bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of VHA Policy Directive 1163 on Acceptance and Employment Rates for Veterans with Substance Use Disorders Referred to VHA Vocational Rehabilitation
Authors: Sprong Matthew E , Hollender Heaven , Pechek Ashley A , Forziat-Pytel Kellie , Buono Frank D 
Published: November 2022

Introduction: Research has shown that Veterans with Substance/Alcohol Use Disorders (SUDs/AUDs) are at a greater risk for employment-related issues (eg, lower labor force participation rates), and interventions such as Vocational Rehabilitation (VR) have been used as a tool to reduce employment obtainment and maintenance. The purpose of the current study was to evaluate acceptance rates and employment rates at closure for Veterans with SUDs/AUDs prior to the implementation of VHA Policy Directive 1163 (mandated that Veterans are not refused services based on prior or current SUD/AUDs). SUD/AUDs were coded to reflect DSM 5-TR criteria of active use and in-remission. Methods: Data from a VHA Vocational Rehabilitation program in the Veterans Integrated Service Network 12 network were obtained for the purpose of the current study. Results: Findings showed that Veterans with AUDs were less likely to be accepted for VR services prior and after implementation of VHA Policy Directive 1163. Conclusions: When examining active and inactive SUDs/AUDs, findings showed that implementation of VHA Policy Directive 1163 was not effective for Veterans with AUDs. One factor that was not explored but could explain disparities in program acceptance rates is duration of program entry. If a Veteran has a consult placed for VHA Vocational Rehabilitation services, and their program entry date (date accepted) is a significant duration, then perhaps Veterans with active AUDs start drinking again given that they are waiting for vocational assistance. Thus, it would be important to assist Veterans with active AUDs into services in a timely manner (perhaps prior them being discharged from SUD treatment).
Comparative effectiveness of cladribine tablets versus other oral disease-modifying treatments for multiple sclerosis: Results from MSBase registry
Authors: Spelman Tim , Ozakbas Serkan , Alroughani Raed , Terzi Murat , Hodgkinson Suzanne , Laureys Guy , Kalincik Tomas , Van Der Walt Anneke , Yamout Bassem , Lechner-Scott Jeannette , Soysal Aysun , Kuhle Jens , Sanchez-Menoyo Jose Luis , Blanco Morgado Yolanda , Spitaleri Daniele LA , van Pesch Vincent , Horakova Dana , Ampapa Radek , Patti Francesco , Macdonell Richard , Al-Asmi Abdullah , Gerlach Oliver , Oh Jiwon , Altintas Ayse , Tundia Namita , Wong Schiffon L , Butzkueven Helmut 
Published: November 2022

Background: Effectiveness of cladribine tablets, an oral disease-modifying treatment (DMT) for multiple sclerosis (MS), was established in clinical trials and confirmed with real-world experience. Objectives: Use real-world data to compare treatment patterns and clinical outcomes in people with MS (pwMS) treated with cladribine tablets versus other oral DMTs. Methods: Retrospective treatment comparisons were based on data from the international MSBase registry. Eligible pwMS started treatment with cladribine, fingolimod, dimethyl fumarate, or teriflunomide tablets from 2018 to mid-2021 and were censored at treatment discontinuation/switch, death, loss to follow-up, pregnancy, or study period end. Treatment persistence was evaluated as time to discontinuation/switch; relapse outcomes included time to first relapse and annualized relapse rate (ARR). Results: Cohorts included 633 pwMS receiving cladribine tablets, 1195 receiving fingolimod, 912 receiving dimethyl fumarate, and 735 receiving teriflunomide. Individuals treated with fingolimod, dimethyl fumarate, or teriflunomide switched treatment significantly more quickly than matched cladribine tablet cohorts (adjusted hazard ratio (95% confidence interval): 4.00 (2.54–6.32), 7.04 (4.16–11.93), and 6.52 (3.79–11.22), respectively). Cladribine tablet cohorts had significantly longer time-to-treatment discontinuation, time to first relapse, and lower ARR, compared with other oral DMT cohorts. Conclusion: Cladribine tablets were associated with a significantly greater real-world treatment persistence and more favorable relapse outcomes than all oral DMT comparators.
Fate of Hemodialysis Patients Undergoing Transcarotid Revascularization
Authors: Martin Gordon H. , Leckie Katherin , Dakour-Aridi Hanaa , Saqib Naveed U. , Motaganahalli Raghu L. , Keyhani Arash , Keyhani Kourosh , Wang S. Keisin 
Published: November 2022

Introduction Carotid revascularization in patients with end-stage renal disease (ESRD) continues to be a controversial topic, as life expectancy is poor, thus, preventing the recouperation of cumulative stroke-risk reduction in the postoperative period. We performed this primarily descriptive analysis of the results of transcarotid revascularization (TCAR) in renal failure patients. Methods A retrospective review of two independent carotid revascularization databases maintained at two large health systems were performed to capture all consecutive TCAR procedures. Patients were classified as either (1) ESRD or (2) preserved renal function (PRF) and compared with standard univariate techniques, where appropriate. Results From December 2015 to April 2022, 851 consecutive TCARs were attempted at our participating facilities. Of these, 27 were performed in ESRD patients (all hemodialysis). These patients were younger and presented with a higher Charlson Comorbidity Index. The incidence of a high anatomic risk criterion as defined for the Centers for Medicare and Medicaid Services (CMS) were similar between groups, as was the incidence of a symptomatic carotid lesion. There were no differences between the groups in terms of intraoperative characteristics and the postoperative medication management were grossly similar by renal function. In the 30-day perioperative period, there were no stroke, death, or myocardial infarction in the 27 ESRD patients treated with TCAR. The mean duration of follow-up in the ESRD cohort was 15.0 months. During this time, there was no ipsilateral stroke events, one contralateral stroke, and one MI. All 27 carotid stents remained patent during this period. Six patients perished after TCAR at a mean interval of 12.2 months after TCAR. Conclusion Survival is poor after carotid revascularization via the TCAR technique on intermediate follow-up. Careful patient selection is required to identify those who will survive to collect on the cumulative stroke-risk reduction afforded by carotid intervention.
Assessing Lateral Ankle Sprains With a New Arthrometer
Authors: Taweel Nicholas R. , Gulick Dawn T. , Palombaro Kerstin M. 
Published: November 2022

Background Lateral ankle sprains are a common musculoskeletal injury across a variety of activities. Researchers have sought to identify a method to objectively assess joint laxity with a device that is simple to use and affordable. Aim The purpose of this study was to assess the use of an ankle arthrometer on individuals with ankle sprains. Methods The participant was evaluated by the physician and the degree of ankle sprain was identified. In the prone position, the arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each). Both clinicians were blinded to the data of the other. Results There were 30 participants, 10 in each group (uninjured, grade 1 sprain, grade 2 sprain). Mann-Whitney U testing found significant differences between the control and grade I ankle sprain groups (P < .001), the control and grade II ankle sprain groups (P < .001), and the grade I and grade II ankle sprain groups (P = .004). There was ±0.31-mm difference in anterior translation between healthy ankles, whereas there was 1.11- and 2.16-mm difference between ankles in grade 1 and grade 2 sprains, respectively. Clinical Application Despite the manual anterior drawer test being convenient, the subjectivity makes it unreliable. This study is consistent with prior literature about the difference in translation (millimeters) between the uninjured and injured ankles corresponding to the magnitude of ankle laxity. This study also contributes to the evolving evidence to support the relationship of a ratio of measures (injured/uninjured) as an objective measure of laxity. These comparisons to the individual’s healthy ankle mitigate the variability of the normative values. The use of an arthrometer to assess ankle joint laxity enhances the objectivity of patient assessment throughout the recovery process. Levels of Evidence: Level III
Values and Meaning in Rural Primary Care Practices: Implications for Interventions Within Context
Authors: Holtrop Jodi Summers , Nederveld Andrea , Lum Hillary D. , Glasgow Russell E. , Gomes Rebekah 
Published: November 2022

Objectives: It is important to understand the unique perspectives and values that motivate patients and clinicians in rural primary care settings to participate in clinical care activities. Our objective was to explore perspectives, preferences, and values related to primary care that could influence implementation of evidence-based programs. Methods: Qualitative study utilizing semi-structured interviews and using immersion/crystallization and thematic analysis. Participants were primary care practice members (clinicians, clinical staff, and administrators) and their patients in rural Colorado. Results: Twenty-six practice members and 23 patients across 9 practices participated. There were 4 emergent themes that were consistent across practice members and some patients. Patient perspectives are located in parenthesis. They included: (1) Focus on quality patient care, patient satisfaction, and continuity of care (patients appreciated quality and compassionate care), (2) Importance of prevention and wellness (patients appreciated help with preventing health problems), (3) Clinician willingness and ability to meet patient preferences for care (patients described comfort with local care), and (4) Passion for serving underserved, uninsured, or vulnerable populations (patients described their vulnerabilities). There were differences in how the perspectives were operationalized by practice member role, illustrating the importance of different ways of addressing these values. Conclusions: Successful implementation requires consideration of context, and much of context is understanding what is important to those involved in the primary care experience. This study sheds light on salient values of rural primary care practice members and their patients, which may inform interventions designed with and for this setting.
Feasibility assessment of solar photovoltaic deployments on building surfaces with the constraint of visual impacts
Authors: Zheng He , Wu Bo , Lin Hui , Jia Junsong , Wei Heyi 
Published: November 2022

As a major component of social acceptance, visual impact is often considered a significant constraint in solar applications. Visual impact assessment of solar applications, however, has been limited to pedestrians in previous studies. The extent to which PV systems can have visual impacts on occupants and whether it is necessary to include occupants in the measurement of visual impact remains uncertain. To fill this gap, we extended it from pedestrians to occupants and proposed a quantitative method to integrate pedestrians and occupants into a framework, combining the estimation of solar potential for the feasibility assessment of PV applications in a built environment. The concept is tested with a real case, located in Qingdao city, China, to present the technical flowchart for the feasibility assessment of solar PV deployments with the visual constraint. Building surfaces with qualified solar irradiation and low visibility were identified and compared in two cases, that is, with and without the inclusion of occupants as the visual constraint. The comparison results show that the change of suitable building surfaces for solar applications is 172,306 m2 (21% of suitable area) and 126 GWh (19% of yield energy) across the study area, indicating the significance of including occupants in the visibility assessment for the deployment of solar applications. The proposed method considers the visual constraint for the feasibility assessment of solar applications from the perspective of pedestrians and occupants, and it is helpful to identify the suitable surfaces for the large-scale deployment of solar applications at an early planning stage of solar city.
Association of Preoperative Opioid Use With Postoperative Opioid Use and Patient-Reported Outcomes in Ankle Fracture Fixation Patients
Authors: Reiners Nicholas , Vang Sandy , Rivard Rachael , Bostrom Nicholas , Nguyen Mai P. 
Published: November 2022

Background: Ankle fracture surgery is a common procedure with many patients receiving opioid medications for postoperative pain control. Whether there are factors associated with higher medication quantities or patient-reported outcomes, however, remains largely unknown. Methods: Patients with isolated, rotational ankle fractures who underwent surgical fixation between January 2018 and March 2020 were retrospectively reviewed. Patient demographics, injury characteristics, and preoperative and postoperative opioid prescription information were recorded. Clinical follow-up and Foot and Ankle Ability Measure (FAAM) questionnaires were collected at 6 weeks and 3 months postoperatively. Multiple linear regression was used to examine the influences of age, sex, body mass index (BMI), fracture characteristics, medical comorbidities, and preoperative opioid use (OU) on postoperative opioid morphine milligram equivalent (MME) amount and FAAM scores. Results: A total of 294 patients were included with an average age of 52.11 ± 17.13 years (range, 18-97). Fracture types were proportional to one another. Chronic pain (mean = 145.89, 95% CI = 36.72, 255.05, P = .0009), preoperative OU (mean = 178.22, 95% CI = 47.46, 308.99, P = .0077), psychiatric diagnoses (mean = 143.81, 95% CI = 58.37, 229.26, P = .001), tobacco use (mean = 137.37, 95% CI = 33.35, 229.26, P = .0098), and trimalleolar fractures (mean = 184.83, 95% CI = 86.82, 282.84, P = .0002) were associated with higher postoperative opioid MME amounts. Older age (mean = ‒0.05, 95% CI = ‒0.08, –0.02, P = .0014) and higher BMI (mean = ‒0.06, 95% CI = ‒0.12, 0.00, P = .048) were both independently associated with lower FAAM scores at 6 weeks. At 3 months, higher BMI (mean = ‒0.09, 95% CI = ‒0.13, –0.04, P = .0002), bimalleolar fractures (mean = ‒1.17, 95% CI = ‒2.17, –0.18, P = .021), and higher postoperative MME amounts (mean = ‒0.10, 95% CI = ‒0.19, –0.01, P = .0256) were each independently associated with lower FAAM scores. Conclusion: In this study, we found that patients with chronic pain, preoperative OU, psychiatric diagnoses, tobacco use, and trimalleolar fractures were more likely to have higher amounts of opioid prescribed following ankle fracture surgery. However, only age, BMI, bimalleolar fractures, and postoperative MME amount were associated with lower FAAM scores postoperatively. Level of Evidence: Level III, retrospective cohort study.
The Role of Probiotics as an Adjunctive Therapy in Psoriasis
Authors: Gilli Isadora O. , da Silva Gabriela C. , Mendes Victoria , Duarte Marcella G. , Tanaka Anber A. 
Published: November 2022

Background During the past decades, several unconventional strategies for controlling chronic inflammatory diseases, including psoriasis, have been developed. The use of probiotics has been gaining importance as an adjuvant therapy in the treatment of these pathologies. Objectives Evaluate the impact of the use of the Lactobacillus rhamnosus probiotic strain in patients diagnosed with common and palmoplantar psoriasis. Methods 35 patients were randomly divided into two groups: 18 using probiotics and 17 using placebo. They were evaluated on days 0 and 60, with photographic records of lesions, IL17 and IL23 quantification and calculations of Psoriasis Area Severity Index (PASI), Body Surface Area (BSA) and Dermatology Life Quality Index (DLQI) clinical evaluation scores. Results There was significative improvement in the clinical presentation and a reduction in the index of all clinical scores (PASI from 4.53 ± 4.457 to 3.57 ± 3.333, BSA from 5.44 ± 6.451 to 4.94 ± 5.961 and DLQI from 8.83 ± 8.631 to 7 ± 7.814, in the probiotic group.) However, there was no reduction in the quantification of IL23 and IL17. Adverse events related to the use of probiotics were minimal. Conclusions There was a Positive correlation between the use of probiotics and improvement of clinical aspects and clinical scores of disease severity, not associated with reduction in interleukins 17 and 23 blood levels.
Influenza vaccination coverage rates and other related factors in high-risk groups in Birjand, East of Iran
Authors: Ebrahimzadeh Azadeh , Bijari Bita , Azarnoosh Amin , Shakhs Emampour Fatemeh 
Published: November 2022

Background and Aims: Influenza is an acute respiratory disease with the highest mortality rate in the high-risk groups. Vaccination is a key public health strategy to prevent influenza in high-risk people. This study aimed to assess the influenza vaccination coverage rate and identify its demographic determinants in patients with end-stage renal disease (ESRD), chronic obstructive pulmonary disease (COPD), and diabetes in Birjand, Eastern Iran. Methods: This cross-sectional study included 400 patients (300 diabetic, 60 dialysis, and 40 COPD patients) from September 2017 to August 2018. Using interview method, we completed a questionnaire containing the patients’ demographic characteristics, questions about patients’ knowledge and attitude toward influenza vaccination, the influenza vaccination history, and the most common causes for vaccination. The relationship between the type of disease and patients’ characteristics (exposure) with vaccination coverage (outcome) was investigated. Results: The mean age of participants was 58.7 ± 11.3 years. Also, 58.8% of the patients received at least one dose of the vaccine and the regular injection rate was 32.8%. The coverage of influenza vaccine in dialysis patients was significantly higher than other patients ( p < 0.001). The mean knowledge score was 6.17 ± 2.15 out of maximum 9 scores. There was a positive association between age [ p = 0.001, odds ratio (OR) = 1.04] and patients’ knowledge ( p < 0.001, OR = 1.42) with the vaccination coverage. Conclusion: The coverage of influenza vaccine in high-risk patients in Birjand was low. Hence, it is essential to increase the knowledge of high-risk groups about the importance of influenza vaccination and facilitate their access to vaccines.
The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends
Authors: Till Brian M. , Mack Shale J. , Whitehorn Gregory , Collins Micaela Langille , Yang Chi-Fu Jeffrey , Grenda Tyler , Evans Nathaniel R. , Okusanya Olugbenga 
Published: November 2022

Background: National-level data on the burden of disease related to surgically managed hiatal hernia (HH) is not available. This study intends to define this burden of disease in the United States with attention to patient demographics, surgical approach, readmissions, mortality, and charges. Methods: Data from national Healthcare Utilization Project (HCUP) databases for 2010-2018 were retrospectively reviewed. Adult patients undergoing elective or emergent non-congenital diaphragmatic hernia repair were included. Spearman’s rank correlation was utilized to determine significance of trends over time. Results: In 2018, an estimated 62 528 HH repairs were performed, an incidence of 19.14/100 000 persons per year. The non-ambulatory procedure incidence was 7.52/100 000 persons in 2010 compared to 12.76/100 000 persons in 2018. Between the first and final years of analysis, patients undergoing non-elective repairs increased in age (2010: 62 years vs 2018: 69 years, P < .01) and frailty (4.9% vs 16.3%, P < .01). Rates of 30-day readmission remained similar for elective (6.5% vs 5.7%, P = .06) and non-elective operations (9.9% vs 9.5%, P = .71). In-hospital mortality increased for elective repairs (0.3% vs 0.6%, P < .01). In the final year of analysis, median charges were: Ambulatory: $37 864 versus Elective laparoscopic: $54 377 versus Elective Open: $73 436 versus Non-elective Laparoscopic: $85 906, versus Non-elective Open: $117 845, and total annual healthcare charges were $4.28 billion. Conclusions: Incidence of HH repair and charges increased over the study period. The proportion of frail patients undergoing elective and non-elective repairs increased. Changes in the incidence of underlying disease, patient perceptions and symptom tolerance, or surgeon decision-making may have contributed to these trends.
The relationship between clinical measures of cognitive function and grip strength in healthy older adults
Authors: Richardson James K. , Ellmers Toby J. 
Published: November 2022

Abstract
Background
Handgrip strength is considered a surrogate for musculoskeletal strength, however there is emerging evidence of an association with cognition. The specific neurocognitive attribute which best associates with grip strength is unknown.

Methods
We performed a secondary analysis on baseline data in 49 healthy older adults. Grip strength was corrected for body mass index. Control independent variables included age, Montreal Cognitive Assessment, and Trails B. Experimental variables included a clinical measure of simple reaction time, and clinical and computerized go/no-go tasks. The clinical Go/No-Go measure was determined with ReacStick, a rod-shaped device which – when released by the examiner – requires the participant to decide within 390 ms whether to catch the device or let it fall to the ground.

Results
Bivariate analysis demonstrated that age and all cognitive measures other than the computer go/no-go response accuracy related to grip strength. Multivariate analyses showed that following inclusion of the control variables, only ReacStick measures (reaction accuracy/simple reaction time) significantly predicted grip strength, explaining an additional 15.90% variance (p = 0.026). In contrast, computerized Go/No-Go accuracy (p = 0.391), response time variability (p = 0.463), and the control variables (p value range = 0.566–0.942) did not predict grip strength.

Conclusion
A short latency (< 390 ms) visuomotor Go/No-Go task independently predicted over 15% of grip strength variance, whereas a slower screen-based Go/No-Go task did not. These findings support the notion that declining grip strength likely reflects sub-clinical brain changes as well as musculoskeletal dysfunction, possibly explaining the potent relationships between grip strength, disability, chronic disease, and mortality.