bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transforming the Heart of Student Learning and Engagement
Authors: Stam Daniel , Jenkins Greta M. , Goettl Hannah , Martinson Jordan , Fondrick Alex , Lindahl Russell , Withrow Zach 
Published: August 2023

Purpose:
Entry-level physical therapists must effectively learn cardiovascular and physiological monitoring, including electrocardiography (ECG) interpretation, to fulfill the demands of acute care hospital settings. Preliminary evidence among medical students and young physicians suggests that proficiency in basic ECG interpretation may be insufficient to meet the needs of a society with increasing levels of cardiovascular disease. In addition, as a new generation of students (Generation Z) enters health care education programs, educators may need to adapt their instructional approaches and technology. The purpose of this study was to evaluate whether a novel virtual reality (VR) learning module resulted in more accurate ECG interpretation than a conventional written learning activity for predominantly Generation Z Doctor of Physical Therapy (DPT) students. The study also assessed whether a preference existed for either of the 2 activities.

Methods:
A blocked-randomized controlled crossover trial was integrated within a second-year cardiopulmonary course for DPT students. Students were blocked into 2 groups, VR-Conventional or Conventional-VR, based on the order in which they participated in the activities. Twenty-item multiple-choice knowledge assessments and a satisfaction survey were the outcomes.

Results:
Eighteen DPT students participated. Median pretest scores for the VR-Conventional group and the Conventional-VR group were 60% (interquartile range [IQR]: 50-75) and 65% (IQR: 55-75), respectively; the distributions were not different (Mann-Whitney U test =36.00, n1 = n2 = 9, P = .688, 2-tailed). Median posttest 1 scores for the VR-Conventional group and the Conventional-VR group were 70% (IQR: 62.50-85) and 75% (IQR: 67.50-85), respectively; the distributions were not different (Mann-Whitney U test = 39.00, n1 = n2 = 9, P = .893, 2-tailed). After crossing over, the VR-Conventional group scored 70% (IQR: 62.50-80) on posttest 2 while the Conventional-VR group scored 70% (IQR: 65-77.50); the distributions were not different (Mann-Whitney U test = 38.50, n1 = n2 = 9, P = .858, 2-tailed). Fifty percent of participants preferred the VR activity, 33% preferred the conventional written activity, and 17% had no preference. All participants reported wanting to see VR used more in education.

Conclusions:
VR was well received and may aid student engagement and motivation for learning complex topics such as ECG interpretation. In this study, VR was not superior to conventional learning activities for knowledge acquisition. Educators should additionally consider an evidence-based instructional design when choosing to integrate VR technologies in the classroom.
Challenging routine: technical difficulties and solutions of endoscopic thyroidectomy via a combined transoral and breast approach, a case-series and learning curve
Authors: Zhou Shiwei , Wu Peng , Li Wu , Li Hui , Wang Zhiyuan , Zhang Lu , Li Jigang , Peng Xiaowei 
Published: August 2023

Objective:
Conventional cervical lymph node dissection often leaves large surgical scars, which seriously compromises the postoperative aesthetic effect and can affect the quality of life of patients. In this study, the safety and feasibility of robotic-assisted endoscopic thyroidectomy with central neck dissection (CND) and lateral neck dissection (LND) via a combined transoral and breast approach are discussed in detail.

Methods:
A retrospective analysis was made of the data of 26 patients with stage cN1b papillary thyroid carcinoma who were admitted to the Thyroid Surgery Department of the XX Hospital from March 2021 to September 2022 and who underwent robotic-assisted endoscopic thyroidectomy with LND via a combined transoral and breast approach. The demographic data, surgical indicators, postoperative data, and the postoperative complication rate of the patients were analyzed, and the learning curve was analyzed by cumulative summation (CUSUM).

Results:
All the patients underwent endoscopic surgery without any conversion to open surgery. The mean operation time was 313.7±50.3 mins, the mean number of total positive/retrieved lymph nodes was 11.2±8.1/36.8±13.7. Two patients developed temporary laryngeal recurrent nerve palsy and three patients developed temporary hypoparathyroidism, all of whom recovered within 3-months postoperatively. No other complications or tumor recurrence occurred during follow-up that ranged from 6-24 months. The mean postoperative quality of life (QOL) score was 189.1±118.2, test results ranging from 0-1300 with a lower score indicating a higher QOL, and the aesthetic satisfaction score was 4.2±0.7, test scores ranging from 0-5 with higher scores indicate higher satisfaction. The turning point of the learning curve was in the 11th case.

Conclusion:
The robotic-assisted endoscopic thyroidectomy with CND and LND via a combined transoral and breast approach is safe and feasible, and the improved cosmetic effect is remarkable, which is conducive to improving the postoperative QOL of patients. It provides a new surgical option for patients.
Affordable Care Act Medicaid Expansion was Associated With Reductions in the Proportion of Hospitalizations That are Potentially Preventable Among Hispanic and White Adults
Authors: Hanchate Amresh D. , Abdelfattah Lindsey , Lin Meng-Yun , Lasser Karen E. , Paasche-Orlow Michael K. 
Published: August 2023

Objective:
Using data on 5 years of postexpansion experience, we examined whether the coverage gains from Affordable Care Act Medicaid expansion among Black, Hispanic, and White individuals led to improvements in objective indicators of outpatient care adequacy and quality.

Research Design:
For the population of adults aged 45–64 with no insurance or Medicaid coverage, we obtained data on census population and hospitalizations for ambulatory care sensitive conditions (ACSCs) during 2010–2018 in 14 expansion and 7 nonexpansion states. Our primary outcome was the percentage share of hospitalizations due to ACSC out of all hospitalizations (“ACSC share”) among uninsured and Medicaid-covered patients. Secondary outcomes were the population rate of ACSC and all hospitalizations. We used multivariate regression models with an event-study difference-in-differences specification to estimate the change in the outcome measures associated with expansion in each of the 5 postexpansion years among Hispanic, Black, and White adults.

Principal Findings:
At baseline, ACSC share in the expansion states was 19.0%, 14.5%, and 14.3% among Black, Hispanic, and White adults. Over the 5 years after expansion, Medicaid expansion was associated with an annual reduction in ACSC share of 5.3% (95% CI, −7.4% to −3.1%) among Hispanic and 8.0% (95% CI, −11.3% to −4.5%) among White adults. Among Black adults, estimates were mixed and indicated either no change or a reduction in ACSC share.

Conclusions:
After Medicaid expansion, low-income Hispanic and White adults experienced a decrease in the proportion of potentially preventable hospitalizations out of all hospitalizations.
Role of radiological corroboration in a locally aggressive inverted papilloma: a case report
Authors: Mahat Asim , Yadav Gopal K. , Neupane Durga , Mishra Upama , Khadka Sujan , Lamichhane Bishesh 
Published: August 2023

Introduction and importance:
Sinonasal inverted papilloma is a rare benign tumor of the nasal cavity and paranasal sinuses (PNS). Radiological evaluation is the key to management.

Case presentation:
A 46-year-old male presented with complaints of right nasal congestion and occasional bleeding for 4 months. During anterior rhinoscopy, a pinkish fleshy mass occupying the right nasal cavity was seen. X-ray and computed tomography (CT) PNS view showed opacification in the right nasal cavity and maxillary sinus. An MRI of the nose and PNS revealed a peculiar convoluted striated/cerebriform pattern. Histopathology report described the features of an inverted papilloma. The patient underwent endoscopic removal of the mass under general anesthesia. Surgical resection of the tumor was performed along with adjacent normal mucosal tissues. The patient recovered well and was followed-up for recurrence.

Clinical discussion:
Sinonasal inverted papilloma is commonly found in males in their fifth to sixth decade of life. A CT scan is the initial modality of choice to evaluate the extent of the disease. MRI is superior to CT in distinguishing tumors from other conditions as well as to evaluate soft tissue extensions. Involvement of the frontal sinus is a risk factor for recurrence. The first option for treating an inverted papilloma is complete surgical removal with the adjacent uninvolved mucosa.

Conclusion:
In a biopsy-proven case, radiological assessments like CT and MRI play a pivotal role in studying the typical morphology, delineating the extension, and detecting recurrence.
Expanded dengue syndrome in diabetic patient with history of COVID-19 infection: a case report
Authors: Nelwan Erni J. , Pramanta Pramanta , Safitri Wanda J. , Adiwinata Randy , So Amy , Nainggolan Leonard 
Published: August 2023

Introduction:
Overlapping symptoms between dengue and coronavirus disease 2019 (COVID-19) may become a diagnostic challenge; moreover, social stigma and fear of being diagnosed with COVID-19 may lead the patients to delayed medical visit. Delayed medical management of dengue may lead to expanded dengue syndrome and a fatal outcome.

Case presentation:
A 35-year-old female patient with uncontrolled diabetes mellitus and a recent COVID-19 infection presented with a continuous fever for 4 days. She delayed seeking medical advice due to traumatized being infected by COVID-19, the self-isolation protocol, and the COVID-19 protocol in every hospital for every febrile patient. She developed multiorgan failure during her hospitalization and was diagnosed with expanded dengue syndrome.

Clinical discussion:
Diagnosing the etiology of acute febrile illness in the COVID-19 pandemic era is problematic. Most of healthcare facilities warranted COVID-19 evaluation in every acute febrile patient. This protocol may lead to a potential delayed diagnosis and serve as a barrier to accessing healthcare facility. False perception, fear and anxiety of being isolated, discrimination in society, and others may lead to stigmatization of COVID-19 and affect the individual decision for COVID-19 testing and seeking medical advices. Our patient had a fatal outcome due to delayed detection and treatment of dengue hemorrhagic fever.

Conclusion:
Delayed management of expanded dengue syndrome leads to a fatal outcome. Stigma may play a role as the barrier for seeking medical advice. Having a broad differential diagnosis in COVID-19 pandemic era is essential.
Health Social Networks of Black Women With Hypertension
Authors: Jones Lenette M. , Hawkins Jaclynn , Mitchell Jamie , Wright Kathy D. , Cuffee Yendelela 
Published: August 2023

BackgroundThe prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women.ObjectiveThis substudy aimed to examine health social networks and describe the peers’ characteristics, as reported by a convenience sample of Black women with hypertension.MethodsIn this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network.ResultsCollectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants’ health social network size (number of peers named) and their systolic blood pressure levels.DiscussionThe health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.
Chronic Pain and Pain Management in Older Adults
Authors: LaRowe Lisa R. , Miaskowski Christine , Miller Angela , Mayfield Andrea , Keefe Francis J. , Smith Alexander K. , Cooper Bruce A. , Wei Lee-Jen , Ritchie Christine S. 
Published: August 2023

Background
Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults; the pharmacological and nonpharmacological strategies that older adults use to manage their chronic pain; and the effect of chronic pain on patient-reported outcomes.

Objectives
This article aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacological and nonpharmacological pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study.

Methods
A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago’s AmeriSpeak Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults.

Results
In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacological and nonpharmacological pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing.

Discussion
This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.
Prevalence of depression in women diagnosed with breast cancer in Georgia
Authors: Kakhniashvili Tamar , Okribelashvili Nino , Kiladze Ivane , Fielding Richard 
Published: August 2023

Abstract

Background:
Depression commonly occurs in patients with breast cancer (BC), significantly affecting their quality of life. We screened Georgian women diagnosed with BC for depressive symptoms to determine their prevalence and examine associations with various sociodemographic and clinical characteristics. This is the first study focusing on mental well-being in patients with cancer in Georgia.

Methods:
In a multicenter observational study, 177 women receiving BC treatment were examined at three tertiary oncology hospitals in Georgia. Patient Health Questionnaire 9 (PHQ-9) was used for the identification of depressive symptoms. Patients were stratified using basic information on age, marital status, educational level, social and financial support, employment status, and clinical characteristics.

Results:
The average age was 52.9 years (34–77); 117 (66%) were married; 79 (45%) were working, but only 30 (17%) reported having adequate financial status; 128 (72%) had stage I-III disease; and 64 (36%) reported some degree of pain. Using pro-rated PHQ-9 scores, 46 patients (44%; 95% CI, 37–51) reported some level of depressive symptoms while 25 women (14%; 95% CI, 9–19) met the criteria for probable depressive disorder. A higher proportion of patients reporting pain also reported depressive symptoms (37/66, 56%) compared with those reporting no pain (41/111, 34%) (P = .013); women with stage IV disease were more likely to report depressive symptoms (26/44, 57%) compared with those with stages I-III (53/133, 40%) (P = .049); and single/previously married women (42/60, 70%) were more likely to report depressive symptoms than married women (51/117, 44%) (P = .001). Depressive symptom reporting did not differ by age or reported support.

Conclusion:
One in six of this sample of Georgian patients with BC had depressive symptom levels consistent with a depressive disorder. Depressive symptoms covaried by marital status, staging, and reported pain. These results can inform practitioner oncologists in Georgia of the needs for psychological support for patients with cancer and assist in building such support services.
Effects of Calcitonin Administration on the Amount of Bone Formation After Sutural Expansion Using Micro-CT
Authors: Alatabi Hayder Saad Hanfoosh , Tobji Samir , Haouas Zohra 
Published: August 2023

Objective:
Calcitonin injections were used in this investigation to see whether they influenced the quantity of bone formation after a rabbit model was subjected to micro-computed tomography expansion.

Materials and Methods:
Research was conducted on a total of 16 white male rabbits. Randomly, 4 groups of 4 rabbits each had their bone-borne expanders triggered by the Hyrax appliances as follows: In the first group (the control), the expansion was (0.5) mm per day for 12 days. In the second group, the same expansion protocol was used with 3 subcutaneous injections of calcitonin). In the third group, the expansion was (2.5) mm per day for 7 days followed by (0.5) mm per day for 7 days. In the fourth group, the same expansion protocol was used with 3 subcutaneous injections of calcitonin. As a result, all groups had their Hyrax devices expanded by 6 mm in total. Sutural separation and new bone growth were examined by micro-computed tomography after 6 weeks of retention. To end the experiment, the rabbits were given a high dosage of phenobarbitone (90 mg/kg).

Results:
In the calcitonin-receiving group, there was a significant increase in anterior and posterior sutural separation, when compared with non-calcitonin-receiving groups. In the (2.5) mm instant expansion protocol, there was a significant increase in anterior and posterior sutural separation, when compared with the (0.5) mm instant expansion protocol.

Conclusion:
Calcitonin and the instant expansion protocol enhance new bone formation in rabbits.
Comparison of Posttreatment Stability Between Mandibular Setback Surgery-Early and Conventional Surgery in Class III Patients: A 4.6-Year Follow-Up
Authors: Shin Yonsoo , Choi Tae-Hyun , Yoon Ji-Young , Kim Young-Kyun , Yun Pil-Young , Lee Nam-Ki 
Published: August 2023

Objectives:
This retrospective study aims to compare long-term stability between the mandibular setback surgery-early (MSE) approach, involving minimal orthodontics, and the mandibular setback conventional surgery (MCS) approach, involving sufficient orthodontics, in Class III patients with mandibular prognathism.

Methods:
Among 210 patients who underwent orthognathic surgery, a total of 40 subjects were enrolled based on standardized inclusion criteria: only mandibular surgery, <5 mm setback difference between right and left of the mandible, orthodontics with fixed appliances, and more than 2 years of follow-up after treatment. These patients were allocated to the MSE (n = 20) and MCS groups (n = 20) according to the duration of presurgical orthodontics. Changes in cephalometric measurements were compared between the MSE and MCS groups before surgery (T0), 1 month after surgery (T1), at the end of treatment (T2), and posttreatment retention (T3).

Results:
The MSE and MCS groups had a mean presurgical orthodontic duration of 2 and 9.5 months, respectively. From T1 to T2, the MSE group showed a significantly larger forward movement of the mandible than the MCS group (2.1 versus 0.7 mm; P < 0.001). In addition, from T2 to T3 (average 4.6 years), the MSE group presented anterior relapse of 0.6 mm in the mandible, but there were no statistically significant intergroup differences.

Conclusion:
Although the MSE group showed greater postsurgical forward mandibular relapse than the MCS group, the two groups exhibited similar skeletal and dental stability during the posttreatment retention.
Racial Disparities Following Reconstructive Flap Procedures
Authors: Chwa Emily S. , Applebaum Sarah A. , Khazanchi Rushmin , Wester James R. , Gosain Arun K. 
Published: August 2023

Background:
Prior reports have highlighted disparities in healthcare access, environmental conditions, and food insecurity between Black and White populations in the United States. However, limited studies have explored racial disparities in postoperative complications, particularly reconstructive flap surgeries.

Methods:
Cases of flap reconstruction based on named vascular pedicles were identified in the American College of Surgeons National Surgical Quality Improvement Program database and grouped into 3 time periods: 2005 to 2009, 2010 to 2014, and 2015 to 2019. Logistic regression was used to compare rates of postoperative complications between White and Black patients within each time period while controlling for comorbidities. Data for flap failure was only available from 2005 to 2010.

Results:
A total of 56,116 patients were included in the study, and 6293 (11.2%) were Black. Black patients were significantly younger than White patients and had increased rates of hypertension, smoking, and diabetes across all years (P<0.01). Black patients had significantly higher rates of sepsis compared to White patients in all time periods. From 2005 to 2009, Black patients had a significantly higher incidence of flap failure (aOR=2.58, P<0.01), return to the operating room (aOR=1.53, P=0.01), and having any complication (aOR=1.48, P<0.01). From 2010 to 2019, White patients had a higher incidence of superficial surgical site infection.

Conclusions:
Surgical complication rates following flap reconstruction based on a named vascular pedicle were higher for Black patients. Limited data on this topic currently exists, indicating that additional research on the drivers of racial disparities is warranted to improve plastic surgery outcomes in Black patients.