bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prior Emergency Medical Services Utilization Among People Who Had an Accidental Opioid-Involved Fatal Drug Overdose—Rhode Island, 2018-2020
Authors: Duan Kailai , Chambers Laura C. , Basta Melissa , Scagos Rachel P. , Roberts-Santana Carolina , Hallowell Benjamin D. 
Published: March 2023

Objective: To help understand whether decreased emergency medical services (EMS) utilization due to the COVID-19 pandemic contributed to increased accidental fatal drug overdoses, we characterized recent EMS utilization history among people who had an accidental opioid-involved fatal drug overdose in Rhode Island. Methods: We identified accidental opioid-involved fatal drug overdoses among Rhode Island residents that occurred from January 1, 2018, through December 31, 2020. We linked decedents by name and date of birth to the Rhode Island EMS Information System to obtain EMS utilization history. Results: Among 763 people who had an accidental opioid-involved fatal overdose, 51% had any EMS run and 16% had any opioid overdose–related EMS run in the 2 years before death. Non-Hispanic White decedents were significantly more likely than decedents of other races and ethnicities to have any EMS run ( P < .001) and any opioid overdose–related EMS run ( P = .05) in the 2 years before death. Despite a 31% increase in fatal overdoses from 2019 through 2020, corresponding with the onset of the COVID-19 pandemic, EMS utilization in the prior 2 years, prior 180 days, or prior 90 days did not vary by time frame of death. Conclusion: In Rhode Island, decreased EMS utilization because of the COVID-19 pandemic was not a driving force behind the increase in overdose fatalities observed in 2020. However, with half of people who had an accidental opioid-involved fatal drug overdose having an EMS run in the 2 years before death, emergency care is a potential opportunity to link people to health care and social services.
Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.
Authors: Vafa Aliyar Zahedi , Hans Stéphane , Khalife Mohamad , Lechien Jérôme R 
Published: March 2023

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve. Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue. Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders. Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.
Primary nasal tuberculosis: A rare case report
Authors: Zhang Zhijuan , Ma Zheng , Li Yanrong , Wang Jingyuan , Hou Li 
Published: March 2023

Nasal primary tuberculosis (TB) of the upper respiratory tract is rare and barely reported in literature. Herein, we report a complicated case of nasal primary TB with otitis media. The patient visited the ENT clinic due to left-side nasal obstruction accompanied by rhinorrhea, and intermittent headaches. The diagnosis of nasal TB was confirmed with an acid-fast bacterial test and histopathological examination. After 3 months of treatment with anti-TB drugs, patient’s symptoms of nasal obstruction, rhinorrhea, and other symptoms were remarkably relieved. The left ear purulence substantially reduced. The patient recovered well and had no recurrence post half a year of follow-up. Our case emphasizes the importance of accurate diagnosis and initiation of timely treatment. Additionally, when a patient has nasal TB complicated with otitis media, it is important to consider a diagnosis of middle ear TB.
Determining Who Is Worthy: Stakeholder Perspectives on a District’s De-Leveling Initiatives
Authors: Roegman Rachel , Hinze-Pifer Rebecca , Tanner Nathan , Studamire Danté , Thompson Faith 
Published: March 2023

Background/Context: Scholars and practitioners continue to work to identify ways to change structural conditions, school-level policy, and stakeholder mindsets to support minoritized youth in advanced coursework. Open access policies, in which students do not need a previous teacher’s approval or a prerequisite grade to enroll in an advanced offering, that are coupled with teacher training and student support are one positive direction. However, it is critical to consider whether open access policies are truly “open” and how students are placed in different levels of coursework. Purpose/Objective/Research Question or Focus of Study: The purpose of this article is to examine how key stakeholders, including students, counselors, and principals, understand and act on district initiatives in course placement decisions. Research questions are: (1) How do different stakeholders view their own role, and other stakeholders’ role, in determining who should be enrolled in more advanced coursework? (2) In what ways do different stakeholders understand educational equity in relation to the course placement process? (3) How are students’ reported experiences with course scheduling consistent with or in conflict with the practices and values reported by school administrators and counselors? Research Design: The district at the heart of this study was chosen because of its 10-year-long commitment to reducing barriers to advanced coursework, and implementation of many of the strategies identified as promising by prior research. We utilized a concurrent mixed-methods design involving interviews with principals and counselors and surveys of students, given that both quantitative and qualitative data provide partial perspectives on our research questions. Social reproduction theory served as an explanatory tool, as we considered how different stakeholders understood the idea of “choice” in students’ course-selection process. We looked specifically to ways that the district continues to classify students and contributes to the reproduction of ideas about who is “smart” and “worthy,” and who is not. Conclusions/Recommendations: To address the identified difficulties in reversing race- and class-based inequities in student course-taking, we outlined a set of comprehensive recommendations for policy and practice, at both the school and district level, and the teacher and leader preparation level. In part, these aim to address the variation that existed across the district, in terms of both mindset and policy implementation. Of note, technical solutions are not sufficient for equity-focused reforms, especially with socially constructed concepts such as “interest” and socially constrained pathways of “choice.”
Artificial intelligence for assistance of radiology residents in chest CT evaluation for COVID-19 pneumonia: a comparative diagnostic accuracy study
Authors: Mlynska Lucja , Malouhi Amer , Ingwersen Maja , Güttler Felix , Gräger Stephanie , Teichgräber Ulf 
Published: March 2023

Background In hospitals, it is crucial to rule out coronavirus disease 2019 (COVID-19) timely and reliably. Artificial intelligence (AI) provides sufficient accuracy to identify chest computed tomography (CT) scans with signs of COVID-19. Purpose To compare the diagnostic accuracy of radiologists with different levels of experience with and without assistance of AI in CT evaluation for COVID-19 pneumonia and to develop an optimized diagnostic pathway. Material and Methods The retrospective, single-center, comparative case-control study included 160 consecutive participants who had undergone chest CT scan between March 2020 and May 2021 without or with confirmed diagnosis of COVID-19 pneumonia in a ratio of 1:3. Index tests were chest CT evaluation by five radiological senior residents, five junior residents, and an AI software. Based on the diagnostic accuracy in every group and on comparison of groups, a sequential CT assessment pathway was developed. Results Areas under receiver operating curves were 0.95 (95% confidence interval [CI]=0.88–0.99), 0.96 (95% CI=0.92–1.0), 0.77 (95% CI=0.68–0.86), and 0.95 (95% CI=0.9–1.0) for junior residents, senior residents, AI, and sequential CT assessment, respectively. Proportions of false negatives were 9%, 3%, 17%, and 2%, respectively. With the developed diagnostic pathway, junior residents evaluated all CT scans with the support of AI. Senior residents were only required as second readers in 26% (41/160) of the CT scans. Conclusion AI can support junior residents with chest CT evaluation for COVID-19 and reduce the workload of senior residents. A review of selected CT scans by senior residents is mandatory.
Subjective Complaints are Similar in Subjective Cognitive Decline and Early-Stage Alzheimer’s Disease when Assessed in a Memory Clinic Setting
Authors: Bruus Anna E. , Waldemar Gunhild , Vogel Asmus 
Published: March 2023

Background Subjective cognitive complaints are generally poorly associated with objective memory functioning in older persons. Subjective cognitive decline (SCD) is a key feature in SCD and amnestic mild cognitive impairment (aMCI) which both can represent early Alzheimer’s disease (AD). The aim of this study was to assess how memory clinic patients with SCD, MCI and mild AD dementia scored on 3 different complaint measures and if the format of assessment had an impact on the association with cognitive functioning, age, and depressive symptoms. Methods We included 17 SCD patients, 17 aMCI patients, 17 patients with mild AD, and 30 controls. Complaints were assessed with the Cognitive Change Index (CCI), the Subjective Memory Complaints (SMC) scale, and the Memory Complaint Questionnaire (MAC-Q). Results There were no significant differences between the total scores in the patient groups on the questionnaires. However, significant differences were found in the number of patients classified with impairment when using the CCI, the SMC, and the MAC-Q. Scores on all questionnaires were significantly associated with depressive symptoms, and significant associations with age, gender, and Addenbrookes Cognitive Examination score were found for the SMC. In patients with cognitive dysfunction, lower memory awareness significantly predicted fewer cognitive complaints. Conclusions SCD patients in a memory clinic setting report the same degree of cognitive impairment as patients with aMCI and mild dementia, and in a hospital-based cohort we extend previous findings from healthy controls, that definition of SCD may depend on the format of assessment.
Development of pulsating extensional stress induced melt mixer and its application for polypropylene/carbon fibers composites
Authors: Yin Xiaochun , Wei Weidong , Lin Feng , Zhang Guizhen 
Published: March 2023

In this work, a pulsating extensional stress induced melt mixer was developed. The compositions, structure, working principle, and melt mixing process of the device were introduced in detail. The mixer generated a full-process pulsating extension deformation effect on materials by the eccentric vane units and arc-shaped flow channels, which greatly promoted the dispersion and mixing of the materials. Polypropylene/carbon fibers (PP/CFs) composites were prepared by the new mixer, and the effects of different rotational speeds and mixing time on the properties of the composites were studied. The results showed that proper rotational speed and mixing time effectively promoted the dispersion of CFs in PP matrix, while the fibers still had long remaining lengths. As a result, the overall properties, especially the mechanical properties of the PP/CFs composites improved. When the CFs content was 30 wt.%, at the process parameters of 20 r/min and 2 min, compared with pure PP, the tensile strength (58.46 MPa) and modulus (1962 MPa) of the PP/CFs composite were increased by 78.6% and 263.3%, respectively.
Pregnancy outcomes among Egyptian women with systemic lupus erythematosus: A prospective cohort study
Authors: Mokbel Abir , Attia Doaa HS , Zayed Hania S , Eesa Naeem Nahlaa , Mahmoud Geilan , Riad Rafat , Abou Elewa Soumaya , Youssef Mohamed , Haggag Hisham , Mohamed Sally S 
Published: March 2023

Pregnant patients with systemic lupus erythematosus (SLE) represent a high-risk group. The aim of this study is to describe the pregnancy outcomes among SLE patients who were followed prospectively at a conjoint high-risk pregnancy/rheumatology clinic from 2007 to 2021 and to identify predictors of adverse maternal and fetal outcomes. This study included 201 singleton pregnancies of 123 women with SLE. Their mean age was 27.16 ± 4.80 years, and their mean disease duration was 7.35 ± 5.46 years. Secondary antiphospholipid syndrome (APS) was diagnosed in 77 (38.3%) pregnancies. The pregnancy was planned in 104 (51.7%) pregnancies. Flares occurred in 83 (41.3%) and pre-eclampsia in 15 (7.5%) pregnancies. Full-term pregnancy occurred in 93 (46.3%), fetal loss (miscarriage and intra-uterine fetal death) in 41 (20.4%), and prematurity in 67 (33.3%) of the pregnancies, respectively. Seven neonates died from complications of prematurity, and another one died from cardiac congenital anomalies. In the multivariate analyses, unplanned pregnancy was associated with eight times higher risk of disease flare OR = 7.92 ( p < 0.001), lupus nephritis flare during pregnancy increased the odds of pre-eclampsia occurrence four times OR = 3.98 ( p = 0.02), while disease flares during pregnancy predicted prematurity OR = 2.49, p = 0.049. Patients with secondary APS had three times increased risk of fetal loss OR = 2.97, p = 0.049. To conclude, unplanned pregnancy, disease flares, and APS have been identified as predictors for adverse maternal and/or fetal outcomes. Pregnancy planning is necessary to reduce maternal and fetal complications.
Investigation of the medium-term effect of osteoprotegerin/bone morphogenetic protein 2 combining with collagen sponges on tendon-bone healing in a rabbit
Authors: Wei Bing , Ji Mingliang , Lin Yucheng , Geng Rui , Wang Qing , Lu Jun 
Published: March 2023

Background Osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) could be administered sequentially to promote tendon-bone healing. There remain several unresolved issues in our previously published study: a) the release kinetics of OPG/BMP-2 from the OPG/BMP-2/collagen sponge (CS) combination in vitro remained unclear; b) the medium-term effect of the OPG/BMP-2/CS combination was not analyzed. Hence, we design this study to address the issues mentioned above. Methods 30 rabbits undergoing anterior cruciate ligament reconstruction (ACLR) with an Achilles tendon autograft randomly received one of the 3 delivery at the femoral and tibial tunnels: OPG/BMP-2, OPG/BMP-2/CS combination, and nothing (blank control). At 8 and 24 weeks post-surgery, the biomechanical tests and histologic analysis were used to evaluate the tendon-bone healing. Results In mechanical tests, the OPG/BMP-2/CS group showed a higher final failure load and stiffness than the other groups at 8 and 24 weeks. Additionally, the maximum stretching distance showed a decreasing trend. The mechanical failure pattern of samples shifted from a tunnel pull-away to a graft midsubstance rupture after OPG/BMP-2/CS-treated. From histological analysis, the OPG/BMP-2/CS treatment increased the amount of collagen fibers (collagen I and II) and promoted fibrocartilage attachment. Conclusion CS as a carrier promotes the medium-term effect of OPG and BMP-2 on tendon-bone healing at the tendon-bone interface in a rabbit ACLR model. OPG, BMP-2 and CS were already applied in several clinical practice, but a further study of clinic use of OPG/BMP-2/CS is still needed.
Richard D. Duke: Systems Thinker, Game Science Founder & Beloved Mentor
Authors: Lukosch Heide Karen 
Published: March 2023

Background This remembrance of Richard “Dick” Duke, one of the founding members of the International Simulation and Gaming Association (ISAGA), and dedicated promoter of game science, contains Duke’s contribution to the field of simulation and gaming, as a retrospective into the past, and as inspiration for the present and the future of this discipline. Duke has been a highly respected colleague, and a beloved friend for many in the scientific community. He will be remembered for his academic contributions, but more so for his commitment to support young talent, and for his aim to address societal problems in all of his doing. Purpose The goal of this article is to reflect on the work of Richard D. Duke and the influence he had and still has on the simulation and gaming research and practice community. The overview of his work illustrates his specific approach towards simulation and gaming, while the personal words of colleagues he worked with over the years combine professional and personal perspectives on the work and life of Richard D. Duke. Research Design The article presents a brief literature review along with a collection of contributions from researchers and practitioners in the field of simulation and gaming. Data Collection This obituary dos not represent a scientific article as such. However, a careful review of the articles and books of Richard D. Duke has been carried out for this article, and colleagues have contributed with their thoughts and memories. Results The overview of Richard D. Duke’s work shows how he approached simulation and gaming as a powerful form of human communication, especially suited to analyse and design complex problems. All simulation game design is driven by the purpose to represent and explore alternative solutions and future states of a given situation. Duke’s careful and detailed conceptualisation of simulation gaming as interactive language represents a wealth of information for current and future researchers and practitioners in the field of simulation and gaming. Conclusion After more than 50 years of his first publication in the field of simulation and gaming, Duke’s contributions are still highly relevant to the science and practice in this area. His ideas inspire a large number of researchers and practitioners, and his foundational work had and has a large impact on how the science of simulation and gaming has developed and still advances.
A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia
Authors: Pak Sarah , Bous Rany M. , Acosta Lenis Claudia , Kumar Anand R. , Valiathan Manish 
Published: March 2023

Objective The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). Design This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. Results Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability ( r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% ( P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 ( P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant ( P  >  .05), but an increase in the mean values were observed. Conclusion Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.
Relationship Between Auditory-Perceptual and Objective Measures of Resonance in Children with Cleft Palate: Effects of Intelligibility and Dysphonia
Authors: Fujiki Robert Brinton , Kostas George , Thibeault Susan L. 
Published: March 2023

Objective To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Design Retrospective, observational cohort study Setting Outpatient pediatric cranio-facial anomalies clinic Patients Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Main Outcome Measure Relationship between auditory-perceptual ratings of resonance and nasometry scores Results Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility ( p ≤ .001) and dysphonia ( p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased ( P < .001) and when children presented with moderate dysphonia ( p ≤ .001). No significant impact of articulation testing or sex were observed. Conclusions Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.