bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy
Authors: Dede Belema D. , Robinson Paul D. , Castro Chenda , Waters Karen A. 
Published: February 2023

Background:
Previous studies suggest that infants with Robin sequence show a pattern of steady improvement in the severity of airway obstruction, and of their treatment requirements, during infancy.

Methods:
Three infants with Robin sequence and severe obstructive sleep apnea were managed with nasal continuous positive airways pressure (CPAP). Multiple measures of airway obstruction were made during infancy, including CPAP pressure evaluations and sleep studies (screening and polysomnography studies). Parameters reported include obstructive apnea-hypopnea index, oxygen desaturation parameters, and CPAP pressures required for effective airway management.

Results:
CPAP pressure requirements increased in all three infants during their first weeks of life. Apnea indices on polysomnography did not track with the CPAP pressure requirements. Peak pressure requirements were at 5 and 7 weeks for two patients, with subsequent gradual decline and cessation of therapy CPAP at 39 and 74 weeks, respectively. The third patient had a complicated course, jaw distraction at 17 weeks, and biphasic CPAP pressure requirement (first peak at 3 weeks, but maximum pressure at 74 weeks), with cessation of CPAP at 75 weeks.

Conclusions:
The observed pattern of early increases in CPAP pressure requirements for infants with Robin sequence adds to the complexities of managing this disorder. Factors that may lead to this pattern of change in airway obstruction are discussed.
Chesapeake Regional Healthcare: Support from the Top for Impactful Relationships
Authors: Jackson Reese 
Published: February 2023

When governing boards of healthcare organizations resolve to support their executive teams' commitments of time and money to create strategic action plans that meet their communities' environmental and social criteria—and when those healthcare organizations work with others that share their passion to measurably improve health—their communities can realize remarkable benefits.
For example, this case study describes Chesapeake Regional Healthcare's collaborative approach to a community health need that began with data from the hospital's emergency department. The approach included the development of intentional relationships with local health departments and nonprofits. The possibilities of such evidence-based collaborations are endless, but the support of a solid organizational structure is required as data collection identifies additional needs.
Clonal hematopoiesis: the nonhereditary genetics of age-associated cardiovascular disease
Authors: Sano Soichi , Thel Mark C. , Walsh Kenneth 
Published: February 2023

Purpose of review
Somatic mutations, described as noninherited changes in DNA that arise and are passed on to descendant cells, are well known to cause cancers; however, it is increasingly appreciated that the propagation of somatic mutations within a tissue may have a role in causing nonneoplastic disorders and abnormalities in elderly individuals. The nonmalignant clonal expansion of somatic mutations in the hematopoietic system is termed clonal hematopoiesis. This review will briefly discuss how this condition has been linked to various age-related diseases outside the hematopoietic system.

Recent findings
Clonal hematopoiesis, resulting from leukemic driver gene mutations or mosaic loss of the Y chromosome in leukocytes, is associated with the development of various forms of cardiovascular disease, including atherosclerosis and heart failure, in a mutation-dependent manner.

Summary
Accumulating evidence shows that clonal hematopoiesis represents a new mechanism for cardiovascular disease and a new risk factor that is as prevalent and consequential as the traditional risk factors that have been studied for decades.
Pulmonary arterial hypertension in pregnancy
Authors: Vaidy Anika , Vaidya Anjali 
Published: February 2023

Purpose of review
Although pregnancy in pulmonary arterial hypertension (PAH) is considered high risk and contraindicated, the incidence is rising. It is paramount to understand the pathophysiology and effective management strategies to ensure optimal outcomes for maternal and fetal survival.

Recent findings
In this review, we highlight the outcomes of recent case series of PAH patients in pregnancy, with a focus on proper risk assessment and target goals of PAH therapy. These findings support the notion that the pillars of PAH management, including pulmonary vascular resistance reduction resulting in right heart functional improvement, and widening of the cardiopulmonary reserve, should serve as a blueprint for PAH management in pregnancy.

Summary
Multidisciplinary and tailored management of PAH in pregnancy, with emphasis on optimizing right heart function prior to delivery, can result in excellent clinical outcomes in a referral pulmonary hypertension center.
Outcomes of Functional Testing Versus Invasive Cardiac Catheterization for the Evaluation of Intermediate Severity Coronary Stenosis Detected on Cardiac Computed Tomography Angiography
Authors: Bhagat Aditi A. , Fordham Matthew J. , Lohani Minisha , Teressa Getu 
Published: February 2023

Introduction:
The aim of this study was to evaluate the effectiveness of functional testing in comparison to invasive coronary angiography (ICA) among acute chest pain patients whose first diagnostic modality was a coronary computed tomography angiogram (CCTA) and were found to have intermediate coronary stenosis, defined as 50%–70% luminal stenosis.

Methods:
We conducted a retrospective review of 4763 acute chest pain patients ≥18 years old who received a CCTA as the initial diagnostic modality. Of these, 118 patients met enrollment criteria and proceeded to either stress test (80/118) or directly to ICA (38/118). The primary outcome was 30-day major adverse cardiac event, consisting of acute myocardial infarction, urgent revascularization, or death.

Results:
There was no difference in 30-day major adverse cardiac event among patients who underwent initial stress testing versus directly referred to ICA (0% vs. 2.6%, P = 0.322) following CCTA. The rate of revascularization without acute myocardial infarction was significantly higher among those who underwent ICA versus stress test [36.8% vs. 3.8%, P < 0.0001; adjusted odds ratio: 9.6, 95% confidence interval, 1.8–49.6]. Patients who underwent ICA had a higher rate of catheterization without revascularization within 30 days of the index admission in comparison to those who underwent initial stress testing (55.3% vs. 12.5%, P < 0.0001; adjusted odds ratio: 26.7, 95% confidence interval, 6.6–109.5).

Conclusion:
Among patients with intermediate coronary stenosis on CCTA, a functional stress test compared with ICA may prevent unnecessary revascularization and improve cardiac catheterization yield without negatively affecting the 30-day patient safety profile.
Does the Electrocardiogram Machine Interpretation Affect the Ability to Accurately Diagnose ST-Elevation Myocardial Infarction by Emergency Physicians?
Authors: Paez Perez Yenisleidy , Rimm Sarah , Bove Joseph , Hochman Steven , Liu Tianci , Catapano Anthony , Shroff Ninad , Lim Jessica , Rimm Brian 
Published: February 2023

Introduction:
An ST-elevation myocardial infarction (STEMI) can portend significant morbidity and mortality to the patient and therefore must be rapidly diagnosed by an emergency medicine (EM) physician. The primary aim of this study is to determine whether EM physicians are more or less likely to accurately diagnose STEMI on an electrocardiogram (ECG) if they are blinded to the ECG machine interpretation as opposed to if they are provided the ECG machine interpretation.

Methods:
We performed a retrospective chart review of adult patients over 18 years of age admitted to our large, urban tertiary care center with a diagnosis of STEMI from January 1, 2016, to December 31, 2017. From these patients’ charts, we selected 31 ECGs to create a quiz that was presented twice to a group of emergency physicians. The first quiz contained the 31 ECGs without the computer interpretations revealed. The second quiz, presented to the same physicians 2 weeks later, contained the same set of ECGs with the computer interpretations revealed. Physicians were asked “Based on the ECG above, is there a blocked coronary artery present causing a STEMI?”

Results:
Twenty-five EM physicians completed two 31-question ECG quizzes for a total of 1550 ECG interpretations. On the first quiz with computer interpretations blinded, the overall sensitivity in identifying a “true STEMI” was 67.2% with an overall accuracy of 65.6%. On the second quiz in which the ECG machine interpretation was revealed, the overall sensitivity was 66.4% with an accuracy of 65.8 % in correctly identifying a STEMI. The differences in sensitivity and accuracy were not statistically significant.

Conclusion:
This study demonstrated no significant difference in physicians blinded versus those unblinded to computer interpretations of possible STEMI.
Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives
Authors: Portnoy Yotam , Koren Jonathan , Khoury Amal , Factor Shai , Dadia Solomon , Ran Yuval , Benady Amit 
Published: February 2023

Background:The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery.Methods:The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review.Results:Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms.Conclusions:Overall, 3D technologies are gradually becoming an integral part of a surgeon’s preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.
The Effects of Exercise on Sleep During Pregnancy: A Systematic Review and Meta-analysis
Authors: McCarthy Traci A. , Reddy Pranav S. , Spaeth Andrea M. 
Published: February 2023

Background:
Sleep impairment during pregnancy can impact quality of life and lead to excessive gestational weight gain, gestational diabetes mellitus, postpartum depression, and delivery complications. In nonpregnant adults, exercise improves sleep quality, duration, and onset latency.

Purpose:
To determine whether exercise performed during pregnancy improves sleep outcomes.

Methods:
A systematic review was conducted from January 2021 to July 2022 using online databases and hand searching (PROSPERO registration number: CRD42021243477). Randomized controlled trials (RCTs) available in English were eligible if the sample included pregnant women, the intervention included exercise and was compared to a standard care group, and sleep was included as an outcome measure. Mean differences and standardized mean differences were calculated to compare sleep outcomes across studies. Heterogeneity of results was calculated using I
2 and risk of bias was assessed using the Cochrane Risk of Bias tool.

Results:
A total of 2578 articles were found using the search terms, and 7 studies met inclusion criteria (n = 839). Prenatal exercise reduced the amount of self-reported sleep disturbances (2 RCTs n = 115; instrumental variable [IV] −0.53, 95% confidence interval [CI] −0.90, −0.16, z = 2.79, P = .005) and improved sleep quality (3 RCTs n = 477; IV −0.48, 95% CI −0.61, −0.36) during pregnancy. Other sleep outcomes were not analyzed due to variability of measurements.

Conclusion:
Compared with not exercising, exercise during pregnancy improves sleep quality during pregnancy; however, the quality of existing evidence was low. Given the importance of sleep for health and well-being, more research is needed to determine the utility of exercise for improving sleep in pregnancy.
The Challenge of Intermediate-Risk Pulmonary Embolism
Authors: Weintraub Spencer F. , You Joseph , Wilson Sean , Galmer Andrew 
Published: February 2023

Background:
Intermediate-risk pulmonary embolism is a common disease that is associated with significant morbidity and mortality; however, a standardized treatment protocol is not well-established.

Areas of Uncertainty:
Treatments available for intermediate-risk pulmonary embolisms include anticoagulation, systemic thrombolytics, catheter-directed therapies, surgical embolectomy, and extracorporeal membrane oxygenation. Despite these options, there is no clear consensus on the optimal indication and timing of these interventions.

Therapeutic Advances:
Anticoagulation remains the cornerstone of treatment for pulmonary embolism; however, over the past 2 decades, there have been advances in the safety and efficacy of catheter-directed therapies. For massive pulmonary embolism, systemic thrombolytics and, sometimes, surgical thrombectomy are considered first-line treatments. Patients with intermediate-risk pulmonary embolism are at high risk of clinical deterioration; however, it is unclear whether anticoagulation alone is sufficient. The optimal treatment of intermediate-risk pulmonary embolism in the setting of hemodynamic stability with right heart strain present is not well-defined. Therapies such as catheter-directed thrombolysis and suction thrombectomy are being investigated given their potential to offload right ventricular strain. Several studies have recently evaluated catheter-directed thrombolysis and embolectomies and demonstrated the efficacy and safety of these interventions. Here, we review the literature on the management of intermediate-risk pulmonary embolisms and the evidence behind those interventions.

Conclusions:
There are many treatments available in the management of intermediate-risk pulmonary embolism. Although the current literature does not favor 1 treatment as superior, multiple studies have shown growing data to support catheter-directed therapies as potential options for these patients. Multidisciplinary pulmonary embolism response teams remain a key feature in improving the selection of advanced therapies and optimization of care.
Long-Term Quality of Life in Congenital Heart Disease Surgical Survivors: Multicenter Retrospective Study of Surgical and ICU Explanatory Factors
Authors: Marino Bradley S. , Cassedy Amy , Brown Katherine L. , Franklin Rodney , Gaynor J. William , Cvetkovic Mirjana , Laker Simon , Levinson Katherine , MacGloin Helen , Mahony Lynn , McQuillan Annette , Mussatto Kathleen , O’Shea Deirdre , Newburger Jane , Sykes Michelle , Teele Sarah A. , Wernovsky Gil , Wray Jo 
Published: February 2023

OBJECTIVES:
Greater congenital heart disease (CHD) complexity is associated with lower health-related quality of life (HRQOL). There are no data on the association between surgical and ICU factors and HRQOL in CHD survivors. This study assess the association between surgical and ICU factors and HRQOL in child and adolescent CHD survivors.

DESIGN:
This was a corollary study of the Pediatric Cardiac Quality of Life Inventory (PCQLI) Testing Study.

SETTING:
Eight pediatric hospitals participating in the PCQLI Study.

PATIENTS:
Patients in the study had the Fontan procedure, surgery for tetralogy of Fallot (TOF), and transposition of the great arteries (TGAs).

MEASUREMENTS AND MAIN RESULTS:
Surgical/ICU explanatory variables were collected by reviewing the medical records. Primary outcome variables (PCQLI Total patient and parent scores) and covariates were obtained from the Data Registry. General linear modeling was used to create the multivariable models. There were 572 patients included: mean ± sd of age 11.7 ± 2.9 years; CHD Fontan 45%, TOF/TGA 55%; number of cardiac surgeries 2 (1–9); and number of ICU admissions 3 (1–9). In multivariable models, lowest body temperature on cardiopulmonary bypass (CPB) was negatively associated with patient total score (p < 0.05). The total number of CPB runs was negatively associated with parent-reported PCQLI Total score (p < 0.02). Cumulative days on an inotropic/vasoactive drug in the ICU was negatively associated with all patient-/parent-reported PCQLI scores (p < 0.04). Neurological deficit at discharge was negatively associated with parent-reported PCQLI total score (p < 0.02). The variance explained by these factors ranged from 24% to 29%.

CONCLUSIONS:
Surgical/ICU factors, demographic, and medical care utilization variables explain a low-to-moderate amount of variation in HRQOL. Research is needed to determine whether modification of these surgical and ICU factors improves HRQOL, and to identify other factors that contribute to unexplained variability.
Psychometric properties of outcome measures for lower-limb absence: A protocol for a systematic review
Authors: Tan Jade M. , Halford Gregory R. J. , McBain Brodwen K. , Lukin Martina , Kohler Friedbert 
Published: February 2023

Background:
Outcome measures are an important part of clinical practice to assist with the care of individuals with lower-limb absence (LLA). They aid with the devising and evaluation of rehabilitation plans, and guide decisions regarding the provision and funding of prosthetic services worldwide. To date, no outcome measure has been identified as a gold standard for use in individuals with LLA. Furthermore, the large number of outcome measures available has created uncertainty regarding outcome measures that are most appropriate for individuals with LLA.

Objective:
To critically appraise the existing literature related to the psychometric properties of outcome measures for use in individuals with LLA and provide evidence as to which outcome measures may be most appropriate for this clinical population.

Study design:
This is a systematic review protocol.

Methods:
CINAHL, Embase, MEDLINE (PubMed), and PsycINFO databases will be searched using a combination of Medical Subject Headings terms and keywords. Search terms that define the population (people with LLA or amputation), intervention (outcome measures), and outcome (psychometric properties) will be used to identify studies. The reference lists of included studies will be hand-search to identify other pertinent articles, with a further search conducted through Google Scholar to ensure that all studies not yet indexed through MEDLINE are captured. Full-text peer-reviewed journal studies published in English will be included, with no date limit set. Included studies will be appraised using the 2018 and 2020 COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklists. Data extraction and study appraisal will be completed by two authors, with a third author serving as an adjudicator. Quantitative synthesis will be used to summarize characteristics of the included studies, with kappa statistics used to determine agreement between authors for study inclusion and the application of COSMIN. Qualitative synthesis will be conducted to report on both quality of the included studies and psychometric properties of the included outcome measures.

Conclusion:
This protocol was designed to identify, appraise, and summarize patient-reported and performance-based outcome measures that have been psychometrically tested in people with LLA. Results from this review will be used to guide a consensus process on outcome measure use for people with LLA.
Systematic review registration: PROSPERO registry number: CRD42020217820.
The Cooperative Re-Engagement Controlled Trial (CoRECT): Durable Viral Suppression Assessment
Authors: O'Shea Jesse , Fanfair Robyn Neblett , Williams Tiffany , Khalil George , Brady Kathleen A. , DeMaria Alfred , Villanueva Merceditas , Randall Liisa M. , Jenkins Heidi , Altice Frederick L. , Camp Nasima , Lucas Crystal , Buchelli Marianne , Samandari Taraz , Weidle Paul J. 
Published: February 2023

Background:
A collaborative, data-to-care strategy to identify persons with HIV (PWH) newly out-of-care, combined with an active public health intervention, significantly increases the proportion of PWH re-engaged in HIV care. We assessed this strategy's impact on durable viral suppression (DVS).

Methods:
A multisite, prospective randomized controlled trial for out-of-care individuals using a data-to-care strategy and comparing public health field services to locate, contact, and facilitate access to care versus the standard of care. DVS was defined as the last viral load, the viral load at least 3 months before, and any viral load between the 2 were all <200 copies/mL during the 18-month postrandomization. Alternative definitions of DVS were also analyzed.

Results:
Between August 1, 2016–July 31, 2018, 1893 participants were randomized from Connecticut (n = 654), Massachusetts (n = 630), and Philadelphia (n = 609). Rates of achieving DVS were similar in the intervention and standard-of-care arms in all jurisdictions (all sites: 43.4% vs 42.4%, P = 0.67; Connecticut: 46.7% vs 45.0%, P = 0.67; Massachusetts: 40.7 vs 44.4%, P = 0.35; Philadelphia: 42.4% vs 37.3%, P = 0.20). There was no association between DVS and the intervention (RR: 1.01, CI: 0.91–1.12; P = 0.85) adjusting for site, age categories, race/ethnicity, birth sex, CD4 categories, and exposure categories.

Conclusion:
A collaborative, data-to-care strategy, and active public health intervention did not increase the proportion of PWH achieving DVS, suggesting additional support to promote retention in care and antiretroviral adherence may be needed. Initial linkage and engagement services, through data-to-care or other means, are likely necessary but insufficient for achieving DVS for all PWH.