bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Shielding Guideline for Pediatric Patients Receiving Intraoperative Ionizing Radiation
Authors: Stoner Heather , Falyar Christian , Hooge Nicolette , Pitman Jessica , Thompson Julie A. , Sattin Sarah , Funk Emily M. 
Published: February 2023

Introduction Approximately 350 million diagnostic radiation imaging procedures are performed on pediatric patients annually. This population is at a greater risk of developing cancer after exposure to ionizing radiation because of a higher intake, accumulation, and increased sensitivity to radiation as well as a long-life expectancy postexposure. Methods This quality improvement project used convenience sampling with a pre–post design to evaluate two independent samples: (a) pediatric intraoperative staff members including registered nurses and scrub technicians and (b) pediatric patients receiving intraoperative ionizing radiation imaging. Outcome measures included pediatric intraoperative staff knowledge and confidence of education for intraoperative shielding (preimplementation: n = 9; postimplementation: n = 6). Shielding audits were performed to assess for frequency of shield placement to radiosensitive organs and accuracy of shield placement (preimplementation: n = 26; postimplementation: n = 27). Results Data analysis showed improvement in staff confidence related to gonad shield placement ( p = .013) and self-reported frequency of gonad shield use ( p = .032). Knowledge scores showed nonsignificant improvement ( p = .076). Shielding audits showed statistically significant improvement in shield placements for thyroid, gonads, and breast tissue ( p < .05). Discussion The pediatric population has unique characteristics to consider when making decisions about shielding practice. This project discusses these characteristics, considerations for “exception-based shielding,” and how to improve the rates of shielding in situations where the practice is appropriate.
Patient-Centered Paradigm for Managing Autonomic Long COVID Symptoms During Sports and Exercise
Authors: Messinger-Rapport Barbara , Grubb Blair 
Published: February 2023

Abstract:
This report highlights a new, patient-centered paradigm for managing post–COVID-19 dysautonomia symptoms during sports and exercise. The patient was a healthcare worker exposed before vaccination. She experienced postural orthostatic tachycardia plus exertional tachycardia, with postexertional fatigue, beginning a few weeks after testing positive for COVID-19. Stress test, echo, and an extensive dysautonomia evaluation were negative. Recommended nonpharmacological and pharmacological interventions were poorly tolerated. Prescription of a novel regimen of “basal-dose” ivabradine, plus very low-dose metoprolol according to an exertional “sliding scale” managed symptoms to an acceptable level for work and recreation.
A Transformative Leadership Journey: Experiences of Graduates of the American Physical Therapy Association Fellowship in Education Leadership
Authors: Jette Diane U. , Nordstrom Terrence M. , Gresham Barbara , Peel Claire , Majsak Michael J. , Mohr Thomas 
Published: February 2023

Introduction.
Physical therapy education has an acute need for effective leaders due to multiple factors, including increasing numbers of programs and retirement of experienced leaders. Recognizing the need for formal leadership education, the American Physical Therapy Association (APTA) developed a fellowship in physical therapy educational leadership in 2011. This study aimed to understand participants' perceptions of their leadership experience and the role of the APTA fellowship.

Literature Review.
A commonly reported approach to evaluating leadership education programs was designed by Kirkpatrick.

Participants.
Twenty-five fellowship graduates from 2012 to 2019 participated.

Methods.
We used a qualitative methodological approach incorporating a heuristic technique to gain an understanding of fellowship graduates' long-term perspectives. Semi-structured interviews were conducted via Zoom. Data were analyzed using thematic analysis.

Results.
Three themes were constructed using a journey metaphor: embarking on the journey, engaging in the journey, and realizing the effects of the journey. 1) Embarking on the journey included 2 subthemes: a) participants' personal aspirations as career planners, reluctant leaders, or explorers; and b) institutions' goals for a change in leadership or intentional succession planning. 2) Engaging in the journey included 3 subthemes: a) the fellowship learning environment builds a sense of community; b) consideration of leadership frames influences participants' thinking about leadership; and c) participants' institutional environment influences their learning. 3) Effects of the journey included 3 subthemes: a) personal growth as a leader including personal awareness and confidence; b) institutions' benefits from participants' leadership projects and increased engagement in institutional leadership; and c) physical therapy professions' gains from participants' seeking leadership positions in professional organizations.

Discussion/Conclusions.
The APTA Fellowship in Educational Leadership results in transformative change of participants as leaders. Findings offer guidance to individuals considering embarking on a leadership journey and institutions considering how to prepare and support emerging leaders in physical therapy education.
Developing a Transformative Praxis-Based Curriculum to Educate Physical Therapy Students for Social Responsibility: A Philippine Qualitative Case Study
Authors: Palad Yves Y. , Armsby Pauline , Qualter Anne 
Published: February 2023

Introduction.
Physical therapy (PT) academic institutions are called upon to strengthen their transformative role in developing more socially responsible graduates. Study objectives were to explore faculty perspectives on educating PT students for social responsibility (SR) and to identify strategies for improvement.

Review of Literature.
Adopting a “curriculum as praxis” orientation for curriculum development supports educating for SR because of its focus on transforming self and the world through recurring critical reflection and action. To complement the curriculum, ensuring SR in the entire academic environment, including institutional structures and capable educators, will enrich student development.

Subjects.
Six PT educators from a Philippine university with distinct SR mandates were purposively invited to participate based on their key involvements in various aspects of educating for SR.

Methods.
A participatory approach guided the methods to encourage collaborative creation of practical knowledge. Participant perspectives were gathered through focus group discussions, which were informed by research on SR in Philippine PT. Discussions were transcribed and then subjected to thematic analysis.

Results.
Three themes highlighted main areas for practice improvement: 1) strengthening curricular focus on SR through a whole-of-curriculum approach to incorporating opportunities for cognitive learning on SR and praxis (reflection and action); 2) maximizing institutional programs by helping students recognize them as further opportunities for developing SR; 3) and ensuring faculty has the capacity to educate for SR.

Discussion and Conclusion.
Educating for SR requires a transformative curriculum supported by aligned institutional programs and capable educators. This study enjoins PT educators to ensure a strong SR agenda in their PT programs by analyzing and acting on the transformative purpose of their curricula, including the influence of institutional structures, and support needed by educators to enable students to respond to the needs of the society they serve.
Postradiotherapy Urinary Extracellular Vesicle Concentrations Predict Late Bladder Toxicity in Patients with Prostate Cancer
Authors: Molony Ryan D. , Kerns Sarah L. , Marples Brian , Oshodi Emmanuel , Chen YuhChyau , Lee Yi-Fen 
Published: February 2023

Purpose:
Radiotherapy (RT) is a standard-of-care option for over 50% of patients with prostate cancer (PCa), but up to 25% develop delayed bladder toxicities months to years after treatment. Late radiation cystitis is a form of dose-limiting toxicity that can cause hematuria and other potentially severe symptoms, leading to further morbidity and decisional regret. Additional work is needed to define early biomarkers of late radiation cystitis to better guide patient care. Extracellular vesicles (EVs) are stable membrane-enclosed particles that are released from diverse cell types and are present at high levels in biofluid samples. This study was developed to explore the relationships between late hematuria incidence and urinary and serum EV concentrations analyzed in a cohort of patients with PCa undergoing RT.

Materials and Methods:
We analyzed EV profiles of preserved urine and serum samples from a longitudinal study of bladder toxicity in 30 patients with PCa undergoing standard-of-care pelvic RT. EVs in these samples were quantified through nanoparticle tracking analyses. EV concentrations at different collection time points were then compared between patients who did and did not develop hematuria.

Results:
RT was found to significantly increase urinary EV concentrations relative to pre-RT levels in patients who subsequently developed late hematuria, whereas such EV induction was absent in patients without hematuria. The same effect was evident but less robust in patient serum samples.

Conclusion:
These results suggest that RT-induced changes in EV dynamics may offer value as a robust biomarker that can predict the risk of late radiation cystitis months before overt symptom presentation.
Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time
Authors: Harrington Claire R. , Levy Paul , Cabrera Elizabeth , Gao Jing , Gregory Dyanna L. , Padilla Cynthia , Crespo Gonzalo , VanWagner Lisa B. 
Published: February 2023

Major adverse cardiovascular events (MACEs) are the leading cause of early (<1 y) complications after liver transplantation (LT). NASH, the leading indication for waitlisting for LT, is associated with high cardiac risk factor burden. The contemporary prevalence and temporal trends in pretransplant cardiac risk factor burden and post-LT MACE among LT recipients (LTRs) with and without NASH are unknown. The aim of this study was to evaluate (1) the evolution of post-LT cardiac risk factors in LTRs over time and (2) post-LT MACE over time, stratified by NASH status. This is a retrospective cohort of 1775 adult LTRs at a single transplant center (2003–2020). MACE was defined as death or hospitalization from myocardial infarction, revascularization, stroke, heart failure during the first post-LT year. Between 2003 and 2020, there was a significant increase in pre-LT NASH (p
trend <0.05). There was also a significant increase in pre-LT obesity, atherosclerotic cardiovascular (CV) disease, and older age (≥65 y old) (p
trend<0.05 for all). There was no significant change in the proportion of LTRs with diabetes, chronic kidney disease, or heart failure. Unexpectedly, there were no changes in the rate of post-LT MACE over the study period (−0.1% per year, p
trend=0.44). The lack of change in MACE despite an increase in CV risk factor prevalence may reflect advancement in the identification and management of CV risk factors in LTRs. With projected continued increase in cardiac risk burden and the proportion of patients transplanted for NASH, it is critical for LT programs to develop and implement quality improvement efforts to optimize CV care in LTRs.
Systematic Review and Meta-analysis for Surgery Versus Stereotactic Radiosurgery for Jugular Paragangliomas
Authors: Campbell James C. , Lee Jessica W. , Ledbetter Leila , Wick Cameron C. , Riska Kristal M. , Cunningham Calhoun D. , Russomando Alessandra C. , Truong Tracy , Hong Hwanhee , Kuchibhatla Maragatha , Kaylie David M. 
Published: February 2023

Objective
Comprehensively analyze tumor control and treatment complications for jugular paraganglioma patients undergoing surgery versus stereotactic radiosurgery (SRS).

Databases Reviewed
EMBASE, Medline, and Scopus.

Methods
The databases were searched for English and Spanish articles from January 1, 1995, to January, 1, 2019, for studies reporting tumor control and treatment side effects regarding patients with jugular paraganglioma treated with surgery or SRS. Main outcome measures included short-term and long-term tumor recurrence, as well as postintervention complications.

Results
We identified 10,952 original abstracts, 705 eligible studies, and 107 studies for final data extraction. There were 3,498 patients—2,215 surgical patients and 1,283 SRS patients. Bayesian meta-analysis was applied to the extracted data, with tau measurements for study heterogeneity. SRS tumors were larger (3.9 cm3 versus 8.1 cm3). Meta-analysis results demonstrated low rates of long-term recurrence for both modalities (surgery, 15%; SRS, 7%), with SRS demonstrating lower rates of postintervention cerebrospinal fluid leak, dysphagia, and cranial nerve Vll, lX, X, Xl, or Xll palsies.

Conclusions
This study demonstrates excellent control of jugular paragangiomas with both surgery and SRS, with higher rates of lower cranial neuropathies, dysphagia, and cerebrospinal fluid leaks among surgical patients.
Readability and Quality of English and Spanish Online Health Information about Cochlear Implants
Authors: Nix Evan , Willgruber Abbigayle , Rawls Chase , Kinealy Brian P. , Zeitler Daniel , Schuh Marissa , Bush Matthew 
Published: February 2023

Objective
According to the American Medical Association, Internet web site health information should be written at or below a 6th grade reading level. The purpose of this study was to evaluate the readability and quality of cochlear implant web site health information.

Study Design
Cross-sectional web site analysis.

Setting
Four Internet search engines involving the top 200 web sites (English and Spanish).

Intervention/Methods
“Cochlear implant” was queried in four Internet search engines, and the top 200 English and Spanish web sites were aggregated. After removing duplicates, the web sites were evaluated for readability by using the following validated online readability calculators: Flesch Reading Ease score for English web sites and the Fernandez–Huerta Formula for Spanish web sites. Information quality was assessed using the validated DISCERN quality criteria and the presence of Health on the Net Code of Conduct (HONcode) certification.

Results
A total of 80 non-industry-sponsored (43 English and 37 Spanish) and 11 industry-sponsored (4 English and 7 Spanish) cochlear implant health information web sites were included in the study. English web sites were written at a higher reading level (mean = 50.88, SD = 11.98) compared with Spanish web sites (mean = 59.79, SD = 6.04) (p < 0.01). For both English and Spanish web sites, these scores correlate to the reading level of the average 10th to 12th grade student. Only 12% of Spanish web sites and 27% of English web sites were HONcode certified. The average DISCERN quality score was 41.67 for English web sites and 43.46 for Spanish, indicating significant concerns for quality. There was no association found between readability and quality of the web sites analyzed.

Conclusions
Patient-directed English and Spanish web sites regarding cochlear implantation were written at reading levels that significantly exceed those recommended by the AMA. Furthermore, these web sites have significant quality shortcomings. Patients would benefit from more rigorous editing to improve readability and quality of content.
Institutional Experience With Cochlear Implants Falling Under the 2020 FDA Corrective Action
Authors: Schwam Zachary G. , Perez Enrique , Goldin Lisa , Wong Kevin , Fan Caleb , Oh Samuel , Wanna George B. , Cosetti Maura K. 
Published: February 2023

Objective
To determine the rate of device failure for those cochlear implants falling under the 2020 Food and Drug Administration (FDA) voluntary corrective action.

Study Design
Retrospective chart review.

Setting
Tertiary otology-neurotology practice.

Patients
Those with cochlear implant failure falling under the FDA corrective action.

Interventions
Cochlear implant explant and reimplantation.

Outcome Measures
Reason for cochlear implant failure, time to failure, symptoms of failure, and benefit from reimplantation.

Results
The overall failure rate was 20.0% (18 of 90 ears); of the failures, 15 of 18 (83.3%) were hard device failures, and 3 of 18 (16.7%) were medical or surgical failures. All hard device failures were confirmed with integrity testing as performed by the company. The average time to integrity testing was 38.0 months. Of the hard failures, 14 of 15 had successful initial activation and benefit. Lack of expected progress was seen in 7 of 15 and a sudden decline in function in 8 of 15. Electrodes 9 to 16 were most often defunct. Significant drops in speech perception were often seen in device failure cases. Three medical/surgical failures were explanted; one had migration of the receiver/stimulator causing discomfort, and the other two had electrode migration after partial insertion. Of the reimplanted patients, 11 of 12 are deriving benefit from their new devices.

Conclusions
The rate of device failure for the cochlear implants of interest is significantly higher in our series than reported in the initial FDA voluntary field corrective action publication.
Hearing After Vestibular Schwannoma Surgery: Is It Preserved Forever?
Authors: Fik Zdenek , Zverina Eduard , Lisy Jiri , Balatkova Zuzana , Vlasak Ales , Chovanec Martin , Lazak Jan , Tesarova Michaela , Peterkova Lenka , Betka Jan 
Published: February 2023

Introduction
Currently, it is possible to preserve the auditory nerve in a large number of cases, but the preservation of the hearing itself is unpredictable. Apart from wait and scan strategy and stereoradiotherapy, hearing after vestibular schwannoma surgery is considered to remain stable even in long-term follow-up.

Materials and Methods
Twenty-eight patients had preserved hearing after retrosigmoid suboccipital microsurgery of the vestibular schwannoma between 2008 and 2014. A standard audiological protocol was performed together with an magnetic resonance imaging evaluation of the fluid content of the inner ear.

Results
The mean difference in pure-tone average between the direct and final postsurgical examination was 12.758 dB (p = 2.5E − 06). The word recognition score deteriorated by 17.45% (p = 0.03516). The mean American Academy of Otolaryngology–Head and Neck Surgery score on the second examination was 2.5, and that on the second examination was 3.111 (p = 0.00483). There was no significant deterioration in the healthy ear.
The signal intensity ratio in the basal turn of the cochlea increased by an average of 0.13 points (p < 0.05).
Patients with persistent tumor or nodular enhancement in the internal acoustic meatus deteriorated significantly in hearing according to the American Academy of Otolaryngology–Head and Neck Surgery scale compared with patients without any finding in the meatus (p = 0.01299).

Conclusions
There is a discrete but gradual deterioration of the hearing in the postoperative period. Hearing impairment is more pronounced in patients with a nodular process in the internal acoustic meatus, regardless of whether it is growth active. After surgery, the pathological content of the inner ear normalizes (evaluated on T2 magnetic resonance imaging sequences).
Predictors of Short-Term Changes in Quality of Life after Cochlear Implantation
Authors: Walia Amit , Bao James , Dwyer Noel , Rathgeb Susan , Chen Stephanie , Shew Matthew A. , Durakovic Nedim , Herzog Jacques A. , Buchman Craig A. , Wick Cameron C. 
Published: February 2023

Objective
This study aimed 1) to measure the effect of cochlear implantation on health-related quality of life (HR-QOL) using the Cochlear Implant Quality of Life (CIQOL) questionnaire and 2) to determine audiologic, demographic, and non-CI/hearing-related QOL factors influencing the CIQOL.

Study Design
Prospective observational study.

Setting
Tertiary referral center.

Patients and Interventions
Thirty-seven adult patients with sensorineural hearing loss undergoing cochlear implantation.

Main Outcome Measure(s)
CIQOL-global score preimplantation and 6 months postimplantation. Physical function score as measured by the short-form survey, audiologic, and demographic variables.

Results
CIQOL showed significant improvement from preimplantation to 6 months postactivation with a mean difference of 14.9 points (95% confidence interval, 11.3 to 18.5, p < 0.0001). Improvement in CIQOL (ΔCIQOL) correlated linearly with age (r = −0.49, p = 0.001) and improvement in speech perception testing (r = 0.63, p < 0.0001). Multivariate modeling using age and change in consonant–vowel nucleus–consonant (CNC) score explained 46% of the variability measured by the ΔCIQOL-global score.

Conclusions
Nearly all CI recipients achieve significant gains for all domains as measured by the CIQOL. However, younger patients and those with a greater improvement in speech perception performance (CNC) are more likely to achieve a greater CIQOL benefit. Results here suggest the importance of considering preoperative CIQOL and speech perception measures when evaluating predictors of HR-QOL.
Psychometric Properties of the Short Version of the Activities-Specific Balance Confidence Scale in Vestibular Patients
Authors: Castillejos-Carrasco-Muñoz Rodrigo , Ibáñez-Vera Alfonso Javier , Peinado-Rubia Ana Belén , Tapia-Toca Maria Cruz , Paez-Mantilla Daniela , Lomas-Vega Rafael 
Published: February 2023

Background
This study aimed to analyze the psychometric properties of the Activities-specific Balance Confidence Scale Short Version (ABC-6) in vestibular patients.

Methods
The sample consisted of 87 subjects aged over 18 years with vestibular pathology. Construct validity, internal consistency, test-retest reliability, concurrent validity, and capacity to discriminate between subjects with or without risk of falling as measured with the ABC-16 standard version were analyzed.

Results
The ABC-6 showed a unifactorial structure. Cronbach's alpha was 0.873. The reliability was moderate for each of the items and substantial for the total score (intraclass correlation coefficient = 0.778). The standard error of measurement was 10.24, with a minimum detectable change of 20.07. The ABC-6 version showed a strong correlation with physical and functional measures, moderate correlation with emotional measures, and poor correlation with the Physical Component Summary of SF-12 and retrospective 12-month falls. A cutoff point ≤55 showed a sensitivity = 94.44% and a specificity = 92.75% in differentiating between patients with or without risk of falling measured with the ABC-16 standard version, with an area under the curve = 0.975.

Conclusions
The ABC-6 showed acceptable psychometric properties for measuring balance confidence and risk of falling in vestibular patients.