bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurogenic Thoracic Outlet Syndrome in Division 1 Collegiate Athletes: Presentation, Diagnosis, and Treatment
Authors: Olson Emily Miller , Dyrek Paige , Harris Taylor , Fereydooni Arash , Lee Jason T. , Kussman Andrea , Roh Eugene 
Published: May 2023

Objective:
Athletes who engage in repetitive upper-extremity exercise are susceptible to neurogenic thoracic outlet syndrome (nTOS). We sought to identify typical presenting symptoms and common findings on diagnostic workup, in addition to evaluating rates of return to play following various treatment interventions.

Design:
Retrospective chart review.

Setting:
Single institution.

Participants:
Medical records of Division 1 athletes containing the diagnosis of nTOS between the years 2000 and 2020 were identified. Athletes with arterial or venous thoracic outlet syndrome were excluded.

Independent Variables:
Demographics, sport, participation status, clinical presentation, physical examination findings, diagnostic workup, and treatments provided.

Main Outcome Measures:
Rate of return to play (RTP) to collegiate athletics.

Results:
Twenty-three female and 13 male athletes were diagnosed and treated for nTOS. Digit plethysmography showed diminished or obliterated waveforms with provocative maneuvers in 23 of 25 athletes. Forty-two percent were able to continue competing despite symptoms. Of the athletes who were initially unable to compete, 12% returned to full competition after physical therapy alone, 42% of those remaining were able to RTP after botulinum toxin injection, and an additional 42% of the remaining athletes RTP after thoracic outlet decompression surgery.

Conclusions:
Many athletes diagnosed with nTOS will be able to continue competing despite symptoms. Digit plethysmography is a sensitive diagnostic tool for nTOS to document anatomical compression at the thoracic inlet. Botulinum toxin injection had a significant positive effect on symptoms and a high rate of RTP (42%), allowing numerous athletes to avoid surgery and its prolonged recovery and associated risks.

Clinical Relevance:
This study demonstrates that botulinum toxin injection had a high rate of return to full competition in elite athletes without the risks and recovery needed for surgical intervention, suggesting that this may be a good intervention especially among elite athletes who only experience symptoms with sport-related activities.
Incidence of Cochlear Implantation Among Adult Candidates in the United States
Authors: Nassiri Ashley M. , Marinelli John P. , Lohse Christine M. , Carlson Matthew L. 
Published: May 2023

ObjectivesTo investigate the associations of age and year of cochlear implantation (CI) with CI incidence among adults 20 years and older residing in the US.Study DesignDeidentified cochlear implant data were acquired from prospective patient registries from two cochlear implant manufacturers (Cochlear Americas and Advanced Bionics), which supply an estimated 85% of cochlear implants in the US. Population estimates for severe-to-profound sensorineural hearing loss by age group were extracted from Census and National Health and Nutrition Examination Survey data.SettingUS CI centers.PatientsAdults 20 years and older who underwent CI.InterventionsCI.Main Outcome MeasuresCI incidence.ResultsThe study cohort included 30,066 adults 20 years and older who underwent CI from 2015 to 2019. When combining actual and estimated data from all three manufacturers, the annual number of cochlear implants increased 5,406 in 2015 to 8,509 in 2019. Overall, the incidence of CI among adult traditional (bilateral severe-to-profound hearing loss) CI candidates increased from 244 per 100,000 person-years in 2015 to 350 in 2019 (p< 0.001). Although the elderly (80 years and older) population had the lowest incidence of CI, this cohort experienced the largest growth from an incidence of 105 per 100,000 person-years to 202 during the study period.ConclusionsDespite growing incidence among those with qualifying hearing loss, cochlear implants remain widely underutilized. Elderly adults continue to exhibit the lowest relative cochlear implant utilization rates; however, trends over the last half-decade suggest a shift has occurred, resulting in improved access among this underserved subset.
Case report of tokophobia
Authors: Kattan Wid , Albarraq Rahaf 
Published: May 2023

Introduction:
Tokophobia is a pathological fear of pregnancy that can lead to avoidance of childbirth. It is classified as primary or secondary. Approximately 20% to 78% of pregnant women report fears associated with pregnancy and childbirth. This report describes a patient with tokophobia: presentation, risk factors, comorbidities, and treatment.

Case presentation:
A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in 2 clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires that aimed to assess different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth. Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practices. Full symptomatic recovery was achieved immediately after delivery.

Conclusion:
We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.
Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans
Authors: Han Benjamin H. , Bronson Jennifer , Washington Lance , Yu Mengfei , Kelton Katherine , Tsai Jack , Finlay Andrea K. 
Published: May 2023

Background:
Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes.

Objectives:
To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older.

Research Design:
Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions.

Subjects:
Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447).

Methods:
Mental illness, SUD, medical multimorbidity.

Results:
An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35–5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04–2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01–1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35–2.49).

Conclusions:
Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population
High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic
Authors: Schissler Kathryn , Stewart Sidney , Phamduy Timothy , Brimacombe Michael , Waynik Ilana , Hoppa Eric 
Published: May 2023

Objectives
There was an overall decline in pediatric emergency department visits during the COVID-19 pandemic. Caregivers are educated to bring febrile neonates promptly to the emergency department; however, for infants aged 29 to 60 days, there may not be the same urgency especially during a pandemic. There may have been a resultant change in the clinical and laboratory high-risk markers and infection rates in this patient population during the pandemic.

Methods
This was a single-center retrospective cohort study of infants aged 29 to 60 days presenting to the emergency department of an urban tertiary care children's hospital because of fever (>38°C) between March 11 and December 31, 2020, compared with those presenting in the same period during the 3 prior years (2017 through 2019). Patients were categorized as having high-risk criteria on a predetermined definition of ill appearance, white blood cell count, and urinalysis based on our hospital's evidence-based pathway. Information on infection type was also collected.

Results
A total of 251 patients were included in the final analysis. Comparison of the prepandemic and pandemic cohorts showed a significant increase in the proportion of patients with urinary tract infections (P = 0.017) and bacteremia (P = 0.02) and those presenting with high-risk white blood cell count (P = 0.028) and urinalysis (P = 0.034). There was no significant difference in patient demographics or in high-risk ill appearance (P = 0.208).

Conclusions
This study demonstrates a significant increase in the rates of urinary tract infection and bacteremia in addition to the objective markers used to risk-stratify febrile infants aged 29 to 60 days. This supports the need for attentiveness in evaluating these febrile infants in the emergency department.
A Summer of Fevers and Fussiness
Authors: Calardo Sarah J. , Raj Niketa , Miller Jonathan , Loiselle Claire , Zerhusen Holli , Solaiman Adil 
Published: May 2023

Objective
To define the presentation, spectrum of illness, and outcomes in infants with parechovirus (PeV) meningitis admitted to our inpatient general pediatrics service during a spike in incidence of admissions in summer 2022.

Patients and Methods
This study is a retrospective case series of all patients aged 3 months and younger discharged from our institution with a CSF BioFire (BioFire Diagnostics, Salt Lake City, UT) FilmArray Polymerase Chain Reaction Meningitis/Encephalitis Panel result positive for PeV between January 1 and September 19, 2022. We collected and analyzed clinical and demographic data.

Results
Eighteen infants with PeV meningitis were admitted within our time frame, with 8 (44%) of the admissions occurring in July. Patients' mean age was 28.7 days and mean length of stay was 50.5 hours. Although all had a history of fever, only 72% were febrile on presentation. Laboratory findings showed a procalcitonin of less than 0.5 ng/mL in 86% of the 14 patients who had it drawn and no cerebrospinal fluid (CSF) pleocytosis in 83% of the patients who had CSF cell counts sent. Neutropenia was present in 17%. Although 89% of infants were given initial antibiotics, antibiotics were discontinued in 63% once their CSF panel returned positive for PeV, and in all by 48 hours.

Conclusions
Infants hospitalized with PeV meningitis were febrile and fussy, but experienced uncomplicated hospital stays without neurological deficits. Parechovirus meningitis must be considered as a common cause of acute viral meningitis in young infants even without CSF pleocytosis. This study, although limited in scope and follow-up, can potentially assist in the diagnosis and treatment of PeV meningitis at other institutions.
Assessing the New Norm
Authors: Mehmood Noormah , Nesiama Jo-Ann O. , Yen Kenneth , Dhar Archana , Lowe Geoffrey S. 
Published: May 2023

Introduction
Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians.

Method
Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR.

Results
Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures.

Conclusions
Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.
How Subjective and Objective Factors in Research and Practice May Perpetuate Health Disparities amongst Patients with Traumatic Brain Injury
Authors: Johnson Karen T. , You HyunBin , Kandel Melissa , Oyesanya Tolu O. 
Published: May 2023

Abstract
Research shows disparities exist in traumatic brain injury (TBI)-related outcomes and are associated with objective and subjective factors. We define objective factors (e.g., age, sex, race/ethnicity, health insurance status, and socioeconomic status) as variables that are frequently measured, not easily modifiable, and not easily influenced by individual perceptions, opinions, or experiences. Conversely, we define subjective factors (e.g., personal health literacy, cultural competence, patient/family-clinician communication, implicit bias, and trust) as variables that may be less frequently measured, more easily modifiable, and more easily influenced by individual perceptions, opinions, or experiences. The purpose of this analysis and perspective is to provide recommendations for further examination of subjective factors within TBI research and practice, with the overarching goal of reducing TBI-related disparities. We recommend establishing reliable and valid measures of subjective factors to allow for further examination of the influence of both objective factors and subjective factors in the TBI population. Providers and researchers must also engage in education and training to recognize their biases and how bias influences decision-making. The influence of subjective factors in practice and research must also be considered to ensure we generate knowledge needed to advance health equity and reduce disparities in outcomes for patients with TBI.
Effect of exercise therapy on cancer-related fatigue in patients with breast cancer: A systematic review and network meta-analysis
Authors: Wu Tong , Yan Fanghong , Wei Yuanyuan , Yuan Chenlu , Jiao Yanxia , Pan Yayan , Zhang Yilin , Zhang Hongyan , Ma Yuxia , Han Lin 
Published: May 2023

AbstractObjectiveThis study aimed to explore the efficacy of different exercise therapies in reducing fatigue in patients with breast cancer.DesignPubMed, Embase, Web of Science, Cochrane Library, CINAHL, CBM, CNKI, VIP, and Wanfang databases were searched from their inception to March 2022. The authors independently screened all randomized controlled trials (RCTs) of exercise therapy in patients with breast cancer. A network meta-analysis was performed using Stata 16.0 software.ResultsSeventy-eight studies were analyzed, with 167 comparisons and 6235 patients. The network results showed that stretching (SMD = -0.74, CI: -1.43, -0.06), yoga (SMD = -0.49, CI: -0.75, -0.22), combined exercise (SMD = -0.47, CI: -0.70, -0.24), aerobic exercise (SMD = -0.46, CI: -0.66, -0.26), and resistance exercise (SMD = -0.42, CI: -0.77, -0.08) significantly reduced fatigue. Pairwise comparisons confirmed that yoga, combined exercise, aerobic exercise, and resistance exercise were positively associated with fatigue relief. However, no significant association was identified between reduced fatigue and traditional Chinese exercises or stretching.ConclusionThe most effective exercise therapy to relieve cancer-related fatigue in patients with breast cancer was yoga, followed by combined aerobic and resistance exercises. It is expected that more RCTs will be conducted to further explore the efficacy and mechanisms of exercise.
EFFECTS OF AEROBIC AND RESISTIVE EXERCISE ON MUSCLE MEASUREMENTS AND BODY COMPOSITION IN FEMALE PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Ayyildiz Aylin , Yilmaz Figen , Altindaş Havva , Çiftci Selda , Kuran Banu 
Published: May 2023

ABSTRACTObjectiveThis study aimed to show the effects of different exercise types on disease activity, pain, functional status, and quality of life in female patients with rheumatoid arthritis with low disease activity or in remission and supported these findings with body composition and muscle measurements.DesignThis randomized controlled prospective study screened female patients aged 20-50-year-old with rheumatoid arthritis. The patients were randomized into 12-week resistance exercise, aerobic exercise, and control groups.ResultsThe mean age of the 66 patients was 42.5 ± 5.6 years. In the resistance and aerobic exercise groups compared to the control group, a positive significant difference was found in the pain, disease activity, several sub-parameters of quality of life,M.GastrocnemiusandM.Biceps Femorismuscle thickness measurements, and fat mass in the lower extremities before and after treatment(p < 0.05). Compared to the other groups, the resistance exercise group showed a significant improvement inM.Rectus FemorisandM.Vastus Intermediusmuscle thickness measurements, whole body fat mass, whole body and lower extremity lean body mass, and timed up-and-go test when comparing before and after treatment(p < 0.05).ConclusionIn rheumatoid arthritis patients, resistance exercises led to a significant increase in muscle thickness, functional status, lean body mass compared to other exercises; resistance exercises also resulted in a significant reduction in pain and disease activity.
Performing Quality Control on Magnetic Resonance Imaging Liver Fat/Iron Quantification Studies: A Critical Requirement
Authors: Hajibonabi Farid , Sharma Puneet , Davarpanah Amir H. , Balthazar Patricia , Moreno Courtney C. , Pectasides Melina , Nandwana Sadhna B. 
Published: May 2023

Objective
Nonalcoholic fatty liver and iron overload can lead to cirrhosis requiring early detection. Magnetic resonance (MR) imaging utilizing chemical shift–encoded sequences and multi-Time of Echo single-voxel spectroscopy (SVS) are frequently used for assessment. The purpose of this study was to assess various quality factors of technical acceptability and any deficiencies in technologist performance in these fat/iron MR quantification studies.

Methods
Institutional review board waived retrospective quality improvement review of 87 fat/iron MR studies performed over a 6-month period was evaluated. Technical acceptability/unacceptability for chemical shift–encoded sequences (q-Dixon and IDEAL-IQ) included data handling errors (missing maps), liver field coverage, fat/water swap, motion, or other artifacts. Similarly, data handling (missing table/spectroscopy), curve-fit, fat- and water-peak separation, and water-peak sharpness were evaluated for SVS technical acceptability.

Results
Data handling errors were found in 11% (10/87) of studies with missing maps or entire sequence (SVS or q-Dixon). Twenty-seven percent (23/86) of the q-Dixon/IDEAL-IQ were technically unacceptable (incomplete liver-field [39%], other artifacts [35%], significant/severe motion [18%], global fat/water swap [4%], and multiple reasons [4%]). Twenty-eight percent (21/75) of SVS sequences were unacceptable (water-peak broadness [67%], poor curve-fit [19%] overlapping fat and water peaks [5%], and multiple reasons [9%]).

Conclusions
A high rate of preventable errors in fat/iron MR quantification studies indicates the need for routine quality control and evaluation of technologist performance and technical deficiencies that may exist within a radiology practice. Potential solutions such as instituting a checklist for technologists during each acquisition procedure and routine auditing may be required.
Predicting Breast Cancer Subtypes Using Magnetic Resonance Imaging Based Radiomics With Automatic Segmentation
Authors: Yue Wen-Yi , Zhang Hong-Tao , Gao Shen , Li Guang , Sun Ze-Yu , Tang Zhe , Cai Jian-Ming , Tian Ning , Zhou Juan , Dong Jing-Hui , Liu Yuan , Bai Xu , Sheng Fu-Geng 
Published: May 2023

Objective
The aim of the study is to demonstrate whether radiomics based on an automatic segmentation method is feasible for predicting molecular subtypes.

Methods
This retrospective study included 516 patients with confirmed breast cancer. An automatic segmentation—3-dimensional UNet-based Convolutional Neural Networks, trained on our in-house data set—was applied to segment the regions of interest. A set of 1316 radiomics features per region of interest was extracted. Eighteen cross-combination radiomics methods—with 6 feature selection methods and 3 classifiers—were used for model selection. Model classification performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity.

Results
The average dice similarity coefficient value of the automatic segmentation was 0.89. The radiomics models were predictive of 4 molecular subtypes with the best average: AUC = 0.8623, accuracy = 0.6596, sensitivity = 0.6383, and specificity = 0.8775. For luminal versus nonluminal subtypes, AUC = 0.8788 (95% confidence interval [CI], 0.8505–0.9071), accuracy = 0.7756, sensitivity = 0.7973, and specificity = 0.7466. For human epidermal growth factor receptor 2 (HER2)–enriched versus non-HER2–enriched subtypes, AUC = 0.8676 (95% CI, 0.8370–0.8982), accuracy = 0.7737, sensitivity = 0.8859, and specificity = 0.7283. For triple-negative breast cancer versus non–triple-negative breast cancer subtypes, AUC = 0.9335 (95% CI, 0.9027–0.9643), accuracy = 0.9110, sensitivity = 0.4444, and specificity = 0.9865.

Conclusions
Radiomics based on automatic segmentation of magnetic resonance imaging can predict breast cancer of 4 molecular subtypes noninvasively and is potentially applicable in large samples.