bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of virtual reality interventions of the upper limb in children and young adults with cerebral palsy: A systematic review with meta-analysis
Authors: Burin-Chu Simone , Baillet Héloïse , Leconte Pascale , Lejeune Laure , Thouvarecq Régis , Benguigui Nicolas 
Published: July 2023

Objective To examine the characteristics and the effectiveness of virtual reality systems on upper limb impairments in children and young adults with cerebral palsy. Data sources An electronic search was conducted on PubMed, PEDro, Web of Science, Central, and EMBASE. Methods The protocol of this review was prospectively registered in the PROSPERO database (CRD42022302271). Randomized controlled trials that tested the effects of virtual reality-based interventions on the upper limb of participants with cerebral palsy were included. The methodological quality of the studies was measured by the PEDro scale. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. The data of the studies were analyzed in meta-analysis and presented in forest plots and narrative synthesis. Results Twenty-two studies involving 746 participants were included. Ten different virtual reality systems were used in the interventions, of which six were designed specifically for rehabilitation and four commercial video games. We found an effect in favor of virtual reality when it was used in combination with conventional therapy for upper limb activity (SMD = 0.65; 95% CI (0.19 to 1.11)). However, the certainty of the evidence of the comparisons ranged from very low to low. Conclusion Virtual reality seems to be an effective tool for upper limb activity in children and young adults with cerebral palsy. Nevertheless, future studies should present a better methodological quality, a larger sample size, and well-defined rehabilitation programs to reduce the inconsistency of the evidence in this domain.
Major Increase in Incidence of Pediatric ACL Reconstructions From 2005 to 2021: A Study From the Norwegian Knee Ligament Register
Authors: Kooy Caroline E. v. W. , Jakobsen Rune B. , Fenstad Anne M. , Persson Andreas , Visnes Håvard , Engebretsen Lars , Ekås Guri R. 
Published: July 2023

Background: The incidence of pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) is increasing in several countries. It is uncertain whether this trend applies to countries that traditionally prefer an initial nonoperative treatment approach whenever possible, like Norway. Nationwide, long-term patient-reported outcomes and revision rates after ACLR in the pediatric population are also lacking. Purpose: To determine the incidence of pediatric ACLR in Norway since 2005, as well as to detect trends in surgical details and describe patient-reported outcomes up to 10 years after ACLR. Study Design: Descriptive cohort study. Methods: This study is based on prospectively collected data on girls ≤14 years and boys ≤16 years, registered in the Norwegian Knee Ligament Register at the time of their primary ACLR, between 2005 and 2021. The main outcome was the incidence of ACLR, adjusted to the corresponding population numbers for each year. The time trend was analyzed by comparing the mean of the first and last 3-year period (2005-2007 and 2019-2021). Patient-reported outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score preoperatively and at 2, 5, and 10 years postoperatively. Results: A total of 1476 patients (1484 cases) were included, with a mean follow-up of 8.1 years (range, 1-17). The incidence of pediatric ACLRs per 100,000 population increased from 18 to 26, which corresponds to an increase of 40% for boys and 55% for girls. Concurrent meniscal procedures increased significantly from 45% to 62%, and the proportion of meniscal repairs increased from 19% to 43% when comparing the first and last time period. The mean Knee injury and Osteoarthritis Outcome Score values for the Sport and Recreation and Quality of Life subscales were between 72 and 75 at the 2-, 5- and 10-year follow-up. The 5-year revision rate was 9.9%. Conclusion: There was a major increase in incidence of pediatric ACLR in Norway during the study period. There was a shift in the approach to concomitant meniscal procedures from resection to repair, with more than a doubling of the proportion of meniscal repairs. Patient-reported outcomes revealed long-lasting reduced knee function.
Hidden consequences: Uncovering belimumab’s role in the development of Pneumocystis jirovecii pneumonia in a lupus patient
Authors: Ng Maria , Mackay Meggan , Gautam-Goyal Pranisha , Goyal Sameer , Vikraman Praveen Kumar 
Published: July 2023

Introduction Pneumocystis jirovecii is an opportunistic fungal organism that can cause fatal pneumonia in immunocompromised individuals. It is a disease associated with CD4+ T cell depletion or high-dose steroids. However, there is increasing evidence that B cell dysfunction may also play a role in this illness. Case Report A 33-year-old female with SLE, who was maintained on belimumab and low-dose prednisone (2.5 mg daily), presented with progressive cough and shortness of breath. She had been on monthly belimumab and prednisone 2.5 mg daily for 19 months, and her CD4 count was >200/uL, but her CD19+ B cell was <1% due to the belimumab. She developed a persistent cough and progressive dyspnea that did not respond to empiric antibiotic therapy for pneumonia. She went to the hospital for acute worsening of her dyspnea and cough. An extensive workup was performed, including a VATS procedure and surgical biopsy, which gave a definitive diagnosis of PJP. The patient was treated and discharged on trimethoprim-sulfamethoxazole. She made a complete recovery. Discussion Our report demonstrates the first confirmed case of pneumocystis jirovecii pneumonia in a patient with B cell depletion due to chronic maintenance therapy with belimumab. Our patient’s diagnosis of PJP was unexpected, given her normal CD4+ count and the use of such a low dose of prednisone. We attribute her susceptibility to PJP infection to her profound B cell depletion in response to her belimumab therapy, supporting previous research indicating the importance of CD4+ T cells and B cells in the protective immune response against PJP. This case may help shape future clinical guidelines concerning PJP prophylaxis, particularly in SLE patients with deficient B lymphocytic activity and B cell depletion.
Neuroscience Engagement and Outreach on Neurodevelopmental Disorders: A Report from India
Authors: Bhatia Divya 
Published: July 2023

The current project was funded by the Global Engagement Seed Grant from the International Brain Research Organisation (IBRO) as part of the IBRO-led Global Engagement Initiative. The project was focused on public awareness about neurodevelopmental disorders (NDDs) as well as neuroscience engagement. Thus, the project had two specific aims: (a) public awareness about epidemiology, diagnosis, risk factors, prevention of NDDs and relevant government guidelines and available policies (b) public engagement in neuroscience. Therefore, the current project report with an emphasis on the requirement of neuroscience engagement and outreach at the societal level, highlights several activities such as population-based workshops and webinars, carried out as part of the project in both rural and urban areas to enhance the public engagement in neuroscience and awareness on several NDDs. Key message India is an extremely diverse country with significant variations in cultural, educational, financial, socioeconomic status and linguistic aspects. With about 27% of its population living below the poverty line, India accounts for about 23 million children suffering from a disability, most of whom do not seek medical help. These data highlight the gravity of the situation which calls for urgent actions from governments, healthcare professionals, researchers and policymakers to design adequate public awareness programs regarding several prevalent NDDs. Therefore, the current project was an effort to bring public awareness about brain health and the epidemiology, diagnosis and prevention of NDDs and relevant government guidelines and available policies.
Simulated Weightbearing and Articular Injury From Transarticular Screws in a Ligamentous Lisfranc Injury Model
Authors: Denove Nicholas , Muriuki Muturi G. , Juntavee Vongtawan , Zmugg Stephan , Dekker Robert , Havey Robert M. , Kadakia Anish 
Published: July 2023

Background Transarticular screw fixation is a common surgical treatment for tarsometatarsal ligamentous (Lisfranc) injuries. Iatrogenic damage to articular cartilage from screw placement, however, has been thought to potentially lead to increased risk of tarsometatarsal (TMT) joint arthritis after initial injury. To date, no study has evaluated the effect of weightbearing on articular cartilage after screw fixation. The aim of this study was to create a Lisfranc injury and quantify and compare articular damage due to screw fixation before and after simulated weightbearing. Methods: A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed. Results: Simulated partial weightbearing increased articular injury 1.44-fold ( P < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold, P = .0047), whereas the first (M1) showed the least (1.35-fold, P = .0083). Increases seen at the medial (1.43-fold, P = .0387) and middle cuneiform (1.44-fold, P = .0292) were intermediate between the values seen at M2 and M1. Conclusion: Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries. Clinical Relevance: Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.
Childhood ADHD With and Without Co-occurring Internalizing/Externalizing Problems: Prospective Predictions of Change in Adolescent Academic and Social Functioning
Authors: Reinke Amber L. , Stiles Kelsey , Lee Steve S. 
Published: July 2023

Objective: Internalizing and externalizing problems predict poor academic and social outcomes. However, ADHD co-occurs with internalizing and externalizing problems and is itself a risk factor, thus preventing precise inferences. This study evaluated childhood anxiety, depression, and aggression as predictors of change in adolescent academic and social outcomes, including moderation by childhood ADHD. Methods: 182 ethnically-diverse 5- to 11-year-old youth with (54.7%) and without (45.3%) ADHD completed a separate baseline and 6- to 7-year prospective follow-up assessment, consisting of parallel measures across youth psychopathology, academic functioning (i.e., academic achievement, school competence), and friendship quality domains. Results: Whereas childhood ADHD inversely predicted academic competence, depression and aggression uniquely predicted worsening friendship quality. Interestingly, anxiety was unrelated to change in academic and friendship outcomes; similarly, neither ADHD, depression, nor aggression predicted change in objectively-measured academic achievement from a standardized assessment. Conclusion: Implications for intervention and prevention are considered, including school-based approaches, within a developmental psychopathology framework.
Assessing everyday functional activity in cognitively impaired people with multiple sclerosis: The use of Actual RealityTM
Authors: Goverover Yael , Salter Amber , DeLuca John 
Published: July 2023

Background: There is considerable evidence that persons with multiple sclerosis (PwMS) who experience cognitive impairments (CIs) are at risk of having significant limitations in activities of daily living (ADLs). However, ADL assessment often consists of proxies or self-report of ADLs. This study examined whether the performance of instrumental ADLs (I-ADL) is impaired in PwMS with and without CI. Methods: Participants included 72 PwMS and 48 matched healthy controls (HCs). PwMS were divided into MS-CI ( n = 25) and MS-not-impaired ( n = 47) groups based on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) scores. All participants performed the Actual RealityTM (AR) test, measuring I-ADL using authentic websites. Results: The MS-CI performed significantly worse on AR compared with HC and MS-not-impaired. In addition, the MS-not-impaired performed significantly worse than HC on AR. AR differentiates well between PwMS with and without CI. Conclusions: While CI in MS results in significant limitations in the performance of I-ADL, PwMS who do not show evidence of CI can have limitations in I-ADL. AR assessment is a valid and reliable tool sensitive to CI. It should be used in addition to traditional cognitive assessments to detect early functional deterioration through the course of MS.
The emotional support plan: Feasibility trials of a brief, telehealth-based mobile intervention to support coping for autistic adults
Authors: Bal Vanessa H , Mournet Annabelle M , Glascock Tori , Shinall Jacqueline , Gunin Gabrielle , Jadav Nikita , Zhang Henry , Brennan Emily , Istvan Emily , Kleiman Evan M 
Published: July 2023

Difficulties regulating emotions during periods of distress may contribute to the high rates of co-occurring depression and anxiety in autistic adults. The emotional support plan (ESP) is a brief intervention designed to support autistic adults to use positive coping skills during periods of distress. Thirty-six autistic adults participated in studies to assess the acceptability of the ESP intervention to cope with stressors during the COVID-19 pandemic and postsecondary education and feasibility of the study design elements to inform future trials. Most participants reported using strategies from their ESP; 86%–89% reported the intervention had a positive impact on them and 67%–71% would recommend it to another person. Completion of weekly monitoring and outcome assessments were high; ecological momentary assessment was more variable. The current results provide preliminary support for the acceptability of the ESP intervention. Important insights were also gained to inform feasibility of the design to assess its potential efficacy in future studies. While further research is clearly needed, the brief nature of the ESP may provide benefit as a starting point for those who may be proactively seeking support to cope with anticipated stressors or those who would benefit from guidance to promote emotion regulation during stressful life events. Lay abstract Autistic adults may have difficulty coping during stressful periods, which could make them more vulnerable to depression and anxiety. We designed the emotional support plan (ESP) to help autistic people find ways to cope in stressful situations. Thirty-six autistic adults created an ESP and answered questions about their opinions of the ESP. Most autistic adults found the ESP to have a positive impact on them and many would recommend the ESP to another person. Feedback from autistic adults suggested ways that we might test the ESP in future studies. Overall, autistic adults in this study found the ESP to be useful and a worthwhile intervention to study more in the future. While more research is clearly needed, we hope that the brief nature of the ESP will make it helpful for autistic people who are trying to handle negative feelings during stressful life events.
Evaluating national guidelines for monitoring early growth using routinely collected data in Bergen, Norway
Authors: Balthasar Melissa R. , Roelants Mathieu , Brannsether-Ellingsen Bente , Stangenes Kristine M. , Magnus Maria C. , Håberg Siri E. , Øverland Simon N. , Júlíusson Pétur B. 
Published: July 2023

Aims: The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth. Methods: Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference. Results: Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI. Conclusions: The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.
Practicing Emergency Medicine in the Metaverse: A Novel Mixed Reality Casualty Care Training Platform
Authors: Rabotin Alexandra , Glick Yuval , Gelman Ram , Ketko Itay , Taran Boris , Fink Noam , Furer Ariel 
Published: July 2023

Background Current casualty care training modalities present several challenges, including limited simulation facilities, instructor dependence, lack of standardization, documentation of trainees’ performance and training personalization. The study presents the design, development and preliminary evaluation of a novel hybrid training platform to address these challenges. Methods A mixed reality platform was chosen and developed to address field operators’ requirements. The platform is easy to operate and can be set up by laypeople within 20-min in multiple environments. Individual-level training documentation is generated autonomously following each session, evaluating 30 aspects of performance. From this, a unique aggregated dataset emerges as a substrate for executives’ dashboards and intelligent planning of future sessions. Results An evaluation process took part using simulator-based training in different stages along the project using a questionnaire (Likert-scale based). Fifty military physicians took part in an identical head injury scenario requiring airway management by endotracheal intubation and were immediately surveyed. Conclusion TrauMR is an agile hybrid training that harbors the potential to address many of the emerging challenges of training for prehospital care in combat and civilian environments.
Risk factors for radial artery occlusion after neurointervention for unruptured intracranial aneurysm via transradial access
Authors: Fuga Michiyasu , Tanaka Toshihide , Tachi Rintaro , Tomoto Kyoichi , Kazami Kenta , Teshigawara Akihiko , Ishibashi Toshihiro , Hasegawa Yuzuru , Murayama Yuichi 
Published: July 2023

Purpose Neurointervention via transradial access (TRA) is less invasive than via transfemoral access. However, radial artery occlusion (RAO) may occur with TRA. The purpose of this study was to explore risk factors for RAO after coil embolization of unruptured intracranial aneurysms (UIAs) via TRA. Methods Forty-two consecutive patients who underwent coil embolization for UIAs via TRA between March 2021 and March 2022 and were available for angiographic evaluation 1 year after treatment were retrospectively reviewed. Multivariate logistic regression analysis was conducted to identify potential risk factors for RAO. Results Seventeen (40%) of the 42 patients showed RAO. Compared with the non-RAO group, radial artery size was significantly smaller (2.2 mm [interquartile range (IQR): 2.1, 2.4 mm] vs 2.6 mm [IQR: 2.5, 2.7 mm]; p = 0.001) and the incidence of radial artery spasm (RAS) was significantly higher in the RAO group. Multivariate analysis identified radial artery size (odds ratio [OR] 4.9 × 10−3, 95% confidence interval [CI] 6.4 × 10−5–0.38) and incidence of RAS (OR 14.8, 95%CI 2.1–105) as significant independent predictors of subsequent RAO. Based on receiver operating characteristic (ROC) curve analysis, the optimal cutoff for radial artery size was 2.5 mm (sensitivity, 82.4%; specificity, 76.0%; area under the ROC curve, 0.80 [95%CI 0.66–0.95]). Conclusion Radial artery size and RAS represent reliable parameters for predicting RAO 1 year after coil embolization for UIA via TRA. Prophylaxis against RAS and limiting neurointervention via TRA to patients with radial artery larger than 2.5 mm in diameter may reduce the risk of postoperative RAO.
Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators
Authors: López-Gigosos R , Vegas-Romero M , Mariscal A , Mariscal-López E , Fang J , Gutiérrez-Bedmar M 
Published: July 2023

Aims: For better understanding of the impact of COVID-19 pandemic on mortality in different countries, we studied the excess mortality from any cause during 2020 and 2021 in 22 European countries, and its relationship with three socioeconomic variables: life expectancy at birth in 2019, per capita income, and low education level. Methods: Using an ecological design, we analyzed excess mortality data between January 2020 and December 2021 in 22 European countries, obtained from the EuroMOMO surveillance system. Using weekly Z-score data for each country, we estimated the annual average deviation in mortality during 2020 and 2021 for each country. We analyzed possible relationships between the excess mortality and three independent variables: gross domestic product per capita (GDPpc) in 2020, life expectancy at birth in 2019, and proportion of the population over age 18 years with a lower than secondary education level in 2018. Results: In the 22 European countries analyzed, the total number of excess deaths in 2020 and 2021 was 800,011 (11%) more than expected, with deaths among those aged 65 years and over accounting for 87.66% of these. Excess mortality was higher in 2020, especially in Spain, UK, Italy, and France. In 2021, excess mortality was highest in Hungary, the Netherlands, France, and Germany. Excess mortality during 2021 was inversely correlated with life expectancy ( r =−.489, p = .021) and income level ( r =−.550, p = .008). Conclusion: Reducing socioeconomic inequalities among countries not only improves conditions of most disadvantages but also will help to reduce excess of mortality from future pandemics.