bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation
Authors: Totman Alissa A. , Lamm Adam G. , Goldstein Richard , Giacino Joseph T. , Bodien Yelena G. , Ryan Colleen M. , Schneider Jeffrey C. , Zafonte Ross 
Published: February 2023

Objective:
The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI).

Methods:
Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002, and December 31, 2017, with a diagnosis of TBI and an admission Functional Independence Measure of 18, the lowest possible score, were obtained and analyzed.

Results:
Of the 252 112 patients with TBI discharged during the study period, 10 098 met the study criteria. From 2002 to 2017, the number of patients with an IRF admission Functional Independence Measure of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression (coefficient = −2.97; P = .001), and the mean age (SD) increased from 43.0 (21.0) to 53.7 (21.3) years (coefficient = 0.70; P < .001). During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% (odds ratio = 0.95; P < .001) and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days (coefficient = −0.83; P < .001].

Conclusion:
The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.
Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?
Authors: Bukhari Rayyan A. , Graham James E. , Kinney Adam R. , Hoffman Amanda , Malcolm Matt P. 
Published: February 2023

Objective:
To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI).

Setting:
14 acute care hospitals in the state of Colorado.

Participants:
We studied 5825 adults with TBI.

Design:
In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them.

Main Measures:
Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services.

Results:
Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (−0.32 [−0.60, −0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service.

Conclusion:
Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.
Risk of Epilepsy Following Traumatic Brain Injury: A Systematic Review and Meta-analysis
Authors: Sui Songtao , Sun Jinbo , Chen Xiqi , Fan Feng 
Published: February 2023

Background:
Limited evidence has explored the impact of traumatic brain injury (TBI) on posttraumatic epilepsy with control cohort for comparison. In addition, we could not find any review to identify the effect of TBI on the outcomes. Thus, we conducted this study to compare the risk of epilepsy between individuals with TBI and without TBI.

Methods:
Systematic and comprehensive search was carried out in the following databases and search engines: EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar from 1954 until January 2022. The Newcastle Ottawa (NO) Scale was utilized to assess the risk of bias. Meta-analysis was carried out using the random-effects model, and pooled odds ratio (OR) along with 95% CI was reported.

Results:
In total, we included 10 studies satisfying inclusion criteria. Most studies had good to satisfactory quality. The pooled OR was 4.25 (95% CI, 1.77-10.25; I
2 = 100%), indicating that the individuals with TBI had 4.25 times higher risk of having epilepsy than individuals without TBI, and this association was statistically significant (P = .001). Subgroup analysis based on the years of follow-up revealed that the patients within 5 years post-TBI had the highest risk of epilepsy (pooled OR = 7.27; 95% CI, 3.61-14.64).

Conclusion:
Individuals with TBI had a significantly higher risk of epilepsy than the individuals without TBI, irrespective of the duration of the injury. Hence, long-term follow-up of the individuals with TBI is necessary to prevent any adverse consequences.
A Network Analysis of the PART-O at 1 and 2 Years After TBI: A Veterans Affairs Model Systems Study
Authors: West Samuel J. , Klyce Daniel W. , Perrin Paul B. , Juengst Shannon B. , Dams-O'Connor Kristen , Vargas Tiffanie A. , Grover Ria , Finn Jacob A. , Eagye CB , Agtarap Stephanie D. , Chung Joyce S. , Campbell Thomas A. 
Published: February 2023

Objective:
The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years (T
1 and T
2) postinjury.

Participants:
Participants (N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC).

Setting:
Five VA PRCs.

Design:
Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study.

Main Measures:
PART-O.

Results:
Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between “spending time with friends” and “giving emotional support” to others. This association was more than twice as strong at T
2 as at T
1. The “out of the house” item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity). When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T
1, and the internet was the strongest connector at T
2.

Conclusion:
Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment.
Research Letter: Traumatic Brain Injury Among Veterans Accessing VA Justice-Related Services
Authors: Holliday Ryan , Smith Alexandra A. , Kinney Adam R. , Forster Jeri E. , Bahraini Nazanin , Monteith Lindsey L. , Brenner Lisa A. 
Published: February 2023

Objective:
Risk for traumatic brain injury (TBI) within both the Veteran population and among individuals with a history of criminal justice involvement is notably high. Despite this, research examining TBI among Veterans with a history of criminal justice involvement (ie, justice-involved Veterans) remains limited. The sequelae of TBI can impact justice-involved Veterans' engagement in Department of Veterans Affairs (VA) justice-related services (ie, Veterans Justice Outreach and Health Care for Re-entry Veterans), thus potentially increasing risk for recidivism and impacting psychosocial functioning. As such, further understanding of TBI risk among justice-involved Veterans has the potential to inform the need for tailored screening and interventional efforts within VA justice-related service settings. We sought to better understand relative risk for TBI diagnosis among male and female Veteran recipients and nonrecipients of VA justice-related services.

Setting:
Electronic medical record data for Veterans accessing VA services from 2005 to 2018.

Participants:
1517 447 (12.48% justice-involved) male and 126 237 (8.89% justice-involved) female Veterans.

Design:
A cross-sectional examination of national VA electronic medical record data. Sex-stratified analyses were conducted to examine relative risk of TBI diagnosis based on use of VA justice-related services.

Main Measures:
Documented TBI diagnosis was the main outcome. Covariates included VA service use, age, race, and ethnicity.

Results:
Both male and female Veterans using VA justice-related services were more likely to have a documented TBI diagnosis in their electronic VA medical record. Associations were attenuated, yet maintained significance, in all adjusted and sensitivity models.

Conclusions:
Given potential risk for TBI, enhancing and tailoring care for justice-involved Veterans may be critical to facilitating rehabilitation and reducing recidivism. Examination of existing services within justice-related settings and methods of augmenting care is an important next step.
Research Letter: Prevalence of Spine Injuries Among US Military Personnel With Combat-Related Concussion
Authors: MacGregor Andrew J. , D'Souza Edwin W. , Dougherty Amber L. , Fraser John J. 
Published: February 2023

Objective:
To describe the prevalence of spine injuries among US service members with combat-related concussion.

Design and Participants:
A retrospective review of medical records for US service members injured during combat operations in Iraq and Afghanistan between 2002 and 2020. The study sample included 27 897 service members categorized into 3 groups: concussion with loss of consciousness (LOC, n = 4631), concussion non-LOC (n = 5533), and non-concussion (n = 17 333).

Main Measures:
Spine injuries were identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and classified by body region and nature of injury using the Barell injury diagnosis matrix. Differences in prevalence of spine injuries by concussion group were evaluated using χ2 tests.

Results:
Spine injuries were most prevalent among service members with concussion LOC (31.1%), followed by concussion non-LOC (18.3%), and non-concussion (10.0%, P < .001). Sprains and strains were the most prevalent spine injury category, with injuries to the cervical, thoracic, and lumbar regions significantly more prevalent in the concussion groups (P values < .001), particularly individuals with LOC compared with non-concussion.

Conclusion:
The US military personnel with combat-related concussion, especially individuals with LOC, may also have spine injuries. Routine assessment for spine injury is recommended during concussion screening because this may impact clinical management and rehabilitation.
Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood
Authors: Wilson Judith , McGiffin Jed N. , Smith Michelle , Garduño-Ortega Olga , Talis Elina , Zarate Alejandro , Jenkins Natalie , Rath Joseph F. , Bushnik Tamara 
Published: February 2023

Objective:
To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood.

Setting:
The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City.

Participants:
A total of 143 individuals with TBI or their family members.

Design:
An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test.

Main Measures:
Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories.

Results:
Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor.

Conclusion:
Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.
Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring
Authors: Seddon Ian A. , Rahimy Ehsan , Miller John B. , Charles Steve , Kitchens John , Houston Samuel Kenney 
Published: February 2023

Purpose:
To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education.

Methods:
The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2).

Results:
Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000.

Conclusion:
Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.
ADVANTAGES OF OPTICAL COHERENCE TOMOGRAPHY AS A HIGH DYNAMIC RANGE IMAGING MODALITY IN SUBRETINAL HYPERREFLECTIVE MATERIAL
Authors: Montolío-Marzo Santiago , Gallego-Pinazo Roberto , Palacios-Pozo Elena , Dolz-Marco Rosa 
Published: February 2023

Purpose:
To describe the utility of high dynamic range optical coherence tomography imaging to study subretinal hyperreflective material (SHRM) in patients with age-related macular degeneration.

Methods:
Clinical information including visual acuity and optical coherence tomography images (Heidelberg Engineering GmbH, Heidelberg, Germany) of patients undergoing antiangiogenic treatment for neovascular age-related macular degeneration and showing SHRM at baseline were retrospectively reviewed. Contrast between strong signal structures (high dynamic range image) reclassifying SHRM as hyperreflective (HyperR), isoreflective, and hyporeflective was increased. The patients at baseline, 3, 6, and 12-months follow-up were evaluated.

Results:
Forty-four eyes were classified as 15 HyperR (34.1%), 21 as isoreflective (47.7%), and eight as hyporeflective (18.2%). During follow-up, hyporeflective SHRM disappeared in all cases, isoreflective SHRM faded in 16 cases (76.2%); HyperR SHRM remained in all cases. Hyporreflective SHRM showed a greater visual acuity improvement than HyperR SHRM group (P = 0.033). After 12-month follow-up, only the hyporeflective and isoreflective groups significantly reduced the presence of fluid in 37.5% (P = 0.250) and 46.62% (P = 0.006) of the patients, respectively; outer retinal layers were disrupted more frequently in the presence of HyperR SHRM (ellipsoid zone, P = 0.16; external limiting membrane, P = 0.007).

Conclusion:
Contrast-enhanced optical coherence tomography images enabled us to classify SHRM according to its reflectivity, showing groups with different disappearance rates, visual acuity improvement, and outer retinal layer disruption. This easy-to-access tool may be helpful as a prognostic factor in neovascular age-related macular degeneration cases.
ANALYSIS OF VASCULAR CHANGES OF FUNDUS IN BEHCET UVEITIS BY WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND FUNDUS FLUORESCEIN ANGIOGRAPHY
Authors: Guo Suo , Liu Hui , Gao Yu , Dai Lingyu , Xu Jing , Yang Peizeng 
Published: February 2023

Purpose:
To investigate vascular changes of fundus in quiescent Behçet uveitis (BU) based on widefield swept source optical coherence tomography angiography and fluorescein angiography (FA).

Method:
This case–control study included 33 patients with quiescent BU (57 eyes)and 35 healthy people (60 eyes) as the control. All participants underwent the widefield swept source optical coherence tomography angiography, and patients with BU additionally underwent the FA. The quantitative analysis of the widefield swept source optical coherence tomography angiography assessed the vessel density of nine anatomical locations in the fundus. Vascular leakage and retinal nonperfusion on FA were assessed in patients with BU.

Results:
Compared with the control group using Mann–Whitney U test, patients with BU had enlargement of foveal avascular zone (P = 0.005, P = 0.04, respectively) and decreased vessel density within a 300 µm width around the foveal avascular zone (P = 0.001, P < 0.0001, respectively) both in the superficial and deep retina. Larger foveal avascular zone size and lower 300 µm width around the foveal avascular zone were correlated with higher logarithm of the minimum angle of resolution best-corrected visual acuity in BU (P ≤ 0.003, P < 0.0001, respectively). Vessel density of choriocapillaris, as the most widely involved of all layers of the retina and choroid, was lower in six locations (P ≤ 0.03–0.0001) in the peripheral fundus of BU compared with the controls. Vascular leakage and retinal nonperfusion in the peripheral fundus were observed in 54.4% and 66.7% of the patients on FA.

Conclusion:
Fovea and peripheral fundus were prone to the damage of ischemia as evidenced by significantly decreased vessel density of capillaries. Combination of swept source optical coherence tomography angiography with FA could accurately evaluate the changes in the retinal and choroidal vasculature in BU.
COMPARING FUNCTIONAL AND VASCULAR LAYER OUTCOMES OF LASER PHOTOCOAGULATION VERSUS SUBTHRESHOLD MICROPULSE LASER FOR DIABETIC MACULAR EDEMA
Authors: Li Gabriel , Ho Mary , Li Sophia , Chen Lijia , Iu Lawrence , Cheung Carol Y. , Brelen Marten , Young Alvin L. 
Published: February 2023

Purpose:
To compare the efficacy of conventional laser and subthreshold micropulse laser (SML) in treating diabetic macular edema in terms of functional outcomes and changes in quantitative metrics for the retinal capillary and choriocapillary vascular layers.

Methods:
Fifty-two eyes from 52 patients with treatment-naive, clinically significant macular edema were randomly assigned to the conventional laser group or SML group in a 1:1 ratio. Best-corrected visual acuity, central macular thickness (CMT), and optical coherence tomography angiography scans were measured at baseline, 1, 3, and 6 months after treatment.

Results:
The SML group showed rapid visual recovery, improving from baseline of 0.320 ± 0.31 logarithm of the minimum angle of resolution (20/42 Snellen) to 0.270 ± 0.22 logarithm of the minimum angle of resolution (20/37 Snellen) at 1 month (P = 0.038) and had significant improvements in CMT at 6-month post-treatment (353.88–301.00 µm, P = 0.005). Statistically significant changes were detected across all optical coherence tomography angiography metrics, including vessel density, vessel length density, vessel diameter index, and fractal dimension, at 6 months for both groups in the deep capillary plexus and choriocapillary plexus.

Conclusion:
Subthreshold micropulse laser resulted in early visual recovery and sustained macular thickness improvement in the treatment of diabetic macular edema. Microvascular perfusion parameters, including vessel density, vessel length density, and fractal dimension, improved in the deep capillary plexus and choriocapillary plexus for both treatment groups at 6 months post-treatment.
FUNDUS AUTOFLUORESCENCE IN EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN AND DIFFUSE TRICKLING GEOGRAPHIC ATROPHY
Authors: Bianco Lorenzo , Antropoli Alessio , Arrigo Alessandro , Berni Alessandro , La Franca Lamberto , Saladino Andrea , Bandello Francesco , Battaglia Parodi Maurizio 
Published: February 2023

Purpose:
To establish whether extensive macular atrophy with pseudodrusen (EMAP) can be distinguished from the diffuse-trickling phenotype of geographic atrophy (DTGA) secondary to age-related macular degeneration on the basis of its features on blue-light autofluorescence.

Methods:
The authors reviewed our prospectively maintained database to enroll patients with a diagnosis of EMAP, DTGA, and non-DTGA with a minimum follow-up of 1 year. Atrophic areas and growth rates were measured on blue-light autofluorescence images, using the Heidelberg Region Finder tool. Circularity and roundness were chosen as atrophy shape descriptors, extracted using ImageJ, and compared between disease groups.

Results:
A total of 28 EMAP, 27 DTGA, and 30 non-DTGA eyes were included in the analysis. The median follow-up time was around 3.5 years. Extensive macular atrophy with pseudodrusen was characterized by an irregular and elongated shape (low circularity and low roundness) and associated with a fast atrophy growth rate (3.6 mm2/year), compared with non-DTGA. However, these parameters were not significantly different between EMAP and DTGA.

Conclusion:
Our study found that EMAP and DTGA cannot be effectively differentiated on fundus autofluorescence. In both diseases, the macular atrophic area has a major vertical axis, fringed borders, and fast progression.