bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffusion Basis Spectrum Imaging Identifies Clinically Relevant Disease Phenotypes of Cervical Spondylotic Myelopathy
Authors: Zhang Justin K. , Javeed Saad , Greenberg Jacob K. , Dibble Christopher F. , Song Sheng-Kwei , Ray Wilson Z. 
Published: February 2023

Study Design:
Prospective cohort study.

Objective:
Apply a machine learning clustering algorithm to baseline imaging data to identify clinically relevant cervical spondylotic myelopathy (CSM) patient phenotypes.

Summary of Background Data:
A major shortcoming in improving care for CSM patients is the lack of robust quantitative imaging tools to guide surgical decision-making. Advanced diffusion-weighted magnetic resonance imaging (MRI) techniques, such as diffusion basis spectrum imaging (DBSI), may help address this limitation by providing detailed evaluations of white matter injury in CSM.

Methods:
Fifty CSM patients underwent comprehensive clinical assessments and diffusion-weighted MRI, followed by DBSI modeling. DBSI metrics included fractional anisotropy, axial and radial diffusivity, fiber fraction, extra-axonal fraction, restricted fraction, and nonrestricted fraction. Neurofunctional status was assessed by the modified Japanese Orthopedic Association, myelopathic disability index, and disabilities of the arm, shoulder, and hand. Quality-of-life was measured by the 36-Item Short Form Survey physical component summary and mental component summary. The neck disability index was used to measure self-reported neck pain. K-means clustering was applied to baseline DBSI measures to identify 3 clinically relevant CSM disease phenotypes. Baseline demographic, clinical, radiographic, and patient-reported outcome measures were compared among clusters using one-way analysis of variance (ANOVA).

Results:
Twenty-three (55%) mild, 9 (21%) moderate, and 10 (24%) severe myelopathy patients were enrolled. Eight patients were excluded due to MRI data of insufficient quality. Of the remaining 42 patients, 3 groups were generated by k-means clustering. When compared with clusters 1 and 2, cluster 3 performed significantly worse on the modified Japanese Orthopedic Association and all patient-reported outcome measures (P<0.001), except the 36-Item Short Form Survey mental component summary (P>0.05). Cluster 3 also possessed the highest proportion of non-Caucasian patients (43%, P=0.04), the worst hand dynamometer measurements (P<0.05), and significantly higher intra-axonal axial diffusivity and extra-axonal fraction values (P<0.001).

Conclusions:
Using baseline imaging data, we delineated a clinically meaningful CSM disease phenotype, characterized by worse neurofunctional status, quality-of-life, and pain, and more severe imaging markers of vasogenic edema.

Level of Evidence:
II.
Interprofessional Case Conference Enhances Group Learning and the Quality, Safety, Value, and Equity of Team-Based Care
Authors: Papermaster Amy E. , Whitney Margaret , Vinas Emily K. 
Published: February 2023

Introduction:
Patients seeking treatment for complex conditions require coordinated care from interprofessional clinicians. Collaborative engagement in an interprofessional community of practice is crucial to the collective competence of a team and the provision of high-quality, safe health care leading to improved patient outcomes. The objective of this descriptive, cross-sectional study was to describe interprofessional communication, coordination, and collaboration of participants in an integrated practice unit that was structured to include weekly case conferences as part of routine practice.

Methods:
Data were collected from October 2019 to February 2020. Web-based surveys were administered to a convenience sample that included 33 questions and followed the CHERRIES checklist for reporting results. Items focused on team knowledge, impact on patient care, and communication, and conference focus and effectiveness. Descriptive and survey item analysis included frequency, percentage, means and standard deviation, Chi-square, and Pearson correlation analysis. Patient outcome data were collected via a Patient Global Impression of Improvement scale and were analyzed using a paired sample t test.

Results:
Survey respondents (n = 161) included clinicians and administrative staff. Results demonstrated that interprofessional case conferences improved the collective competence of the team, including team knowledge and communication. Participants viewed case conferences as a means to enhance care delivery quality, value, safety, and equity. In the study period, there was also a statistically significant improvement between the patient's first follow-up and last visits.

Conclusion:
Survey respondents indicated that case conferences were an effective means to deliver high-quality, patient-centered care through interprofessional collaboration and education.
Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection
Authors: Chen Dunjin , Dai Yue , Liu Xinghui , Qi Hongbo , Wang Chen , Wang Lan , Wei Yuan , Xu Xiaochao , Zhang Chuan , Zhang Lingli , Zhang Yuquan , Zhao Ruihua , Zhao Yangyu , Zhou Borong , Wang Ai-Ling , Yang Huixia , Song Li 
Published: February 2023

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human’s health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumulates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.
Changes in Outpatient Healthcare Utilization and Costs Following Mild Traumatic Brain Injury Among Service Members in the Military Health System by Preexisting Behavioral Health Condition Status
Authors: Hoover Peter , Adirim-Lanza Andrew , Adams Rachel Sayko , Dismuke-Greer Clara E. , French Louis M. , Caban Jesus 
Published: February 2023

Objective:
To evaluate changes in healthcare utilization and cost following an index mild traumatic brain injury (mTBI) diagnosis among service members (SMs). We hypothesized that differences in utilization and cost will be observed by preexisting behavioral health (BH) diagnosis status.

Setting:
Direct care outpatient healthcare facilities within the Military Health System.

Participants:
A total of 21 984 active-duty SMs diagnosed with an index mTBI diagnosis between 2017 and 2018.

Design:
This retrospective study analyzed changes in healthcare utilization and cost in military treatment facilities among SMs with an index mTBI diagnosis. Encounter records 1 year before and after mTBI were assessed; preexisting BH conditions were identified in the year before mTBI.

Main Measures:
Ordinary least squares regressions evaluated difference in the average change of total outpatient encounters and costs among SMs with and with no preexisting BH conditions (eg, posttraumatic stress disorder, adjustment disorder). Additional regressions explored changes in utilization and cost within clinic types (eg, mental health, physical rehabilitation).

Results:
There was a 39.5% increase in overall healthcare utilization during the following year, representing a 34.8% increase in total expenditures. Those with preexisting BH conditions exhibited smaller changes in overall utilization (β, −4.9; [95% confidence interval (CI), −6.1 to −3.8]) and cost (β, $−1873; [95% CI, $−2722 to $−1024]), compared with those with no BH condition. The greatest differences were observed in primary care clinics, in which those with prior BH conditions exhibited an average decreased change of 3.2 encounters (95% CI, −3.5 to −3) and reduced cost of $544 (95% CI, $−599 to $−490) compared with those with no prior BH conditions.

Conclusion:
Despite being higher utilizers of healthcare services both pre- and post-mTBI diagnosis, those with preexisting BH conditions exhibited smaller changes in overall cost and utilization. This highlights the importance of considering prior utilization and cost when evaluating the impact of mTBI and other injury events on the Military Health System.
Comparing the Etiology of Viral Acute Respiratory Illnesses Between Children Who Do and Do Not Attend Childcare
Authors: DeJonge Peter M. , Monto Arnold S. , Malosh Ryan E. , Petrie Joshua G. , Callear Amy , Segaloff Hannah E. , Truscon Rachel , Johnson Emileigh , Cheng Bonnie , Cranis Mara , Tiseo Katie , Foote Sydney , Musci Adrienne , Martin Emily T. 
Published: February 2023

Background and Objective:
Childcare attendance is a common risk factor for acute respiratory illness (ARI) in young children. Our goal was to better understand the specific respiratory viruses that predominate in childcare, which may support the development of tailored illness prevention and intervention strategies in childcare settings.

Methods:
Using data from a prospective household cohort of ARI surveillance, we assessed specimen from 1418 ARIs reported by 359 childcare-aged children over 6 study seasons (2012/2013 through 2017/2018). Respiratory swabs were tested by polymerase chain reaction for 9 respiratory viruses. A mixed-effect logistic regression model was used to compare odds of various viral detection outcomes. The Shannon’s Diversity index was used to compare the richness (ie, number of species) and diversity (ie, relative species abundance) associated with respiratory viruses detected in both groups.

Results:
At least 1 virus was detected in 75.5% of childcare-associated ARIs and in 80.1% of homecare ARIs. Compared with illnesses among homecare children, childcare illnesses were associated with significantly higher odds of detected adenovirus (odds ratio = 1.86, 95% confidence interval = 1.05–3.28) and human metapneumovirus (odds ratio = 1.76, 95% confidence interval = 1.03–3.0). The pool of viruses associated with childcare ARI was found to be significantly richer and more diverse than that of viruses associated with homecare ARI (P < 0.0001).

Conclusions:
Children attending childcare experience a higher risk of adenovirus and human metapneumovirus infection and are regularly exposed to a rich and diverse pool of respiratory viruses in childcare environments. Our results underscore the necessity of thorough and multifaceted viral prevention strategies in childcare settings.
Validation of a web-based distance visual acuity test
Authors: Labiris Georgios , Panagiotopoulou Eirini-Kanella , Delibasis Konstantinos , Duzha Erald , Bakirtzis Minas , Panagis Christos , Boboridis Kostas , Mokka Agni , Balidis Miltiadis , Damtsi Charoula , Ntonti Panagiota 
Published: February 2023

Purpose:
To validate the Democritus Digital Acuity and Reading Test (DDART) as a distance VA (dVA) test against a series of prevalent conventional distance vision charts.

Setting:
Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece; Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece; and Ophthalmica Institute of Ophthalmology & Microsurgery, Thessaloniki, Greece.

Design:
Prospective multicenter validation study.

Methods:
The distance best spectacle-corrected visual acuity (dBSCVA) was compared in normal (NVG) and low (LVG) vision participants against 4 prevalent conventional distance vision charts (ETDRS, Snellen, Landolt C, and Tumbling E) by a predefined 2.5-symbol noninferiority margin and intraclass correlation coefficients (ICCs). DDART's test–retest (TRT) reliability was assessed with ICCs.

Results:
534 participants (471 and 63 with normal and low vision, respectively) were included in the study. The mean difference between dBSCVA measured with DDART and conventional charts ranged between −0.84 and +0.85 symbols, without exceeding the 2.5-symbol noninferiority margin. ICCs indicated an excellent level of agreement for all patient groups (from 0.848 to 0.985). TRT reliability indicated differences below 1 symbol both for the NVG and LVG, with ICCs ranging between 0.912 and 0.964 for the 4 DDARTs.

Conclusions:
DDART was a valid web-based dVA test that provided reliable measurements in clinical and telemedical settings, both for normal and low vision patients.
Fill levels, cost comparisons, and expulsion force requirements of commonly used topical ophthalmic nonsteroidal anti-inflammatory drugs
Authors: Heath Michael , McDonald Michael C. , Murphy David A. , Shah Simren V. , Shah Semony , Ding Kai , Riaz Kamran M. 
Published: February 2023

Purpose:
To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) commonly perioperatively in the United States.

Setting:
Tertiary care academic medical center.

Design:
Prospective laboratory investigation.

Methods:
8 commercially available NSAIDs (3 branded, 5 generic) were tested: branded bromfenac 0.07%, generic bromfenac 0.09%, diclofenac 0.1%, flurbiprofen 0.03%, generic ketorolac 0.5%, branded ketorolac 0.5%, ketorolac 0.47%, and branded nepafenac 0.3%. 10 bottles of each medication were tested, with an additional bottle tested for expulsion force requirements. A double-blinded method was used to measure the actual bottle fill volume and number of drops per bottle. The total cost per drop was calculated using published cash prices. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using the Kruskal-Wallis test, followed by pairwise comparisons with the Dwass, Steel, Critchlow-Fligner Method.

Results:
2 branded NSAIDs (bromfenac and nepafenac) had slightly lower-than-sticker volumes while generics other than ketorolac had higher-than-sticker volumes. Diclofenac and branded bromfenac had the highest and lowest adjusted number of drops respectively. Generic bromfenac and generic ketorolac had the highest and lowest adjusted volume compared with sticker volume respectively. Branded bromfenac was the most expensive medication, while generic diclofenac was the least expensive. Force expulsion requirements varied significantly among generic and branded NSAIDs.

Conclusions:
Volume fill levels, patient-incurred costs, and expulsion force requirements per bottle of topical NSAID medications vary significantly. Surgeons may wish to consider these factors when deciding how best to use these medications perioperatively.
Erythrocyte pyruvate kinase activation in red cell disorders
Authors: Matte Alessandro , Federti Enrica , De Franceschi Lucia 
Published: February 2023

Purpose of review
In red cells, pyruvate kinase is a key enzyme in the final step of glycolytic degradative process, which generates a constant energy supply via ATP production. This commentary discusses recent findings on pyruvate kinase activators as new therapeutic option in hereditary red cell disorders such as thalassemic syndromes or sickle cell disease (SCD).

Recent findings
Mitapivat and etavopivat are two oral pyruvate kinase activators. Studies in a mouse model for β thalassemia have shown beneficial effects of mitapivat on both red cell survival and ineffective erythropoiesis, with an amelioration of iron homeostasis. This was confirmed in a proof-of-concept study in patients with nontransfusion-dependent thalassemias. Both mitapivat and etavopivat have been evaluated in mouse models for SCD, showing an increased 2-3DPG/ATP ratio and a reduction in haemolysis as well as in sickling. These data were confirmed in proof-of-concept clinical studies with both molecules carried in patients with SCD.

Summary
Preclinical and clinical evidence indicate that pyruvate kinase activators represent new therapeutic option in hemoglobinopathies or SCD. Other red cell disorders such as hereditary spherocytosis or hereditary anaemias characterized by defective erythropoiesis might represent additional areas to investigate the therapeutic impact of pyruvate kinase activators.
Getting to Zero in Allegheny County: Implementation of a Collective Impact Model to Achieve Ending the HIV Epidemic Objectives
Authors: Whitfield Darren L. , Chung Ashley , Mangum Laurenia , Stoner Jerone T. , Seagle Emma E. , Och Julia , Steele Sue ,   for AIDS Free Pittsburgh
Published: February 2023

Background
Allegheny County Pennsylvania has the second highest HIV prevalence in the state. In the county, racial and ethnic minorities are disproportionately impacted by HIV.

Methods
In responses to HIV epidemic in the Allegheny County, AIDS Free Pittsburgh was created with the goals of reducing new HIV infections by 75% and declaring Allegheny County AIDS free (no new AIDS cases) by 2020. AIDS Free Pittsburgh uses a collective impact framework in which partners pledge to collect and share data uniformly across health systems, to co-organize events for provider and community education, and to enhance access to quality healthcare by developing resources and referral networks.

Results
Since its inception, there has been nearly a 43% decrease in new HIV cases, a 23% decrease in new AIDS cases, and other promising trends related to HIV testing, preexposure prophylaxis, linkage to care, and viral load suppression for people living with HIV in Allegheny County.

Conclusions
This article provides a detailed description of the community-level project, the activities conducted by collective group, a summary of project outcomes, and lessons learned for replicating this project in other midsized, mid-HIV incidence jurisdictions.
Excellence in Pediatric Physical Therapy Education: Recommendations and Action Items
Authors: Birkmeier Marisa , Lundeen Heather , Furze Jennifer , Moore James G. , Dannemiller Lisa , Anderson Deborah 
Published: February 2023

Purpose:
This special communication identifies evidence-based recommendations and offers action items to facilitate the uptake of new knowledge from the National Study of Excellence in Pediatric Physical Therapy Education (NSE-Peds).

Summary of Key Points:
The NSE-Peds identified a conceptual framework consisting of 4 key dimensions and associated elements that dynamically interact to prepare future physical therapists to meet the needs of society. The conceptual framework serves as the Knowledge Creation component of the knowledge to action (KTA) framework, but translation into practice requires the Action Cycle, the second component of the KTA framework. Recommendations and action items provide tangible products derived from the NSE-Peds conceptual framework for application in the Action Cycle.

Conclusions:
Using the KTA framework, implementation of the recommendations at the level of the individual, program, and organization should enhance pediatric physical therapy education and ultimately physical therapy care provided to children and families.
Modified Ride-on Car Intervention for Children With Profound Intellectual and Multiple Disabilities: A Case Series
Authors: Sloane Bethany M. , Case Felicity , Quinn Emily , Sanford-Keller Hannah , Logan Samuel W. 
Published: February 2023

Purpose:
To describe a pilot clinical case series of a modified ride-on car (MROC) intervention on mobility and alertness for young children with profound intellectual and multiple disabilities (PIMD).

Methods:
Four young children with PIMD participated in 4 baseline observations and 5 intervention sessions (A-B design). Data collection occurred via video. Assessment of mobility and alertness duration used structured visual analysis.

Results:
Three of the 4 children increased their independent mobility during the intervention sessions. One of the 4 children increased their active alertness during the intervention sessions.

Conclusions:
This pilot study demonstrates the initial feasibility of an MROC intervention in a clinical setting and outcome measures of mobility and alertness for children with PIMD. This provides support that this population should be considered for power mobility in early childhood. Further, this study used a novel, caregiver-implemented prompting protocol to teach children how to use the MROC.
Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals
Authors: Shah Tejen A , Knapp Leandra , Cohen Mark E , Brethauer Stacy A , Wick Elizabeth C , Ko Clifford Y 
Published: February 2023

BACKGROUND:Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERPs). However, hospitals have anecdotally reported difficulties in achieving similar improvement gains. This study evaluates improvement uniformity among 151 hospitals exposed to an 18-month implementation protocol for 6 colorectal ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, and early solid intake).STUDY DESIGN:One hundred fifty-one hospitals implemented a colorectal ERP with pathway, educational and supporting materials, and data capture protocols; 906 opportunities existed for process compliance improvement across the cohort (151 hospitals × 6 process measures). However, 240 opportunities were excluded due to high starting compliance rates (ie compliance >80%) and 3 opportunities were excluded because compliance rates were recorded for fewer than 2 cases. Thus, 663 opportunities for improvement across 151 hospitals were studied.RESULTS:Of 663 opportunities, minimal improvement (0% to 20% increase in compliance) occurred in 52% of opportunities, substantial improvement (>20% increase in compliance) in 20%, and worsening compliance occurred in 28%. Of the 6 processes, multimodal pain control and use of oral antibiotics improved the most.CONCLUSIONS:Contrary to published ERP literature, the majority of study hospitals had difficulty improving process compliance with 80% of the opportunities not achieving substantial improvement. This discordance between ERP implementation success rates reported in the literature and what is observed in a large sample could reflect differences in hospitals’ culture or characteristics, or a publication bias. Attention needs to be directed toward improving ERP adoption across the spectrum of hospital types.