bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild Traumatic Brain Injury and Functional Outcome in Older Adults: Pain Interference But Not Cognition Mediates the Relationship Between Traumatic Injury and Functional Difficulties
Authors: Hume Camilla H. , Mitra Biswadev , Wright Bradley J. , Kinsella Glynda J. 
Published: January 2023

Objective:
To examine functional status of older people 3 months after mild traumatic brain injury (mTBI) and identify whether pain interference or cognition mediates any relationship found between injury status and functional outcomes.

Setting:
Patients admitted to a Melbourne-based emergency department.

Participants:
Older adults 65 years and older: 40 with mTBI, 66 with orthopedic injury without mTBI (TC), and 47 healthy controls (CC) without injury.

Design:
Observational cohort study.

Main Measures:
Functional outcome was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and single- and dual-task conditions of the Timed-Up-and-Go task. Pain interference and cognitive performance at 3 months post-injury were examined as mediators of the relationship between injury status (injured vs noninjured) and functional outcome.

Results:
Patients with mTBI and/or orthopedic injury reported greater difficulties in overall functioning, including community participation, compared with noninjured older people (CC group). Both trauma groups walked slower than the CC group on the mobility task, but all groups were similar on the dual-task condition. Pain interference mediated the relationship between injury status and overall functioning [b = 0.284; 95% CI = 0.057, 0.536), community participation (b = 0.259; 95% CI = 0.051, 0.485), and mobility (b = 0.116; 95% CI = 0.019, 0.247). However, cognition did not mediate the relationship between injury status and functional outcomes.

Conclusions:
Three months after mild traumatic injury (with and without mTBI), patients 65 years and older had greater functional difficulties compared with noninjured peers. Pain interference, but not cognition, partially explained the impact of traumatic injury on functional outcomes. This highlights the importance of reducing pain interference for older patients after injury (including mTBI) to support better functional recovery.
Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and Neuropsychological Profiles in Active-Duty Military Service Members
Authors: de Souza Nicola L. , Esopenko Carrie , Jia Yuane , Parrott J. Scott , Merkley Tricia L. , Dennis Emily L. , Hillary Frank G. , Velez Carmen , Cooper Douglas B. , Kennedy Jan E. , Lewis Jeffrey D. , York Gerald E. , Menefee Deleene S. , McCauley Stephen R. , Bowles Amy O. , Wilde Elisabeth A. , Tate David F. 
Published: January 2023

Objective:
Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD.

Methods:
Active-Duty US Service Members (n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals.

Results:
For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified.

Conclusions:
The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.
Neurobehavioral Symptom Inventory Item-Level Change Complements the Reliable Change Method
Authors: Scarlett Emily , Lu Lisa H. , Cummings Latiba D. , Bowles Amy O. 
Published: January 2023

Objective:
To determine correspondence between the statistically derived 8-point reliable change index for the Neurobehavioral Symptom Inventory (NSI) against clinically significant item-level change in symptom severity from intake to discharge for mild traumatic brain injury (mTBI).

Setting:
Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.

Patients:
In total, 655 active-duty service members with a diagnosis of mTBI who received treatment and completed self-report measures between 2007 and 2020.

Design:
Observational retrospective analysis of outpatient clinical outcomes data.

Main Measures:
NSI total score change was used to divide patients into responder and nonresponders based on whether they met an 8-point decrease between intake and discharge. In addition, patients who had at least one NSI item that changed from a rating of 3 (severe) or 4 (very severe) at intake to a rating of 0 (none) or 1 (mild) at discharge were coded as an individual with significant item-level change.

Results:
Forty-five percent of the sample had significant item-level change and were classified as responders according to the reliable change method. Eight percent of the sample had significant item-level change but did not meet the 8-point reliable change threshold. Fifteen percent of the sample did not experience significant item-level change but were classified as responders according to reliable change. Thirty-one percent did not meet either method's criterion for change. Classification agreement between the reliable change and item-level change methods was 76%, which was statistically significant (

= 181.32, P < .001).

Conclusion:
There is good correspondence between reliable change and item-level change on the NSI in this population. Reliable change is easily calculated and thus much more accessible than the item-level change method. There may be some situations where calculating item-level change may be helpful.
Future regenerative therapies for corneal disease
Authors: Lee John Y. , Knight Robert J. , Deng Sophie X. 
Published: January 2023

Purpose of review
To highlight the progress and future direction of stem-cell based regenerative therapies for the treatment of corneal disease

Recent findings
Corneal stem cell-based therapies, such as limbal stem cell transplantation, corneal stromal stem cell transplantation, endothelial stem cell transplantation, and stem cell-derived extracellular vesicles have demonstrated promising results in the laboratory. Although most are still in preclinical development or early phase clinical trials, these stem cell-based therapies hold potential to facilitate tissue regeneration, restore native function, and inhibit pathologic disease processes such as fibrosis, inflammation, and neovascularization.

Summary
Stem cell-based therapy offers a promising therapeutic option that can circumvent several of the challenges and limitations of traditional surgical treatment. This concise review summarizes the progress in stem-cell based therapies for corneal diseases along with their history, underlying mechanisms, limitations, and future areas for development.
Healthcare Workers' Perceptions of On-Site Childcare
Authors: Braddock Amy , Malm-Buatsi Elizabeth , Hicks Sarah , Harris Grant , Alafaireet Patricia 
Published: January 2023

Goal:
Measures taken by healthcare organizations to address COVID-19 highlighted the long-standing lack of childcare infrastructure required to support healthcare workers. This study, designed to provide evidence to support operations at an academic medical center, looked at the influence that in-house and emergency childcare could have on the retention, recruitment, and productivity of healthcare workers. This study also outlined the implications that childcare, or its lack, has for healthcare organizations during and after the COVID-19 pandemic.

Methods:
We conducted a 35-question electronic employee survey (under institutional review board approval) during pandemic-induced public school closures, which included both quantitative and qualitative (write-in) questions.

Principal Findings:
The survey results showed that weekday on-site childcare was very or extremely important to more than half of survey respondents, the majority of whom were staff members (28%) or physicians (25%), followed by administrators (15%), researchers (12%), others (10%), nurses (5%), educators (2%), and residents (1%). Sixty percent of respondents reported that emergency on-site childcare was extremely important (34%) or very important (26%). Almost half (49%) reported that emergency childcare needs have disrupted their work in the past year, including canceling of clinics or surgical cases. Analysis of qualitative comments via a strategy based on coding and categorization showed that, when asked how childcare influences their work choices, employees responded that childcare availability has limited the hours or times they could work, that lack of childcare has prevented career growth, that they left a previous job or will leave their current job because of childcare needs, or that they stayed at a previous job or have remained in their current job longer because of the availability of childcare.

Practical Applications:
Although data from this mixed-methods study support findings in the literature that there is a need for in-house and emergency childcare, the data suggest that current employees at this academic medical center do not currently expect it, likely because such childcare is not generally available at most academic institutions. With increased rates of burnout and healthcare workers leaving the field since COVID-19, offering in-house and emergency childcare provides hospital systems with new opportunities to retain and recruit physicians, nurses, and staff, as well as to improve their well-being and productivity.
Primary care nurse practitioner practices to lower type 2 diabetes risks in women with a history of gestational diabetes mellitus
Authors: Quelly Susan B. , LaManna Jacqueline B. , Hyer Suzanne , Davis Jean W. , Giurgescu Carmen , Martinez Valerie 
Published: January 2023

ABSTRACT

Background:
Women with a gestational diabetes mellitus (GDM) history have increased lifetime type 2 diabetes (T2D) risk, with 16 times greater risk 3 to 6 years after the pregnancy, compared with women without GDM. Offspring from diabetes-complicated pregnancies also face increased health risks.

Purpose:
The study purpose was to describe the primary care practices of nurse practitioners (NPs) aimed at reducing T2D-related health risks in women with a history of GDM.

Methodology:
Florida-licensed primary care NPs (n = 47) completed a 57-item online survey that included an 8-item scale about recommended practices to reduce T2D risks for women with GDM history. Descriptive statistics, Chi Square test, and Fisher exact test were conducted.

Results:
Most (67%) participants “often/always” screened for T2D every 1–3 years per guidelines, but only 31.8% “often/always” advised about pregnancy planning/preconception T2D assessment. Compared with “none” or ≤2 hours of GDM care education, participants with >2 hours were more likely (p < .05) to “often/always” perform five recommended practices: 1) counsel about increased T2D risks; 2) educate about self-advocacy for T2D screening; 3) T2D screening every 1–3 years; 4) counsel about breastfeeding to reduce T2D risk; and 5) discuss postpartum weight loss and increased physical activity to lower T2D risk.

Conclusion:
Findings indicate inconsistent care practices and suggest that >2 hours of education about care of women with GDM history may increase primary care NPs performing recommended practices to reduce T2D risks and prevent health problems for women and future offspring.

Implications:
Nurse practitioner education is needed involving care of women with GDM history to mitigate risks for T2D.
Postoperative Handheld Gastric Point-of-Care Ultrasound and Delayed Bowel Function
Authors: Lamm Ryan , Collins Micaela , Bloom Jamie , Joel Marisa , Iosif Leah , Park Doo , Reny Jacky , Schultz Samuel , Yeo Charles J , Beausang David , Schwenk Eric S , Costanzo Caitlyn , Phillips Benjamin R 
Published: January 2023

Background:
Delayed bowel function (DBF) following intra-abdominal surgery is a common problem that contributes to postoperative complications and prolonged length of stay. Utilization of a handheld Gastric Point of Care Ultrasound (GPOCUS) can identify a full versus empty stomach in the postoperative period. We hypothesized that the findings of a full stomach identified on a postoperative day 1 (POD1) GPOCUS exam would predict an increased risk of delayed bowel function.

Study Design:
A blinded, prospective cohort study was performed. Postoperative colorectal surgery patients were identified as having either a full or empty stomach based on previously published definitions. GPOCUS examinations were performed on POD1 using a handheld ultrasound device and clinicians were blinded to the results. Demographic and perioperative data were collected. The primary outcome variable was Gastrointestinal-3 (GI-3) recovery, defined as time to tolerance of diet and either flatus or bowel movement.

Results:
Fifty-six patients agreed to participate in the study; fifty were eligible and included. Eighteen patients’ stomachs were identified as full on POD1 GPOCUS examination and thirty-two were identified as empty. No significant demographic or perioperative differences existed between groups. Full stomach patients had significantly delayed GI-3 recovery (4 v 1 days, p<0.0001) and longer length of stay (5 v 3 days, p<0.0001). Full stomach patients also had significantly more emesis and NGT placement (both p<0.05).

Conclusion:
GPOCUS performed on POD1 can predict delayed bowel function, length of stay, likelihood of emesis, and NGT placement. Utilization of handheld devices for GPOCUS showed promise for the identification of patients at high risk for DBF and could provide an opportunity for preemptive intervention.
Comparative efficacy of exercise therapy for patellofemoral pain: A network meta-analysis of randomized controlled trials
Authors: Ji Yu-Xiu , Xie Yu-Jie , Zhou Xiao-Zhu , Wang Shuang , Li Ling , Miyamoto Akira , Zhang Chi 
Published: January 2023

AbstractObjectiveTo investigate the effective exercise prescription in randomized controlled trials (RCTs) for patellofemoral pain (PFP).DesignA network meta-analysis.Data sourcesPubMed (including Medline), Embase, Web of Science, PEDro,Clinicaltrials.govand other resourses for RCTs.Eligibility criteria for selecting studiesRCTs of exercise interventions for PFP with outcomes of pain intensity or functional improvement.Primary outcome measurePain intensity is measured by ‘worst pain in the past week’ on a Visual Analogue Scale (VAS) or Numerical Rating Pain Scale (NRS).Data extractionTwo researchers independently extracted data and assessed the bias of risks. We used Grading of Recommendations, Assessment, Development, and Evaluation to appraise the strength of the evidence.ResultsA total of 45 trials with 42,319 patients were included in this network meta-analysis (NMA). For the primary outcomes, all included treatments were superior to a wait-and-see approach: PNF + exercise (SMD -2.88, 95%CIs -4.75 to -1.02), whole body exercise (-1.57, -3.15 to -0.00), hip-and knee-focused exercise therapy (-1.32, -2.57 to -0.06), foot orthoses + exercise (-1.06, -2.92 to -0.06), hip exercise (-1.10, -2.44 to 0.24), knee brace + exercise(-0.91, -2.54 to 0.72), gait retraining exercise (-2.55, -4.72 to -0.37), knee exercise (-0.92, -2.16 to 0.33), knee arthroscopy + exercise (-0.61, -2.44 to 1.22), target exercise (-0.52, -2.38 to 1.33), kinesiotaping + exercise (-0.54, -2.07 to 0.99), education + exercise (-0.47, -2.31 to 1.38), feedback exercise (-0.22, -1.86 to 1.43). Exercise therapy with education (SMD -0.25, 95%CIs -1.76 to 1.26) was better than exercise alone in alleviating pain intensity.ConclusionThe knee and hip combination strength training is highly effective in muscle strength improvement. All treatments in our NMA were superior to nontreatment, we recommend avoiding a wait-and-see approach. Comprehensive therapy based on individual evaluation can effectively improve the symptoms of patients.Key points (what are the new findings?)The combination of knee and hip strength training is highly effective in pain relief and function improvement for PFP.The exercise therapy with biomechanical devices, such as foot orthoses, braces, and kinesiotaping can improve knee function.Education with exercise therapy shows a great effect on pain relief and function improvement than exercise alone.Target exercise based on individual evaluation is superior to general exercise therapy for keen function.
The effect of using group-averaged or individualized brain parcellations when investigating connectome dysfunction: A case study in psychosis
Authors: Levi Priscila T. , Chopra Sidhant , Pang James C. , Holmes Alexander , Sassenberg Tyler A. , DeYoung Colin G. , Fornito Alex 
Published: January 2023

AbstractFunctional magnetic resonance imaging (fMRI) is widely used to investigate functional coupling (FC) disturbances in a range of clinical disorders. Most analyses performed to date have used group-based parcellations for defining regions of interest (ROIs), in which a single parcellation is applied to each brain. This approach neglects individual differences in brain functional organization and may inaccurately delineate the true borders of functional regions. These inaccuracies could inflate or under-estimate group differences in case-control analyses. We investigated how individual differences in brain organization influence group comparisons of FC using psychosis as a case-study, drawing on fMRI data in 121 early psychosis patients and 57 controls. We defined FC networks using either a group-based parcellation or an individually-tailored variant of the same parcellation. Individualized parcellations yielded more functionally homogeneous ROIs than group-based parcellations. At individual connections level, case-control FC differences were widespread, but the group-based parcellation identified approximately 9% more connections as dysfunctional than the individualized parcellation. When considering differences at the level of functional networks, the results from both parcellations converged. Our results suggest that a substantial fraction of dysconnectivity previously observed in psychosis can be attributed to erroneous ROI delineation, rather than a pathophysiological process related to psychosis.
Time-to-event analysis of factors influencing delay in discharge from a subacute Complex Discharge Unit during the first year of the pandemic (2020) in an Irish tertiary centre hospital
Authors: Rajendran Nithya , Rameli Puteri Maisarah , Malomo Keneilwe , Byrne Declan , Browne Joseph , Ntlholang Ontefetse 
Published: January 2023

ABSTRACTBackgroundThere is a paucity of data investigating delays in discharges from subacute complex care units exclusively dealing with complex cases. We aimed to analyse factors causing delays in discharges and explore their implications on the healthcare system in terms of length of stay (LOS), during the COVID-19 pandemic, using time-to-event analysis, to assist in future pandemic healthcare planning decisions.MethodsSingle-centre, retrospective, cross-sectional study. Demographics, clinical characteristics and length of stay (LOS) of all patients admitted to our subacute Complex Discharge Unit at our model 4 hospital during the pandemic were retrieved from electronic patient records. The outcome variable in our time-to-event analysis was a delay in discharge with a LOS >15 days. A cox proportional hazards regression model delineated factors contributing to delays.Results390 patients were admitted between March 2020 - February 2021 to the subacute complex discharge unit. Among these, 326 (83.6%) patients were >65 years of age, and 233 (59.7%) patients were female. The median (IQR) age was 79 (70-86) years, with a median (IQR) LOS of 19.4 (10-41) days. A total of 237 (60.7%) events were uncensored, LOS > 15 days of which 138 (58.2%) were female, 124 (52.32%) had >4 comorbidities, and 153 (39.2%) were censored into LOS ≤15 days and death 19 (4.8%). Kaplan Meier’s plot allowed the comparison of factors causing a delay in discharge to single factors: age, gender, and multimorbidity. A multivariate cox regression analysis adjusted to each strata age, gender and multimorbidity predicted factors affecting LOS: Age strata 65 - 75 & 75 - 85 [HR 0.233; 95% CI (0.077-.708); p=.010] & [HR .301; 95% CI(.155-.588); p<.001] had common factor patient-centred needs prolonging LOS. The common factors complications arising from comorbidities in male [HR .145; 95 % CI (.081 -.261); p<.001] and female [HR .479; 95% CI (.311 -.737); p<.001], and patient-centred needs in male [HR .472; 95 % CI (.243 -.917); p.027] female [HR .361; 95% CI (.215 -.608); p<.001] exhibited statistically significant results.ConclusionReducing LOS is imperative for better patient outcomes and hospital management. The most common factors delaying discharge were complexities that arose from primary diagnoses and patient-centred needs such as cognition, psychosocial needs and carer needs. Further research is needed into exploring multimorbidity as a risk factor for mortality in patients who experience prolonged LOS within a complex discharge unit.