bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resident-Driven Dysphagia Screening Protocol for Expedited Antithrombotic Delivery in Acute Ischemic Stroke
Authors: Zhang Linda , Kamen Scott , Niles Jennifer , Goss Jessica , Heslin Mark E. , Vigilante Nicholas , Thau Lauren , Edwards Christopher , Marden Kyle R. , Thon Jesse M. , Yeager Terri , Siegler James E. 
Published: May 2022

Background We implemented a multi-disciplinary process improvement intervention at our Comprehensive Stroke Center with speech/language pathologists to expedite oral medication delivery in stroke patients. Following a failed nursing dysphagia screen, trained neurology physicians screened dysphagia further to approve use of oral medications. We analyzed the safety and efficacy of this intervention. Methods We analyzed retrospectively collected data for hospital course, timing of first screen, first oral medication use, and complications (e.g., aspiration pneumonia) in consecutive ischemic stroke patients (9/2019-07/2021). Patients were included if they passed a dysphagia assessment by physicians (Ph), nurses (RN), or speech/language pathologists (SLP). Arrival-to-dysphagia screen and arrival-to-antithrombotic were assessed using restricted mean survival time (RMST). Results Of the 789 included patients, 673 were passed by RN, 104 by SLP, and 12 by Ph. Compared to patients passed by SLP, those passed by Ph were younger and had less severe deficits ( P < .01 for both). Patients were screened more quickly by Ph than RN or SLP (median 38 vs 182 vs 1330-min post-arrival, P = .0001; 299-min RMST difference vs RN [95%CI 22-575, P = .03]; 470-min RMST difference vs SLP [95%CI 175-765, P = .002]). This translated to faster oral antithrombotic use for Ph-passed patients (138-min RMST difference vs RN [95%CI 59-216]; 332-min RMST difference vs SLP [95%CI 253-411]). No patients passed by Ph experienced aspiration pneumonia (0%). Conclusions We safely conducted a physician-driven dysphagia screening paradigm which led to faster oral antithrombotic delivery without signal of patient harm. Physician availability to complete dysphagia screens in acute stroke patients was a limitation.
Changes in Attachment to Parents and Peers and Relations With Mental Health During the COVID-19 Pandemic
Authors: Song Qingfang , Vicman Jess M. , Doan Stacey N. 
Published: May 2022

Using a longitudinal design, we examined changes in parent and peer attachment among college students, and their predictive and protective roles in relation to mental health problems during the COVID-19 pandemic. College students ( N = 106) rated their parent and peer attachment, and self-reported anxiety, loneliness, and depressive symptoms 1 year before and during the pandemic. Participants also rated the impact of COVID-19 related stressors (CRS). Results demonstrate significant increases in loneliness and depression and a decrease in peer attachment security during the pandemic. Increases in peer attachment security were negatively correlated with loneliness during the pandemic. Parent attachment buffered the relationship between the impact of CRS and mental health problems during the pandemic. Guided by the integrated framework from attachment theory and life course theory, the current study discussed findings and practices regarding the important role of attachment for college students and their adjustment to the pandemic.
Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review
Authors: Ogawa Kiyohisa , Yoshida Atsushi , Matsumura Noboru , Inokuchi Wataru 
Published: May 2022

Background: Arm wrestling is a popular sport in which various injuries have occurred, even in children. Purpose: To analyze reported fracture-separation of the medial humeral epicondyle (MHE) caused by arm wrestling to determine its mechanism and provide a current overview. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Web of Science databases were searched using the terms “arm wrestling” and “humeral fracture” or “medial humeral epicondyle fracture”; and “sports” and “humeral fracture” or “medial humeral epicondyle fracture,” following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were English full-text articles on arm wrestling–induced MHE fracture that described patient characteristics and presented appropriate images. Studies with a lack of appropriate images or detailed description of the injury situation were excluded. The patient characteristics were evaluated, and the ratios of treatment selection and outcomes were evaluated using the chi-square test. Results: Included were 27 studies with a total of 68 patients, all boys with a mean age of 14.6 ± 1.24 years (based on n = 65, with 3 patients excluded from this calculation as no definitive age was provided). Boys aged 14 to 15 years accounted for 72% (49/68) of the cases. Fracture occurred suddenly during arm wrestling in 63 boys, while the other 5 boys experienced antecedent medial elbow pain. The match status at the time of injury, provided for 46 patients, was varied. In 31 boys with known match details, injury occurred when a participant suddenly added more force to change the match status. Eight patients displayed anterior and/or proximal displacement of the MHE fragment. Treatment was nonoperative in 25 patients and operative in 38 patients (n = 63, excluding 5 unknown patients). In 35 patients followed up for ≥3 months (mean, 17.6 ± 12.3 months), outcomes were not significantly different between the operative and nonoperative groups. Conclusion: MHE fracture-separation caused by arm wrestling occurred mostly in boys aged 14 to 15 years regardless of the match status. The likely direct cause is forceful traction of the attached flexor-pronator muscles. A relative mechanical imbalance during adolescence may be an underlying cause. A sudden change from concentric to eccentric contraction of the flexor-pronator muscles increases the likelihood of fracture occurrence.
Coproducing the Learning Environment: Lessons Learned from a Year of Near-Peer Teaching
Authors: Humphrey Kristen N. , Daulton Robert S. , Weber Danielle , Sall Dana , Kelleher Matthew 
Published: May 2022

PURPOSE Few medical schools offer electives with the goal of teaching medical students to be effective teachers prior to residency. We developed a novel year-long, longitudinal course, the Clinical Teaching Elective (CTE), that develops fourth-year medical students as student teachers within Clinical Skills (CS). APPROACH/METHODS The elective was designed by Clinical Skills (CS) Course Directors and two fourth-year medical students (M4) as a longitudinal elective. The elective involves teaching in the Simulation Center where M4 student instructors teach first and second-year medical students. Each session, in addition to simulated patient case topics, emphasizes application of a key topic within medical education (ie clinical reasoning, reflective practice, dual process reasoning). DISCUSSION Six “teaching takeaways” were crafted to summarize common themes experienced by near-peer medical student educators. Teaching is not about the destination, but rather the diagnostic journey. Students thrive when learning is co-produced. A little bit of praise goes a long way. You can't please every learner. When students struggle, there is more to teach than just the answer. Facilitating learner independent thinking promotes future autonomy. SIGNIFICANCE A novel CTE for fourth-year medical students that emphasizes medical education pedagogy prepares students to serve as educators in residency. The CTE provides an opportunity for medical students to develop into effective clinical educators prior to residency. The focus of our elective on medical education pedagogy furthers medical student understanding of adult learning theory and fosters professional development in teaching clinical reasoning.
Anatomic Total Shoulder Arthroplasty: Component Size Prediction with 3-Dimensional Pre-Operative Digital Planning
Authors: Freehill Michael T. , Weick Jack W. , Ponce Brent A. , Bedi Asheesh , Haas Derek , Ruffino Bethany , Robbins Chris , Prete Alexander M. , Costouros John G. , Warner Jon JP 
Published: May 2022

Background The rate, complexity, and cost of total shoulder arthroplasty (TSA) continues to grow. Technology has advanced pre-operative templating. Reducing cost of TSA has positive impact for the patient, manufacturer, and hospital. The aim of this study was to evaluate the accuracy of implant size selection based on 3-D templating. Our hypothesis was that pre-operative templating would enable accurate implant prediction within one size. Methods Multicenter retrospective study of anatomic TSAs templated utilizing 3-D virtual planning technology. This program uses computed tomography (CT) scans allowing the surgeon to predict component sizes of the glenoid and humeral head and stem. Pre-operative templated implant size were compared to actual implant size at the time of surgery. Primary data analysis utilized unweighted Cohen's Kappa test. Results 111 TSAs were analyzed from five surgeons. Pre-operative templated glenoid sizes were within one size of actual implant in 99% and exactly matched in 89%. For patients requiring a posterior glenoid augment (n = 14), 100% of implants were within one size of the template and 93% matched exactly. For stemless humeral components (n = 87) implanted, 98% matched the pre-operative template within one size with 79% exactly matched. For stemmed components (n = 24), 88% of cases were within one size of the preoperative plan and exactly matching in 83%. Humeral head diameter matched within one size of the pre-operative template in 84% of cases and exactly matched in 72%. Conclusion Pre-operative 3-D templating for TSAs can accurately predict glenoid and humeral component size. This study sets the groundwork for utilization of pre-operative 3-D templating as a potential method to reduce overall TSA costs by managing cost of implants, reducing inventory needs, and improving surgical efficiency.
Evaluation of Neutrophil-to-Lymphocyte Ratio Among Ischemic Stroke Subtypes and Stroke Severity
Authors: Shah Dhrumil , Rajan Rajeswari , Batra Anuradha , Anand Ish , Saraf Amrita , Sethi Prahlad 
Published: May 2022

Introduction: Recently, neutrophil-to-lymphocyte ratio (NLR) has been proven to be useful in predicting severity, mortality, and morbidity of stroke. NLR is low cost and yet not used widely as a biomarker to predict prognosis. Aims: We evaluated the association of NLR in severity of stroke and ischemic stroke subtypes. Methodology: A total of 69 subjects with ischemic stroke onset within 24 h were included in the study and categorized according to TOAST classification. National Institutes of Health Stroke Scale was used to determine stroke severity at admission. Samples were obtained within 24 h of stroke onset and NLR measured which was later correlated with severity and subtypes of stroke. Results: NLR and severity of stroke showed statistically significant association ( P < .05). Median (interquartile range [IQR]) of NLR was significantly high in severe cases (7.1 [4.03-7.698]), as compared to others. The area under the receiver operating characteristic curve for NLR to predict the stroke severity was 6.07 [area under the curve 0.764; 95% confidence interval: 0.647 to 0.858). When NLR was more than 6.07, there was 90.90% chances of moderate-to-severe stroke and with milder stroke, 93.10% had NLR of less than equal to 6.07. NLR and stroke subtypes also showed statistically significant association ( P < .05). Median (IQR) of NLR in embolic stroke was significantly high (4.75 [2.95-8.2]), as compared to other stroke subtypes. Conclusion: NLR, at a cut-off 6, has moderate sensitivity and higher specificity in predicting stroke severity and NLR was high in embolic stroke among other stroke subtypes.
Resveratrol ameliorates liver fibrosis induced by nonpathogenic Staphylococcus in BALB/c mice through inhibiting its growth
Authors: Li Zhiqin , Dong Jianxia , Wang Meng , Yan Jingya , Hu Yushu , Liu Yang , Pan Yajie , Li Hua 
Published: May 2022

AbstractBackgroundThe altered gut microbiota is implicated in the pathogenesis of liver fibrosis. Resveratrol is a candidate for the treatment of liver fibrosis, which could ameliorate the dysregulation of gut microbiota in mice. This study aimed to clarify the role and mechanism of resveratrol in gut microbiota during liver fibrosis.MethodsA mouse model of liver fibrosis induced by CCl4was conducted to assess the effect of resveratrol on liver fibrosis. The changes of gut microbiota in liver fibrotic mice after resveratrol intervention were assessed using 16S ribosomal RNA sequencing. The mechanism of the gut microbiota dysregulation in liver fibrosis was investigated by Sirius red staining, immunohistochemical assay, bacterial translocation (BT), EUB338 fluorescence in situ hybridization, immunofluorescence, trans-epithelial electrical resistance analysis and paracellular permeability analysis.ResultsResveratrol relieved CCl4-induced liver fibrosis. Besides, resveratrol restrained the gut microbiotaStaphylococcus_lentusandStaphylococcus_xylosusin the liver fibrotic mice, and theStaphylococcus_xylosusandStaphylococcus_lentusfacilitated the occurrence of BT and the cultures of them enhanced the permeability of intestine. The in vivo assay corroborated that the excessiveStaphylococcus_xylosusandStaphylococcus_lentuscanceled the protecting effect of resveratrol on liver fibrosis, andStaphylococcus_xylosusorStaphylococcus_lentusalone had a limited impact on the liver injury of normal mice.ConclusionResveratrol ameliorated liver fibrosis by restraining the growth ofStaphylococcus_xylosusandStaphylococcus_lentus.
A real-world study of acute and preventive medication use, adherence, and persistence in patients prescribed fremanezumab in the United States
Authors: Krasenbaum Lynda J. , Pedarla Vasantha L. , Thompson Stephen F. , Tangirala Krishna , Cohen Joshua M. , Driessen Maurice T. 
Published: May 2022

Abstract
Background
Following approval of fremanezumab for the prevention of migraine in adults, health care decision makers are interested in understanding real-world clinical characteristics and treatment patterns among patients initiating fremanezumab therapy.

Methods
Data were obtained for this retrospective (pre-post) study from the Veradigm Health Insights database. The study period was January 1, 2014, to June 30, 2019. Patients were included if they were aged ≥ 18 years; had ≥ 1 migraine diagnosis during the study period; and had a medication record for fremanezumab on or after diagnosis during the identification period (September 1, 2018–December 31, 2018). Treatment patterns, including adherence, persistence, and utilization of acute and preventive migraine medication prescriptions, were evaluated.

Results
Of 987 patients initiating fremanezumab during the study period, 738 (74.8%) were adherent to fremanezumab by proportion of days covered (PDC; ≥ 80%) and 780 (79.0%) were adherent by medication possession ratio (MPR; ≥ 80%). A total of 746 (75.6%) patients were persistent for ≥ 6 months. Quarterly fremanezumab (n = 186) was associated with higher rates of adherence versus monthly fremanezumab (n = 801) by PDC (quarterly, 91.3%; monthly, 84.9%; P < 0.001) and MPR (quarterly, 92.2%; monthly, 87.9%; P = 0.006) and higher persistence at ≥ 6 months (quarterly, 82.8%; monthly, 73.9%; P = 0.011). After fremanezumab initiation, patients who were persistent for ≥ 6 months experienced significant reductions from baseline in the mean monthly number of acute and preventive migraine medication prescriptions (P < 0.001). Subgroup analyses in patients with comorbid depression and anxiety showed meaningful real-world benefits based on significant reductions in the number of patients who were prescribed antidepressants (baseline, 68.6%; follow-up, 56.4%; P = 0.0025) and anxiolytic medications (baseline, 55.0%; follow-up, 47.2%; P = 0.037), respectively. In a subgroup of patients with comorbid hypertension at baseline, fremanezumab treatment resulted in nonsignificant reductions in blood pressure.

Conclusions
Overall, adherence and persistence to fremanezumab in this real-world study was high in patients with migraine, with higher rates observed for quarterly fremanezumab. Patients who were persistent for ≥ 6 months experienced significant reductions in acute and preventive migraine medication use, while a subgroup of migraine patients with comorbid depression and anxiety at baseline showed significant reductions in antidepressant and anxiolytic medication use.
How predictable is evolution in a chancy world where evolution’s raw material is random mutation?
Authors: Leigh Egbert Giles 
Published: May 2022

AbstractThis is a review of A Series of Fortunate Events, by Sean B. Carroll. First, Carroll uses the decisive role of chance in our lives to deny validity to anthropocentric religion. Then he discusses impacts of chance environmental disasters on the course of evolution, the random origin of all variation on which natural selection acts, and the decisive role of chance in human lives.
Diagnosis of cardiac occupancy as metachronous carcinoma using multimodal imaging: a case report
Authors: Wang Zihan , Xiao Xiang , Lv Shuying , Li Chunyan , Jiang Hong 
Published: May 2022

Abstract
Background
Metachronous carcinoma presenting as a cardiac malignancy is rare, and timely diagnosis is critical. We report a patient with a primary cardiac tumor who eventually died and performed an imaging-related literature review.

Case presentation
A 68-year-old Chinese male patient, who had suffered from multiple malignancies, was suddenly found to have severely reduced platelets and symptoms of decreased cardiac function. After undergoing a series of imaging examinations such as transthoracic echocardiography and positron emission tomography-computed tomography, he was found to have a large occupancy within the right heart and was finally diagnosed with a primary cardiac malignancy. Combined with the patient's previous medical history, it was judged that this time it was a metachronous carcinoma. The patient was unable to accept the risk of surgery and eventually died.

Conclusion
This is a case report reporting a cardiac malignancy. This case highlights the importance of using multiple imaging modalities to make a common diagnosis and the need for more detailed evaluation in patients with metachronous carcinoma.
Markers of cognitive skills important for team leaders in emergency medical services: a qualitative interview study
Authors: Sedlár Martin , Kaššaiová Zuzana 
Published: May 2022

Abstract
Background
Cognitive skills and other non-technical skills are key for emergency medical services (EMS); however, there have been a limited number of their markers identified. This study aims to identify markers of cognitive skills—situation awareness and decision making—important for team leaders in EMS. The focus is on any markers of cognitive skills that are associated with quality and safety at EMS work.

Method
In-depth semi-structured interviews were conducted with 20 EMS team leaders (10 EMS physician team leaders and 10 paramedic team leaders) and analysed by the structured approach utilising the known framework of cognitive skill elements.

Results
The data analysis revealed a set of 50 markers falling into elements of situation awareness (gathering information, interpreting information, anticipating states), elements of decision making (identifying options, implementing decisions, re-evaluating decisions), and an additional cognitive element (maintaining standards). These markers represented cognitive processes, acts, and communications, therefore, some of them can be observable and others rather unobservable. The identified markers were not too specific, applicable mostly in various challenging situations with patients’ medical problems and in EMS team leaders working in ground ambulances in urban and rural/remote areas.

Conclusion
The findings provide a better understanding of EMS team leaders’ cognitive skills, and can aid in the development of assessment and training tools suited particularly to them.
Reasons for bias in ambulance clinicians’ assessments of non-conveyed patients: a mixed-methods study
Authors: Johansson Helena , Lundgren Kristin , Hagiwara Magnus Andersson 
Published: May 2022

Abstract
Background
The number of ambulance assignments and the influx of patients to the emergency departments (EDs) in Sweden have increased in recent years. This is one reason the protocol for prehospital emergency care was developed around referring patients for non-conveyance, either through the see-and-convey elsewhere approach or through the see-and-treat approach. However, this protocol has led to challenges in patient assessments.
This study aimed to investigate the underlying causes of patient harm among those referred for the see-and-treat approach by the emergency medical services.

Methods
This three-phase study involved a mixed-methods design. Cases of injuries, internal investigations and incident analyses of referrals for the see-and-treat approach in two regions in south eastern Sweden from 2015 to 2020 were examined using qualitative content analysis. This qualitative analysis was the basis for the quantitative analysis of the ambulance records. After the qualitative analysis was completed, a review protocol was developed; 34 variables were used to review 240 randomly selected ambulance records logged in 2020, wherein patients were referred for the see-and-treat approach. Finally, the review results were synthesised.

Results
The qualitative analysis revealed three common themes: ‘assessment of patients’, ‘guidelines’ and ‘environment and organisation’. These results were confirmed by a medical journal review. Shortcomings were found in the anamnesis and in the number of targeted examinations performed. The checklist for referring patients for the see-and-treat approach and the information sheet to be provided to the patients were not used. In 34% of the ambulance records examined, the EMS clinicians deviated from the current guidelines for a see-and-treat referral.

Conclusions
The results indicated that the low adherence to guidelines and the patient assessment deviating from the protocol put patients at risk of being harmed during a see-and-treat referral.
Measures are needed to guarantee a safe assessment of an increasing number of patients who are referred for the see-and-treat approach, especially the multi-sick elderly patients.