ashby Dejeunee , Yin Larry , Jones Felica , Wright Aziza-Lucas , Williams Helena , Williams Charlene , Deavenport-Saman Alexis , Vanderbilt Douglas , Solomon Olga 
Published: August 2023

Abstract:

Objective:
The purpose of this study is to identify the sociocultural factors in the Black community that contribute to a delay in identification of Black children with autism spectrum disorder (ASD).

Methods:
Four focus groups with parents of typically developing children were conducted at 2 Black Churches using a community-partnered participatory research approach and the socioecological model. Participants completed sociodemographic surveys, viewed CDC Autism Training Videos of Black children with ASD, and reported on their behavioral observations. Focus groups were audio recorded and transcribed. Thematic data analysis was conducted using NVivo software.

Results:
At the individual level, participants interpreted ASD-associated behaviors as a problem of timing of developmental milestones in the course of normative development rather than a sign of a disorder and positive and negative characteristics. At the interpersonal level, the role of grandparents and extended family was important for monitoring child development. At the organizational level, racial concordance with health care providers was seen as critical because of historical mistrust. At the community level, fear of racism and child protective services and inequitable care emerged. At the policy level, there were concerns about access to affordable, high-quality care.

Conclusion:
This study provides insight into the sociocultural factors in the faith-based Black community that may contribute to a delay in identification of Black children with ASD. Health care professionals need additional training to effectively serve Black children and families in the face of historical mistrust and health care inequity.
Evaluating Rates of Positive Margins After Standard Excision of Cutaneous Adnexal Malignancies
Authors: Cheraghlou Shayan , Doudican Nicole A. , Criscito Maressa C. , Stevenson Mary L. , Carucci John A. 
Published: August 2023

BACKGROUND
It is recommended to excise adnexal neoplasms with standard local excision or Mohs micrographic surgery (MMS), although many occur on high-risk sites such as the head and neck (H&N) and exhibit subclinical extension. Minimal evidence exists on the efficacy of standard excisions for these tumors.

OBJECTIVE
To evaluate the rate of positive surgical margins after standard excision of adnexal tumors.

METHODS
Retrospective cohort study of cutaneous adnexal malignancies from the National Cancer Database diagnosed from 2004 to 2019.

RESULTS
The authors identified a total of 4,402 cases treated with standard excision. Tumors on the H&N were approximately twice as likely as those on the trunk and extremities (T&E) to be excised with positive margins (odds ratio 2.146, p < .001), with the highest estimated rate for eccrine adenocarcinoma (12.1%, SE: 2.3%). The subtype with the highest positive margin rate on the T&E was microcystic adnexal carcinoma (8.0%, SE: 2.9). Positive margins were associated with poorer overall survival on multivariable survival analysis (hazard ratio 1.299, p = .015).

CONCLUSION
The authors present subtype- and site-specific positive margin rates for adnexal tumors treated with standard excision, which suggest that tumors on the H&N and some T&E subtypes, should be considered for MMS.
Cultural diversity in health care teams: A systematic integrative review and research agenda
Authors: Schmidt Manuela , Steigenberger Norbert , Berndtzon Magnus , Uman Timur 
Published: August 2023

Background
Although team-based work is deemed key to improving the quality of national health care systems, adverse events related to teamwork account for up to one third of all incidents. Health care teams are typically multiprofessional and diverse in many aspects, but cultural diversity is one of the most challenging.

Purposes
The objective of this review is to systematically analyze the literature to better understand the impact of cultural diversity in health care teams on team processes as well as team and patient outcomes. This study also explores the conditions that enable or hinder team functioning.

Methodology
Through a systematic integrative literature review, this study builds on the input–process–output–context framework. Multiple searches of the main databases led to identifying 43 relevant articles.

Findings
The results suggest that, when not proactively managed, cultural diversity may have a negative effect on team communication and integration, increasing team conflict and thereby negatively influencing team performance, team climate, and patient safety, both directly and indirectly. Yet, when managed properly and in the presence of engaged and culturally sensitive leadership, cultural training, and open and transparent procedures, cultural diversity in health care teams can be an asset to health care organizations. Analyzing and aggregating these findings into an integrative framework, our study identifies several themes and a research agenda for future studies on culturally diverse health care teams.

Practice Implications
Our findings suggest that culturally diverse health care teams experience a number of challenges, pointing to the need for action or structures that enable these teams to perform better, such as emphasizing learning and allowing team members time to get to know each other outside work.
Physiological Effects of Co-exposure to Ionizing Radiation and Noise within Occupational Exposure Limits
Authors: Liu Wenyi , Liu Huaqing , Gao Weimin , Xie Liangbin , Cao Yanmei 
Published: August 2023

Abstract
Workers are frequently exposed to the occupational hazards of ionizing radiation and noise. Co-exposure to these hazards is not well understood in terms of their physiological effects. The aim of this study was to investigate the physiological effects of co-exposure to ionizing radiation and noise within the occupational limit. This study extracted the physical examination parameters of workers who met the screening criteria from the occupational health surveillance database. The workers were divided into three groups: the co-exposure (COE) group, the ionizing radiation exposure (ION) group, and the non-exposure (NON) group. The age and sex of the three groups were matched with a sample size ratio of 1:3:3. The physical examination parameters of the three groups of workers were compared. The results showed that there was no significant difference in blood pressure and blood biochemical parameters among the three groups. The COE group had higher levels of free triiodothyronine than the ION group, but there was no difference with the NON group. Moreover, the COE group had lower levels of free tetraiodothyronine than the ION group and the NON group. There was no significant difference in thyroid stimulating hormone, total triiodothyronine, and total tetraiodothyronine among the three groups. Additionally, the number of white blood cells of the COE group was lower than that of ION group and NON group. This study suggests that co-exposure to low-dose ionizing radiation and noise can cause alterations in thyroid hormone and peripheral white blood cells. These alterations are different from those observed after single exposure to low-dose ionizing radiation and require further research.
Effects of a Theory-Based Educational Program on Health Behaviors and Cardiovascular Health Outcomes Among Overweight Postmenopausal Women
Authors: Chair Sek-Ying , Lo Sally Wai Sze , Cheng Ho Yu , Choi Kai Chow , Liu Ting , Wang Qun , Sit Janet Wing Hung 
Published: August 2023

Background
With the natural cessation of estrogen, after menopause, women, especially those who are overweight, are at a high risk for cardiovascular disease. Diet control and adequate physical activity (PA) are recommended as the essence of promoting cardiovascular health for women after menopause.

Objective
The aim of this study was to examine the effects of a theory-based educational program on health behaviors and cardiovascular health outcomes among overweight postmenopausal Chinese women compared with conventional didactic education.

Methods
In this randomized controlled trial, 288 participants were randomly allocated to intervention (n = 144) or control (n = 144) groups. The control group received conventional didactic education. The intervention group received a 3-month theory-based educational program. Primary outcomes were PA and dietary behavior. Secondary outcomes included cardiovascular health knowledge, self-efficacy in PA and diet, and cardiovascular health outcomes. Data were collected at baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3).

Results
The intervention group demonstrated significantly greater improvements in PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes (body weight, body mass index, waist circumference, blood pressure, and Framingham risk score [body mass index]) at postintervention compared with the control group (all Ps < .05). These significant effects maintained at T2, and the effects on self-efficacy in PA and diet also were maintained at T3.

Conclusions
A theory-based educational program may be an effective strategy for improving PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes for overweight postmenopausal Chinese women. However, further strategies are needed to enhance the sustainability of the positive changes.
Illness Uncertainty of the Patients With Unruptured Intracranial Aneurysms Treated by Coil Embolization
Authors: Lee JiEun , Lee SukJeong , Kwon O-Ki 
Published: August 2023

ABSTRACT

BACKGROUND: Patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization may experience illness uncertainty despite successful treatment. This study aimed to investigate illness uncertainty in patients with UIAs treated by coil embolization and to identify the factors affecting illness uncertainty. METHODS: This cross-sectional study involved data collected from 267 patients with UIAs who received coil embolization within 2 years at a tertiary hospital in South Korea. The data were collected through structured questionnaires and the patients' medical records. The questionnaires included information on sociodemographic characteristics, the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and Mishel Uncertainty in Illness Scale data. We collected clinical characteristics through the medical records. Data analysis was performed using descriptive statistics, an independent t test, a 1-way analysis of variance, and a Pearson correlation test. We used a multiple linear regression analysis with significant variables in the univariate analysis to determine which variables had a significant impact on illness uncertainty. RESULTS: The mean Mishel Uncertainty in Illness Scale score was 52.33 (12.93). We identified age (P = .002), education level (high school graduation, P = .014; college or higher, P < .001), anxiety (P < .001), and social support (P < .001) as factors affecting illness uncertainty. CONCLUSION: Patients with UIAs who underwent coil embolization did not exhibit severe illness uncertainty. The factors affecting illness uncertainty were age, educational level, anxiety, and social support. This study provides insight into illness uncertainty in this patient population and may help develop appropriate nursing interventions.
Cochlear Implant Outcomes in the Chinese-Speaking Adult Population: A Systematic Review
Authors: Jia Tianyi , Wen Christopher Z. , Arya Priya , Riebe Natalie , Shah Arnav , Naples James G. , Kuang Jianjing , Hwa Tiffany P. 
Published: August 2023

Objective
The purpose of this study is to perform a systematic review of speech perception outcomes in the Chinese-speaking adult cochlear implant (CI) population.

Databases Reviewed
PubMed, EMbase, and Scopus.

Methods
A comprehensive English literature search was performed with MeSH search terms, keywords, and phrases. Literature written in a language other than English was not included. Full-text articles were screened by two blinded reviewers and adjudicated by a third. Relevant outcomes and demographic data were extracted. Qualitative summaries were performed of the demographics and assessment tools. Speech perception outcomes were assessed with quantitative measures.

Results
Forty-four studies (n = 467) notable for marked heterogeneity in speech perception assessment utilized and reporting of relevant patient demographics were included. Mean duration of deafness among studies reporting this metric was 10.27 years (range, 0.08–49; SD, 7.70; n = 250), with 80% of subjects reporting >5 years' duration of deafness and only 19 subjects (7.6%) with <1 year of deafness preimplantation. A summary of the most commonly used assessments is provided.

Conclusion
Within the English-language literature, there is marked heterogeneity and lack of standardization regarding speech perception outcomes, tests utilized, and reported patient demographics in the Chinese-speaking adult CI population. Most Chinese-speaking CI users for whom data were available had prolonged duration of deafness before implantation. This study may serve as an initial reference for providers counseling Chinese-language CI candidates and who may be interested in adopting these tests, while highlighting the need for continued efforts to measure speech perception outcomes after CI for tonal language speakers.
Triamcinolone Injection for Cochlear Implant Magnet Adherence Issues
Authors: Tawk Karen , Goshtasbi Khodayar , Frank Madelyn , Martin Elaine C. , Abouzari Mehdi , Djalilian Hamid R. 
Published: August 2023

Objectives
To evaluate the effectiveness of triamcinolone injections in treating external magnet displacement in cochlear implant (CI) patients with adhesions problems of their processor.

Patients
We present seven CI patients with magnet adhesion issues who presented to our tertiary care neurotology clinic. None of the patients had a history of head trauma, postimplant MRI, or surgery in the head and neck other than the cochlear implantation.

Intervention
Triamcinolone 40 mg/mL injected subcutaneously at the CI magnet site.

Main Outcome Measure
Reduction of scalp thickness and successful magnet retention.

Results
Our cohort consisted of seven patients (eight implant sites) of which five were overweight or obese. The temporoparietal scalp thickness measured on preoperative CT scans varied between 8.4 and 15.9 mm. Initial conservative measures such as hair shaving at the magnet site, using a headband, and increasing magnet strength failed in all patients. After receiving triamcinolone injections at the CI receiver site, six out of seven patients (seven out of eight CI sites) were able to use their processor again without the need for a headband for an average of 9.55 hours/day. The average number of injections required for each patient was 2.57 (SD = 2.18), median (range) = 1 (1–7). One patient required a flap thinning surgery but showed no improvement even after flap thinning. None of the patients showed skin irritation, breakdown, ulceration, necrosis, or magnet exposure during follow-up period.

Conclusions
The significant improvement in CI retention shows that triamcinolone injections are effective in making the subcutaneous tissue thinner and allowing magnet retention.