bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applicability of the Modified Fels and Optimized Oxford Skeletal Maturity Estimation Systems to the Modern Pediatric Population
Authors: Furdock Ryan J. , Kuo Andy , Chen Kallie J. , Benedick Alexander J. , Liu Raymond W. 
Published: December 2022

Background:
The recently developed modified Fels knee and optimized Oxford hip skeletal maturity systems (SMS) have demonstrated impressive performance compared with the Greulich and Pyle skeletal age atlas when applied to the same historical, mostly white, pediatric population. We sought to determine whether these 2 systems require modification before being used in modern children.

Methods:
We collected knee and hip radiographs between January 2015 and September 2020 from our electronic medical record from 4 groups of children: (1) white males, (2) black males, (3) white females, and (4) black females. Males between 9 and 17 years and females between 7 and 15 years were included. After reliability analyses, 5 nonpathologic radiographs for each age and joint were randomly selected from each group and evaluated with the appropriate SMS. The mean discrepancy between each group’s chronological age at the time of radiograph and estimated skeletal age was compared between our modern cohort and the historical Bolton-Brush children. After normality testing, paired t tests or Wilcoxon signed-rank tests were performed, as appropriate. A Bonferroni correction was applied to address multiple testing.

Results:
Three hundred sixty modern radiographs were evaluated (180 knees and 180 hips). All 7 modified Fels knee parameters and all 5 optimized Oxford hip parameters had inter and intrarater reliability coefficients ≥0.7, indicating good to very good reliability. For the modified Fels knee SMS, white males (Δ0.74 y, P<0.001), black males (Δ0.69 y, P<0.001), and black females (Δ0.4 y, P=0.04) had advanced skeletal age compared with their historical counterparts of the same sex. No differences were found between historical and modern patients for the optimized Oxford hip SMS. No differences were found for either SMS comparing modern patients along racial lines (P>0.05 for all).

Conclusions:
Discrepancies in skeletal age estimates made by the modified Fels knee SMS exist between modern pediatric white males, black males, and black females and their historic counterparts. No differences were found when using optimized Oxford hip SMS. Future studies should evaluate how these translate to clinical decision-making.

Level of Evidence:
Level III; retrospective chart review.
Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach
Authors: Goodman Courtney F. , Mittal Rhiya , Awidi Abdelhalim , Vanner Elizabeth A. , Han Elaine , Daoud Yassine J. , Koo Ellen H. 
Published: December 2022

Purpose:
The aim of this study was to compare the outcomes of staged versus combined surgical approach for secondary intraocular lens (IOL) implantation and Descemet stripping endothelial keratoplasty (DSEK).

Methods:
This is a retrospective review of 124 eyes from 124 patients who underwent either staged or combined secondary IOL implantation in addition to DSEK over a 5-year period at 2 academic tertiary referral centers, between January 1, 2014, and October 1, 2019. Corrected distance visual acuity (CDVA), presence of graft detachment, primary graft failure (PGF), and cystoid macular edema were documented and analyzed.

Results:
The CDVA for the 1- to 2- month follow-up period was significantly better in the staged group compared with the combined group (P = 0.011). By the postoperative 6- to 9-month follow-up period, there was no significant difference in the CDVA between the groups (P = 0.591). There was no significant difference in the incidence of PGF or graft detachment between the 2 groups (P > 0.05). In addition, there was no significant difference in the CDVA or rate of postoperative complications between the different methods of IOL fixation.

Conclusions:
The short-term visual outcomes were significantly better in eyes that underwent staged secondary IOL implantation and DSEK versus the combined surgical approach, although the difference was no longer present at 6 to 9 months. There was no difference in the rate of PGF or graft detachment between the 2 groups.
Congenital Cytomegalovirus Infection and Hearing Outcomes in Twins: A Systematic Review of Reported Cases
Authors: Cordray Holly , Liu-Lam Oliver , Tey Ching Siong , Alfonso Kristan 
Published: December 2022

Objective
Congenital cytomegalovirus infection is the leading nonhereditary cause of pediatric sensorineural hearing loss. This systematic review evaluated infection concordance and comparative hearing abilities in twins/multiple births to model infection patterns.

Databases Reviewed
PubMed, Embase, Web of Science, and Google Scholar.

Methods
Studies that reported hearing outcomes of congenital cytomegalovirus infection in at least one multiple birth were eligible. Concordant infections (both twins) and discordant infections (single twin) were included. Multiple reviewers performed data extraction and quality assessment. Analyses involved relative risk of infection concordance by zygosity and chorionicity and odds of hearing loss by infection concordance. Hearing outcomes were compared between siblings.

Results
Of 247 studies screened, 31 were included (74.2% high quality). The review captured 40 eligible multiple births. Among infected patients, 42.9% (95% confidence interval, 31.2–55.2%) demonstrated hearing loss. All uninfected twins had normal hearing. Most infections were concordant, and infected patients experienced 4.11 (1.18–14.36) times greater odds of hearing loss if their twin was also infected (p = .02). Yet siblings’ hearing outcomes diverged in over 40% of concordant cases. If either twin is infected, infection risk in the second twin is 3.25 (1.83–5.79) times greater in monozygotic than dizygotic twins and 2.50 (1.61–3.88) times greater in monochorionic than dichorionic twins (both p < .001). We describe a case from our practice.

Conclusion
Congenital cytomegalovirus infection patterns and hearing outcomes can vary widely even within a shared fetal and postnatal environment. Suspected infection in a twin indicates that both should receive testing and continued monitoring for late-onset sequelae.
Evaluation of Disturbances in Hearing, Tinnitus, and Vestibular Symptoms as Signs of COVID-19 Infection
Authors: Africa Robert E. , Westenhaver Zack K. , Zimmerer René E. , McKinnon Brian J. 
Published: December 2022

Background
There have been reports and studies indicating audiovestibular disturbances in COVID-19 patients with variations in the percentage of sensorineural hearing loss (SNHL). The purpose of this study is to compare the incidence of newly diagnosed SNHL, sudden idiopathic hearing loss (SIHL), tinnitus, and vestibular disturbances between infected and uninfected patients, as well as to identify population groups at risk.

Methods
This study used TriNetX to obtain statistics on COVID-19 (+) and COVID-19 (−) patients from 61 healthcare organizations. Propensity score with 1:1 matching was used to control confounding variables. This study evaluated the relative risk of developing audiovestibular disturbances up to 1 month after a COVID-19 test and further investigated the incidence in COVID-19 (+) subset groups.

Results
Between COVID-19 (+) and COVID-19 (−) patients who had an audiogram, there was no statistically significant difference in SNHL or SIHL (SNHL: relative risk [RR] = 0.69, 95% confidence interval [CI] = 0.46–1.04; SIHL: RR = 1.00, 95% CI = 0.42–2.40). Race/ethnicity or specified comorbidity did not affect the incidence of SNHL or SIHL. There was a statistically significant difference in tinnitus and vestibular disturbances between the COVID-19 (+) and the COVID-19 (−) groups (RR = 1.29, 95% CI = 1.01–1.66; RR = 2.33, 95% CI = 2.19–2.48).

Conclusion
New onset hearing loss is not more common in patients with a positive COVID-19 test than those with a negative COVID-19 test. Audiologic evaluation is needed to verify reported hearing disturbances. Although statistically significant in specific population groups, tinnitus and vestibular disturbances may not be clinically significant due to the low incidence.
Public Perception of Ménière’s Disease: A Social Media Analysis
Authors: Hamdi Osama A. , Bellinger Jeffrey R. , Wright Garrison P. , Churnin Ian T. , Strumpf Andrew M. , Casazza Geoffrey C. , Kesser Bradley W. 
Published: December 2022

Objective
To analyze tweets associated with Ménière’s disease (MD), including type of users who engage, change in usage patterns, and temporal associations, and to compare the perceptions of the general public with healthcare providers.

Methods
An R-program code, academictwitterR API, was used to query Twitter. All tweets mentioning MD from 2007 to 2021 were retrieved and analyzed. Valence Aware Dictionary and Sentiment Reasoning was used as a model to assess sentiment of tweets. Two reviewers assessed 1,007 tweets for qualitative analysis, identifying the source and the topic of the tweet.

Results
A total of 37,402 tweets were analyzed. The number of tweets per user ranged from 1 to 563 (M = 33.7, SD = 91.1). Quantitative analysis showed no temporal or seasonal association; however, tweeting increased when celebrities were diagnosed with MD. Of the 1007 representative tweets analyzed, 60.6% of tweets came from the general public and were largely of negative sentiment focusing on quality of life and support, whereas healthcare providers accounted for 23% of all tweets and focused on treatment/prevention. Tweets by news sources accounted for the remaining 13% of all tweets and were primarily positive in sentiment and focused on awareness.

Conclusions
MD is commonly tweeted about by the general public, with limited input regarding the disease from healthcare providers. Healthcare providers must provide accurate information and awareness regarding MD, especially when awareness is highest, such as when celebrities are diagnosed.

Level of Evidence
Level IV.
Indicate IRB or IACUC
Not applicable.
COVID-19, HIV, and Syphilis Contact Tracing: What have we learned and where are we headed?
Authors: Sachdev Darpun , Chew Ng Rilene A. , Hernandez Katherine , Nguyen Trang Quyen , Cohen Stephanie E. 
Published: December 2022

Abstract
Contact tracing is a core public health intervention for a range of communicable diseases, in which the primary goal is to interrupt disease transmission and decrease morbidity. In this paper, we present lessons learned from COVID-19, HIV, and syphilis in San Francisco to illustrate factors that shape the effectiveness of contact tracing programs, and to highlight the value of investing in a robust disease intervention workforce with capacity to pivot rapidly in response to a range of emerging disease trends and outbreak response needs.
The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery
Authors: Hallet Julie , Jerath Angela , Perez d’Empaire Pablo , Eskander Antoine , Carrier François M. , McIsaac Daniel I. , Turgeon Alexis F. , Idestrup Chris , Flexman Alana M. , Lorello Gianni , Darling Gail , Kidane Biniam , Kaliwal Yosuf , Barabash Victoria , Coburn Natalie , Sutradhar Rinku 
Published: December 2022

Objective:
To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity.

Background:
Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown.

Methods:
We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3–5). Scatterplots visualized the relationship between each hospital’s adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression.

Results:
For 7893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0% to 87.6%, and of major morbidity from 38.2% to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson: −0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio: 0.96; 95% CI, 0.95–0.98; P<0.001 for each 10% increase in the high-volume rate).

Conclusions:
Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital’s rate of major morbidity.
Emergency Department Pediatric Readiness Among US Trauma Centers
Authors: Newgard Craig D. , Babcock Sean R. , Song Xubo , Remick Katherine E. , Gausche-Hill Marianne , Lin Amber , Malveau Susan , Mann N. Clay , Nathens Avery B. , Cook Jennifer N. B. , Jenkins Peter C. , Burd Randall S. , Hewes Hilary A. , Glass Nina E. , Jensen Aaron R. , Fallat Mary E. , Ames Stefanie G. , Salvi Apoorva , McConnell K. John , Ford Rachel , Auerbach Marc , Bailey Jessica , Riddick Tyne A. , Xin Haichang , Kuppermann Nathan ,   On behalf of the Pediatric Readiness Study Group
Published: December 2022

Objective:
We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers.

Background:
ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown.

Methods:
This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival.

Results:
There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%–2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present.

Conclusions:
ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.
Association of Health Professional Shortage Area Hospital Designation With Surgical Outcomes and Expenditures Among Medicare Beneficiaries
Authors: Mullens Cody L. , Lussiez Alisha , Scott John W. , Kunnath Nicholas , Dimick Justin B. , Ibrahim Andrew M. 
Published: December 2022

Objective:
To compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries.

Background:
More than a quarter of Americans live in federally designated Health Professional Shortage Areas. Although there is growing concern that medical outcomes may be worse, far less is known about hospitals providing surgical care in these areas.

Methods:
Cross-sectional retrospective study from 2014 to 2018 of 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair. We assessed risk-adjusted outcomes using multivariable logistic regression accounting for patient factors, admission type, and year were compared for each of the 4 operations. Hospital expenditures were price-standardized, risk-adjusted 30-day surgical episode payments. Primary outcome measures included 30-day mortality, hospital readmissions, and 30-day surgical episode payments.

Results:
Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%, P<0.001) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%, P<0.001). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%, odds ratio=0.90, CI, 0.90–0.91, P<0.001) and readmission (14.99% vs 15.74%, odds ratio=0.94, CI, 0.94–0.95, P<0.001). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685, difference= −$1168, P<0.001).

Conclusions:
Patients presenting to Health Professional Shortage Area hospitals obtain safe care for common surgical procedures without evidence of higher expenditures among Medicare beneficiaries. These findings should be taken into account as current legislative proposals to increase funding for care in these underserved communities are considered.
Asymptomatic Covid-19 Trauma Patients Have Worse Outcomes and Resource Utilization
Authors: Sozzi Marco , Lam Lydia , Nichols Chance , Demetriades Demetrios 
Published: December 2022

Objective:
To evaluate the impact of COVID-19 positivity on outcomes and resource utilization in the trauma population.

Introduction:
COVID-19 infection worsens outcomes of trauma patients, but it is not known if asymptomatic COVID-19 trauma patients have different outcomes from COVID-19-negative patients.

Methods:
All trauma patients admitted to an urban level 1 trauma center between March 2020 and October 2021 were collected and reviewed for COVID-19 status. COVID-19-positive patients with symptoms or initial chest radiographs consistent with infections were excluded. Propensity score model 1:3 matched asymptomatic COVID-19-positive to COVID-19-negative trauma patients for their age, body mass index, MOA, injury severity score, SBP<90, GCS<9, and comorbidities. Outcomes included mortality, complications, and resource utilization.

Results:
A total of 185 asymptomatic COVID-19-positive patients were matched with 554 COVID-19-negative patients. Asymptomatic COVID-19 -positive patients had higher rates of myocardial infarction and cardiac arrest (3.2% vs. 0.9%, P=0.023), higher ventilator days (3.33 vs. 1.49 days, P<0.001), ICU-length of stay [LOS (4.92 vs. 3.41 d, P=0.034)], overall LOS (11.41 vs. 7.24 d, P<0.001), and hospital charges ($ 176.505.80 vs. 107.591.93, P=0.002).

Conclusion:
Asymptomatic COVID-19 trauma patients have significantly higher rates of cardiac events, longer LOS, and higher hospital charges when compared with similar trauma patients who are COVID-19-negative.
Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan
Authors: Valkovskaya Maria , Hassan Arsalan , Zartaloudi Eirini , Hussain Fahad , Umar Muhammad , Khizar Bakht , Khattak Inzemam , Gill Shamshad Ahmed , Khan Shams-Ud-Din Ahmad , Dogar Imtiaz Ahmad , Mustafa Ali Burhan , Ansari Moin Ahmed , Qalb I Hyder Syed , Ali Muhammad , Ilyas Nilofar , Channar Parveen , Mughal Nazish , Channa Sumera , Mufti Khalid , Mufti Ali Ahsan , Hussain Mian Iftikhar , Shafiq Sadia , Tariq Muhammad , Khan Muhammad Kamran , Chaudhry Shahzad Tahir , Choudhary Abdul Rashid , Ali Mian Nizam , Ali Gohar , Hussain Ashfaq , Rehman Muhammad , Ahmad Noman , Farooq Saeed , Naeem Farooq , Nasr Tanveer , Lewis Glyn , Knowles James A. , Ayub Muhammad , Kuchenbaecker Karoline 
Published: December 2022

Introduction
Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan.

Methods
DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology.

Results and discussion
Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings.

Conclusion
DIVERGE is a carefully designed case–control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.
A case series and literature review of infections due to Myroides spp. – Identification of contributing factors and emerging antibiotic susceptibility trends.
Authors: khan Uzair , Pandey Ellora , Gandham Nageswari , Das Nikunja , Mukhida Sahjid , Kannuri Sriram , Bhaumik Shalini , Mirza Shahzad 
Published: December 2022

Introduction: Infections by Myroides spp. can lead to significant morbidity and mortality, particularly in immunocompromised patients with underlying co-morbidities. Recent reports have highlighted its intrinsic and acquired drug resistance, making it a particularly challenging infectious agent to combat.
Methods: Myroides spp. isolated and reported in clinically significant urine samples were considered for the study. Identification of the organism was done by VITEK 2C, BioMerieux. Antibiotic Susceptibility Testing was done using both manual and automated methods following Clinical and Laboratory Standards Institute (CLSI) guidelines. Existing literature was searched on MEDLINE using PubMed.
Results: We present a series of five catheter associated urinary tract infections (CAUTI) due to M. odoratimimus, with sensitivity to only minocycline. This is the first case from Western India, and the third case in existing literature that shows Myroides sensitivity only to minocycline. Our literature review is the first to systemize possible contributory factors to infection, allowing us to devise a clinically relevant tool that delineates contributory factors and efficacious drugs in Myroidesspp. infection
Conclusion: Myroides spp. infections, earlier considered rare and opportunistic, need cognizance and diagnostic suspicion especially in certain associated conditions.