bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burn Pit Exposure Assessment to Support a Cohort Study of US Veterans of the Wars in Iraq and Afghanistan
Authors: Woskie Susan R. , Bello Anila , Rennix Christopher , Jiang Lan , Trivedi Amal N. , Savitz David A. 
Published: February 2023

Objective
For a cohort study of veterans' health conditions, we conducted an exposure assessment for 109 bases in Iraq and Afghanistan and 17 outside transit site bases.

Methods
The Department of Defense records were used to determine burn pit usage and waste disposal methods for each base in each year during the period of 2001 to 2014.

Results
In the final cohort of 475,326 veterans, who had more than 80% of their deployment time characterized by our exposure matrix, only 14.5% were found to have no burn pit exposure. The 2009 Department of Defense regulations on burn pits did produce changes in waste segregation, as well as adding incineration and local disposal of waste.

Conclusion
Most Iraq and Afghanistan veterans were stationed on bases that had burn pits, although the contents disposed of in the burn pits changed over time.
Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey
Authors: Makovec Knight Jennifer , Mitra Biswadev , McIntosh Andrew , Clifton Patrick , Makdissi Michael , Rosenfeld Jeffrey V. , Harcourt Peter , Howard Teresa S. , Willmott Catherine 
Published: February 2023

Objectives:
To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football.

Design:
Online survey.

Setting:
Junior and youth athletes in Australia.

Participants:
Australian football players aged U8 to U18.

Assessment of Variables:
Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity.

Main Outcome Measures:
Rates of padded HG use, and beliefs associated with HG use.

Results:
A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer (P < 0.001) and being able to play harder while wearing HG (P < 0.001). Median responses were “disagree” on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019).

Conclusions:
Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.
Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players?
Authors: Gerschman Tommy , Brooks Brian L. , Mrazik Martin , Eliason Paul H. , Bonfield Stephan , Yeates Keith O. , Emery Carolyn A. , Schneider Kathryn J. 
Published: February 2023

Objective:
To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players.

Design:
Secondary analyses of 2 prospective cohort studies.

Setting:
Canadian youth ice hockey teams.

Participants:
Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season).

Assessment of Risk Factors:
Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition.

Main Outcome Measures:
Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression.

Results:
When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRRSELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRRPARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion.

Conclusions:
Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.
High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students
Authors: Whatman Chris , van den Berg Carla , Black Amanda M. , West Stephen , Hagel Brent , Eliason Paul , Emery Carolyn 
Published: February 2023

Objective:
To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion.

Design:
Cross-sectional study.

Setting:
High schools, Alberta, Canada.

Participants:
High school students (14-19 years) participating in various sports.

Independent Variables:
Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year).

Main Outcome Measures:
Twelve-month injury history (musculoskeletal and concussion).

Results:
Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39).

Conclusions:
Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.
Bilateral Ischial Tuberosity Stress Fractures in an Adolescent Football Player: A Case Report
Authors: Jones Jared M. , Wallenfelsz Grant M. , Worts Phillip R. , Wong Andrew M. 
Published: February 2023

Abstract:
Pelvic stress fractures are rare, making up an estimated 1% to 7% of all stress fractures with the primary locations being the pubic rami, pubic symphysis, and sacrum. Two cases of stress fractures of the ischium have been previously described in the literature, with both occurring in the ischial body. In this case, a 17-year-old high school American football player presented with nonspecific pelvic pain and bilateral point tenderness on deep palpation of the ischial tuberosities. Advanced imaging identified bilateral ischial tuberosity stress fractures. This report outlines the diagnosis and management of the first reported case of bilateral ischial tuberosity stress fractures. We report how ischial tuberosity stress fractures present clinically, potential management strategies, and highlight the use of computed tomography imaging for pelvic stress fractures. Knowledge of unusual stress fracture locations may improve early diagnosis, limit complications, reduce healthcare costs, and promote an accelerated recovery time.
Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review
Authors: Silber Zachary S. , Donnelly Joseph C. , Farias Michael J. , Lama Christopher J. , Luther Lauren I. , Kosinski Lindsay R. , Hoy Austin E. , Gil Joseph A. 
Published: February 2023

Objective:
To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair.

Data Sources:
The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases “TFCC,” “return to sport,” “return to work,” and “athlete.”

Results:
Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively.

Conclusion:
Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored.
Evidence-Based Practice Doctor of Physical Therapy Curricular Guideline Utilization: A Convergent Parallel Mixed Methods Study
Authors: Chen Yuping , Selby-Silverstein Lisa , Greenberger Hilary B. , Gobert Denise , Levine David , Kaplan Sandra L. 
Published: February 2023

Introduction:
In 2014, an expert panel from the American Physical Therapy Association Academy of Research Evidence-Based Practice (EBP) special interest group created the Doctor of Physical Therapy (DPT) EBP Curricular Guideline (EBP-CG). This study describes faculty awareness of the EBP-CG, DPT curricular alignment with its terminal objectives, EBP-CG uses, and challenges addressing the objectives.

Review of Literature:
DPT educators frequently use core curriculum guidelines (CGs) that articulate entry-level knowledge and skills to determine competencies. No such guidelines existed for EBP in 2012 leading to the EBP-CG development to assist educators. Few CGs have been studied for their impact on content standardization. A mixed methods design was chosen to more completely describe this CG's impact.

Subjects:
Faculty teaching EBP in US accredited DPT programs.

Methods:
A mixed-methods design explored what EBP-CG objectives are addressed, to what expected mastery levels, and how faculty use the document.

Results:
Eighty-three of 252 accredited programs completed the survey; 14 respondents were interviewed. The EBP-CG was valued and viewed as reflecting curricular content. Its 33 objectives were taught by most respondents at knowledge and practice levels with independent mastery expected for 7. Interviewees described EBP as commonly practiced through group over individual projects. More EBP curriculum credits predicted more objectives taught (R = .29, R

2
= .09, P = .03) and expected for mastery (R = .28, R

2
= .08, P = .04). No interviewees shared the EBP-CG with clinical partners or Directors of Clinical Education; EBP carryover from classroom to practice is unknown.

Discussion and Conclusion:
Respondents confirmed that the EBP-CG objectives were useful and consistent with curricular content. Four EBP preparation gaps were identified: 1) limited EBP-CG awareness by faculty who teach EBP, 2) use of group over independent projects to practice EBP, 3) communication gaps between academic and clinical education settings about the EBP-CG, and 4) no consensus on minimum EBP competencies.
Motivational Interviewing Education and Utilization in US Physical Therapy
Authors: Kruger Eric , Granzow Rachel 
Published: February 2023

Introduction.
In physical rehabilitation, motivational interviewing (MI) can improve treatment adherence and therapeutic outcomes. The objective of this study was to investigate the relationship between MI education and use of MI skills in physical therapy practice in the United States.

Review of Literature.
Motivational interviewing is an empirically supported technique for facilitating behavior change. Numerous studies have examined its use in physical rehabilitation settings. No research has examined education and utilization of MI in physical therapy in the United States.

Subjects.
Physical therapists (PTs) in the United States (N = 785) responded to an electronic survey distributed through the special interest academies and state chapters of the American Physical Therapy Association.

Methods.
Descriptive, correlational, and group comparisons were used to analyze the survey responses about MI utilization in clinical practice, characteristics of MI training, and self-reported use of MI communication skills.

Results.
Two-thirds of the sample reported using MI and half of the sample received training in MI. Motivational interviewing training was heterogeneous, with interactive elements superior to lecture alone. Interestingly, training received in PT education programs correlated negatively with the use of the MI skills assessed in this study. Use of MI skills significantly correlated with increased perceived patient adherence and decreased struggle with patients.

Discussion and Conclusion.
Incorporation of MI into physical therapy practice has the potential to improve patient care through increased therapeutic rapport, improvement of health outcomes associated with behavior change, and improved job satisfaction. Although MI is becoming more prevalent in physical therapy practice in the United States, the results of this study suggest that MI education should include dynamic components to increase the effective use of MI skills in clinical practice.
Long-Term Follow-up of Disabled Patients With Chronic Pancreatitis
Authors: Liyen Cartelle Anabel , Shah Ishani , Bocchino Rachel , Ahmed Awais , Freedman Steven D. , Kothari Darshan J. , Sheth Sunil G. 
Published: February 2023

Background/Aims:
Patients with chronic pancreatitis (CP) often report a poor quality of life and may be disabled. Our study identifies clinical characteristics, predictors and outcomes in CP patients with disability.

Methods:
A review of established CP patients followed in our Pancreas Center between January 1, 2016 and April 30, 2021. Patients were divided into 2 groups based on disability. Univariate analysis was performed to identify differences in demographics, risk factors, comorbidities, complications, controlled medications, and resource utilization. Multivariate analysis was conducted to identify predictors for disability.

Results:
Out of 404 CP patients, 18% were disabled. These patients were younger (53.8 vs. 58.8, P=0.001), had alcoholic CP (54.1% vs. 30%; P<0.001), more recurrent pancreatitis (83.6% vs. 61.1%; P=0.001), chronic abdominal pain (96.7% vs. 78.2%; P=0.001), exocrine pancreatic insufficiency (83.6% vs. 55.5%; P<0.001), concurrent alcohol (39.3% vs. 23.3%; P=0.001) and tobacco abuse (42.6% vs. 26%; P=0.02), anxiety (23% vs. 18.2%; P<0.001), and depression (57.5% vs. 28.5%; P<0.001). A higher proportion was on opiates (68.9% vs. 43.6%; P<0.001), nonopiate controlled medications (47.5% vs. 23.9%; P<0.001), neuromodulators (73.3% vs. 44%; P<0.001), and recreational drugs (27.9% vs. 15.8%; P=0.036). Predictors of disability were chronic pain (OR 8.71, CI 2.61 to 12.9, P< 0.001), celiac block (OR 4.66, 2.49 to 8.41; P<0.001), neuromodulator use (OR 3.78, CI 2.09 to 6.66; P<0.001), opioid use (OR3.57, CI 2.06 to 6.31; P< 0.001), exocrine pancreatic insufficiency (OR3.56, CI 1.89 to 6.82; P<0.001), non-opioid controlled medications (OR 3.45, CI 2.01 to 5.99; P<0.001), history of recurrent acute pancreatitis (OR 2.49, CI 1.25 to 4.77; P<0.001), depression (OR 2.26, CI 1.79 to 3.01; P <0.001), and active smoking (OR1.8, CI 1.25 to 2.29; P<0.001).

Conclusion:
CP patients with disability have unique characteristics and predictors, which can be targeted to reduce disease burden and health care expenditure in this population.
Disparities in Emergency Department Waiting Times for Acute Gastrointestinal Bleeding
Authors: Aghaie Meybodi Mohamad , Shaikh Amjad , Hashemipour Reza , Ahlawat Sushil 
Published: February 2023

Objective:
The primary aim of this study was to assess waiting time (WT) across different racial groups to determine whether racial disparities exist in patients presenting with gastrointestinal bleeding (GIB) to the United States emergency departments (EDs).

Methods:
Using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2009 to 2018, we compared WT of patients with GIB across different racial/ethnic groups, including nonhispanic white (NHW), African American (AA), Hispanic White (HW), and Nonhispanic other. Multinomial logistic regression was applied to adjust the outcomes for possible confounders. We also assessed the trend of the WT over the study interval and compared the WT between the first (2009) and last year (2018) of the study interval.

Results:
There were an estimated 7.8 million ED visits for GIB between 2009 and 2018. Mean WT ranged from 48 minutes in NHW to 68 minutes in AA. After adjusting for gender, age, geographic regions, payment type, type of GI bleeding, and triage status, multinomial logistic regression showed significantly higher waiting time for AA patients than NHW (OR 1.01, P=0.03). The overall trend showed a significant decrease in the mean WT (P value<0.001). In 2009, AA waited 69 minutes longer than NHW (P value<0.001), while in 2018, this gap was erased with no statistically significant difference (P value=0.26).

Conclusion:
Racial disparities among patients presenting with GIB are present in the United States EDs. African Americans waited longer for their first visits. Over time, ED wait time has decreased, leading to a decline in the observed racial disparity.
Plaque Progression Differences Between Apixaban and Rivaroxaban in Patients With Atrial Fibrillation Measured With Cardiac Computed Tomography and Plaque Quantification
Authors: Aldana-Bitar Jairo , Moore Jeff , Manubolu Venkat Sanjay , Dahal Suraj , Verghese Dhiran , Lakshmanan Suvasini , Hussein Luay , Crabtree Tami , Jonas Rebecca , Min James K. , Earls James P. , Budoff Matthew J. 
Published: February 2023

Background:
Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.

Study Question:
In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?

Study Design:
This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5–5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.

Measures and Outcomes:
Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).

Results:
Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm3, NCP 69.7 mm3, and LD-NCP 27.2 mm3; rivaroxaban: CP 22.9 mm3, NCP 66.3 mm3, and LD-NCP 11.0 mm3) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban (P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant (P = 0.04).

Conclusions:
In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.
Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review
Authors: Elliott James E.G. , Roldao Pereira Luisa , Bell Kim S. , Barnden Tristan 
Published: February 2023

Objective
This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP.

Methods
PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP.

Results
Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications.

Conclusion
This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.