bluuebunny/crossref_metadata_2025_split huggingface dataset:
Manual Lymph Drainage With Progressive Arm Exercises for Axillary Web Syndrome After Breast Cancer Surgery: A Randomized Controlled Trial
Authors: Torres-Lacomba María , Prieto-Gómez Virginia , Arranz-Martín Beatriz , Ferrandez Jean Claude , Yuste-Sánchez María José , Navarro-Brazález Beatriz , Romay-Barrero Helena 
Published: December 2021

Abstract

Objective
This study aimed to determine the effectiveness of a physical therapist–designed program tailored to axillary web syndrome (AWS) in women after breast cancer surgery.

Methods
A prospective, single-center, assessor-blinded, randomized controlled trial was conducted at the Physiotherapy in Women’s Health Research Unit of the Alcalá University (Madrid, Spain). Ninety-six women with AWS were assigned to the physical therapy group (manual lymph drainage [MLD] using resorption strokes and arm exercises as if performing median nerve neurodynamic glide exercises with no neural loading; n = 48) or the control group (standard arm exercises; n = 48), with both groups receiving treatment 3 times a week for 3 weeks. Both interventions included an educational component.

Results
Compared with the control group, the physical therapy group showed significant and clinically relevant improvements in the primary outcome (self-reported pain intensity) at the primary and 3-month follow-ups. Significant and clinically relevant differences between groups were also found in the secondary outcomes (shoulder active range of motion, shoulder disability, and physical and functional aspects of health-related quality of life) at the primary follow-up and in the secondary outcomes as well as the trial outcome index at the 3-month follow-up. No significant differences were found at the 6-month follow-up in either primary or secondary outcomes.

Conclusion
The physical therapy program tailored to AWS was found to be effective for AWS symptoms in women after breast cancer surgery, both immediately after the program and after 3 months.

Impact
To our knowledge, this is the first appropriately designed study to demonstrate the effectiveness of MLD with progressive arm exercises for AWS. Clinicians and health service providers should consider how to provide survivors of breast cancer with AWS the opportunity to participate in physical therapy programs, including MLD with progressive arm exercises.

Lay Summary
For axillary web syndrome following breast cancer surgery, a physical therapist can design a treatment program including manual lymph drainage and progressive arm exercises, which has been shown to result in reduced pain and improved motion compared with standard arm exercises.
Stand Up for Indigenous Health: A Simulation to Educate Residents About the Social Determinants of Health Faced by Indigenous Peoples in Canada
Authors: Sauvé Amanda , Cappelletti Adriana , Murji Latif 
Published: December 2021

Problem
In Canada, Indigenous peoples face significant health disparities. To improve health outcomes of and provide culturally safe care to Indigenous patients, medical learners must receive training on the social determinants of health (SDOH) driving these health inequities. The authors developed Stand Up for Indigenous Health (SU4IH), an immersive 2-hour simulation where participants navigate a series of scenarios as an Indigenous person. The objective of this pilot study was to assess whether SU4IH promotes intercultural empathy and enhances medical learners’ knowledge of Indigenous SDOH.

Approach
The authors partnered with 4 Indigenous communities in Ontario, Canada, from urban, rural, and remote settings to develop the scenarios for SU4IH between June 2015 and March 2016. During each SU4IH simulation, learners experience 14 scenarios using the Stand Up for Health mobile app, which automatically calculates each individual’s financial balance and stress levels as the simulation unfolds. The authors conducted a pre–post intervention study of SU4IH in January 2019 with family medicine residents recruited from 2 training sites in Ontario (n = 29). Residents completed pre- and postsurveys assessing change in empathy toward Indigenous patients (primary outcome), knowledge of Indigenous SDOH (secondary outcome), and motivation to engage with Indigenous patients in a culturally safe manner (secondary outcome).

Outcomes
Residents’ empathy scores significantly increased after participating in SU4IH (P < .001), as did residents’ knowledge of Indigenous SDOH (P < .001) and motivation to engage with Indigenous patients in a culturally safe manner (P = .031).

Next Steps
The authors are working to expand their capacity to implement this learning tool across Canada, which has involved relationship building with medical learners and faculty outside of Ontario who will need to partner with Indigenous communities in their region to develop region-specific scenarios. SU4IH is also being redesigned for small-group and virtual formats to facilitate its expansion.
The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial
Authors: Hansen Matt , Harrod Tabria , Bahr Nathan , Schoonover Amanda , Adams Karen , Kornegay Josh , Stenson Amy , Ng Vivienne , Plitt Jennifer , Cooper Dylan , Scott Nicole , Chinai Sneha , Johnson Julia , Conlon Lauren Weinberger , Salva Catherine , Caretta-Weyer Holly , Huynh Trang , Jones David , Jorda Katherine , Lo Jamie , Mayersak Ryanne , Paré Emmanuelle , Hughes Kate , Ahmed Rami , Patel Soha , Tsao Suzana , Wang Eileen , Ogburn Tony , Guise Jeanne-Marie 
Published: December 2021

Purpose
To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians.

Method
This was a double-blind, randomized controlled trial among obstetrics–gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015–2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.
The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer.

Results
One hundred ten obstetrics–gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from “average” to “good” ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the “average” category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome.

Conclusions
Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.
Screening for Postpartum Depression in a Neonatal Intensive Care Unit
Authors: Brownlee Maggie Hughes 
Published: December 2021

Background:
Postpartum depression (PPD) is a common mental health condition that affects approximately 13% of postpartum women in the United States. However, the prevalence in the neonatal intensive care unit (NICU) has been shown to be higher. Routine screening for maternal PPD is recommended at infant primary care well-child visits up to 6 months of age. The absence of a routine PPD screening program in a level IV NICU created a large gap in screening in an at-risk population.

Purpose:
To develop and implement a screening program in the NICU to increase the identification of maternal PPD symptoms and to develop both a referral algorithm for NICU staff to follow and a referral resource packet to be given to mothers with positive PPD screenings.

Methods:
Mothers with infants in the NICU were screened for PPD using the Edinburgh Postnatal Depression Scale (EPDS). Bedside nurses administered the screening tool and used a referral algorithm to determine appropriate follow-up. EPDS scores of 10 or more were considered positive and indicated a need for referral.

Results:
The overall EPDS screening compliance was 66% with a positive rate of 26%. Nurses followed the referral algorithm appropriately 100% of the time. It was confirmed that 93% of the mothers with positive EPDS screenings sought help from a mental health provider.

Implications for Practice and Research:
Routine maternal PPD screening should be implemented in all NICU settings. Postpartum mental health issues should not be the sole responsibility of obstetricians, mental health providers, or maternal primary care providers.
Prelinguistic Consonant Production and the Influence of Mouthing Before and After Cochlear Implantation
Authors: Fagan Mary K. , Vu Minh-Chau 
Published: December 2021

Objectives:
The goal of the study was to investigate prelinguistic consonant production and the influence of vocalizations that co-occurred with object mouthing on consonant production in infants with profound sensorineural hearing loss before and after cochlear implantation to advance knowledge of early speech development in infants with profound hearing loss.

Design:
Participants were 43 infants, 16 infants with profound sensorineural hearing loss and 27 hearing infants. In the mixed longitudinal and cross-sectional design, infants with profound hearing loss and age-matched hearing infants participated before cochlear implantation, at an average age of 9.9 mo, and/or after cochlear implantation, at an average age of 17.8 mo. Mean age at cochlear implantation for infants with profound hearing loss was 12.4 mo; mean duration of cochlear implant use at time of testing was 4.2 mo.

Results:
Before and after cochlear implantation, infants with profound hearing loss produced significantly fewer supraglottal consonants per consonant-vowel vocalization than hearing peers and had smaller overall consonant inventories. Before, but not after cochlear implantation, infants with profound hearing loss produced proportionally more vocalizations, supraglottal consonant-vowel vocalizations, and different supraglottal consonants in vocalizations during mouthing than did hearing infants.

Conclusions:
The results document consonant production before cochlear implantation in a larger group of infants with profound hearing loss than previously examined. The results also extend evidence of early delays in consonant production to infants who received cochlear implants at 12 mo of age, and show that they likely miss the potential benefits of auditory-motor feedback in vocalization-mouthing combinations that occur before they have access to sound through cochlear implants.
Wideband Tympanometry Findings in School-aged Children: Effects of Age, Gender, Ear Laterality, and Ethnicity
Authors: Downing Cerys , Kei Joseph , Driscoll Carlie , Choi Robyn , Scott Dion 
Published: December 2021

Objectives:
Wideband tympanometry (WBT) measures middle-ear function across a range of frequencies (250 to 8000 Hz) while the ear-canal pressure is varied from +200 to –300 daPa. WBT is a suitable test to evaluate middle-ear function in children, but there is a lack of age-, ear-, gender-, or ethnicity-specific data throughout the literature. The purpose of this study was to investigate the effects of age, ear laterality, gender, and ethnicity on the WBT data retrieved from children aged 4 to 13 years determined to have normal middle-ear function.

Design:
Data were collected cross-sectionally from 924 children aged 4 to 13 years who passed a test battery consisting of 226-Hz tympanometry, ipsilateral acoustic stapedial reflexes, and pure-tone screening, and without significant history of middle-ear dysfunction. Participants were grouped according to their age: 4 to 6 years, 7 to 9 years, 10 to 13 years. Wideband absorbance values were extracted at 0 daPa (WBA0) and tympanometric peak pressure (WBATPP).

Results:
The effects of age, frequency, and pressure (WBA0 versus WBATPP) were statistically significant. There were significant differences between WBA0 and WBATPP for all age groups such that WBA0 had lower absorbance at low frequencies (250 to 1600 Hz) and greater absorbance at mid to high frequencies (2500 to 8000 Hz). Statistically significant effects of age were present for WBA0 and WBATPP such that absorbance generally increased with age from 250 to 1250 Hz and decreased with age from 2000 to 5000 Hz. There were no significant main effects of gender, ear, or ethnicity.

Conclusions:
Gender-, ear-, and ethnicity-specific clinical WBA0 and WBATPP norms are not required for diagnostic purposes; however, age-specific norms may be necessary. Age-related changes in middle-ear function were observed across WBA0 and WBATPP. The data presented in this study are a suitable clinical reference for evaluating the outer- and middle-ear function of school-aged children.
A Rare Case of Pediatric Xanthoma Disseminatum With Diabetes Insipidus and BRAF p.V600E Mutation
Authors: Luo Shuaihantian , Tan Yixin , Zhang Guiying 
Published: December 2021

Abstract:
Xanthoma disseminatum (XD) is a rare non-Langerhans cell histiocytosis characterized by xanthomatous lesions in the absence of hyperlipidemia. XD usually develops in young adults, and there are rare cases among children. BRAF mutations are frequent in Langerhans cell histiocytosis and Erdheim–Chester disease but absent or only rarely detected in other histiocytosis. Herein, we described a 6-year-old Chinese girl presented with generalized skin lesions and diabetes insipidus for 5 months. There were multiple periorbital xanthelasma with histopathological features of foamy histiocytes infiltration with Touton cells. Pituitary magnetic resonance imaging showed pituitary enlargement and pituitary stalk thickening. The presence of BRAF p.V600E mutation makes this case distinctive and also offers a potential therapeutic target. According to our review of the literature, this is the first pediatric XD with diabetes insipidus and BRAF mutation.
Use of Neuromuscular Electrical Stimulation for Abdominal and Quadriceps Muscle Strengthening: A Randomized Controlled Trial
Authors: Spring Leah K. , Petrell Kathleen , Depina Joaninha , Dover Jeffrey S. 
Published: December 2021

BACKGROUND
Radiographic imaging has demonstrated muscle hypertrophy after treatment with noninvasive body contouring devices that target skeletal muscles.

OBJECTIVE
This pilot study sought to evaluate whether increased muscle mass translated to improved functional strength and endurance.

METHODS
A prospective, single-center, randomized open-label controlled study included 26 subjects randomized into 3 groups: 2 treatment groups and 1 control group. Both treatment groups received 4 neuromuscular electrical stimulation (NMES) treatments over a 2-week period. Muscle performance testing was conducted at baseline and 2-week and 4-week posttreatment. Anthropometric measurements were assessed at baseline and at 4-week posttreatment. Study participants completed subject satisfaction surveys and a personal experience assessment.

RESULTS
Treatment with NMES resulted in statistically significant improvements in abdominal and quadriceps strength and endurance from baseline through 4-week posttreatment. Mean waist circumference decreased and quadriceps circumference increased, both nonsignificantly. Subject satisfaction regarding abdominal and quadriceps strength was reported as “satisfied or very satisfied” in 89% and 92% at 4-week and 8-week posttreatment, respectively.

CONCLUSION
Treatment of the abdomen and quadriceps with NMES leads to significant improvements in muscular strength and endurance.
Assessment of Radiological Hazard of Radioactive Waste Using Effective or Organ Doses: How This May Affect Final Waste Disposal
Authors: Ivanov V.K. , Chekin S. Yu. , Lopatkin A.V. , Menyajlo A.N. , Maksioutov M.A. , Tumanov K.A. , Kashcheeva P.V. , Lovachev S.S. 
Published: December 2021

Abstract
The radiological hazard of spent nuclear fuel and radioactive waste slows down further development of nuclear energy systems. The authors evaluate timescales required to reduce the radiological hazard of accumulated waste to the reference level of natural uranium that had been consumed by the nuclear energy system. The estimate of this time scale depends on the radiological hazard metric used in the calculations. In this study, two metrics are compared: (1) the committed effective dose based on ICRP Publication 72 and (2) the lifetime radiation risk calculated with use of organ doses and recent radiation risk models recommended by ICRP. The effective dose of the waste reaches the reference level 300 y after the accumulation of waste, while lifetime attributable risk of waste converges to natural uranium in 100 y. Thus, the lifetime attributable risk (LAR) metric is more appropriate to estimate the time requirements for radioactive waste storage and disposal. The effective dose metric significantly overestimates this timescale as it is not intended for quantifying radiation-related risks.
Changes in the Epidemiology of Zoonotic Infections in Children
Authors: Kuitunen Ilari , Renko Marjo 
Published: December 2021

Objectives:
Zoonotic infections are difficult to recognize in children. The age distributions and seasonal occurrences of these infections vary substantially, even among those transmitted by the same vectors, and their epidemiology may change over time. The aim was to report the incidences and trends of Borrelia burgdorferi, Puumala virus, Francisella tularensis and tick-borne encephalitis (TBE) virus infections in the pediatric population (age 0–19) of Finland.

Methods:
A nationwide survey based on the National Infectious Disease Register was conducted from 1996 to 2019 and all laboratory-confirmed cases were included. Age-stratified incidences per 100,000 person-years were calculated.

Results:
Cumulative incidences were B. burgdorferi 11.2, TBE 0.4, Puumala virus 6.4 and F. tularensis 2.5 per 100,000 person-years. An increasing trend in the incidences of B. burgdorferi and TBE was observed. Borrelia expanded geographically northward and inland. Tularemia follows a 2–4-year epidemic cycle and rates are similar across age groups. Puumala incidences are highest in the older children.

Discussion:
Borrelia infections increased most rapidly in children 5–9 years of age and overall expanded geographically in Finland. Tularemia epidemic cycles were shorter than those previously reported. These results will help clinicians to identify these infections in different geographic areas and age groups in Finland.
Adolescent pain: appraisal of the construct and trajectory prediction-by-symptom between age 12 and 17 years in a Canadian twin birth cohort
Authors: Battaglia Marco , Garon-Carrier Gabrielle , Rappaport Lance , Brendgen Mara , Dionne Ginette , Vitaro Frank , Tremblay Richard E. , Boivin Michel 
Published: December 2021

Abstract
Adolescent pain is common and continues into adulthood, leading to negative long-term outcomes including substance-related morbidity: an empirical definition of its construct may inform the early detection of persistent pain trajectories. These secondary analyses of a classical twin study assessed whether headaches, back pains, abdominal pain, chest pains, stabbing/throbbing pain, and gastric pain/nausea, measured in 501 pairs across 5 waves between age 12 and 17 years, fit a unitary construct or constitute independent manifestations. We then assessed which symptoms were associated with a steady, “frequent pain” trajectory that is associated with risk for early opioid prescriptions. Item response theory results indicated that all 6 pain symptoms index a unitary construct. Binary logistic regressions identified “back pain” as the only symptom consistently associated with membership in the “frequent adolescent pain” trajectory (odds ratio: 1.66-3.38) at all 5 measurement waves. Receiver operating characteristic analyses computed the discriminating power of symptoms to determine participants' membership into the “frequent” trajectory: they yielded acceptable (0.7-0.8) to excellent (0.8-0.9) area under the curve values for all 6 symptoms. The highest area under the curve was attained by “back pain” at age 14 years (0.835); for multiple cut-off thresholds of symptom frequency, “back pain” showed good sensitivity/false alarm probability trade-offs, predominantly in the 13 to 15 years age range, to predict the “frequent pain” trajectory. These data support a unitary conceptualization and assessment of adolescent pain, which is advantageous for epidemiological, clinical, and translational purposes. Persistent back pain constitutes a sensitive indicator of a steady trajectory of adolescent pain.
Combination of inhaled nitrous oxide and oral opioids induces long-lasting analgesic effects in patients with neuropathic pain: ProtoTOP study post hoc exploratory analyses
Authors: Bouhassira Didier , Perrot Serge , Attal Nadine , Ramirez-Gil Juan Fernando , Delval Cécile , Schaller Manuella , Bessière Baptiste , Houéto Patrick , Sommer Claudia 
Published: December 2021

Abstract
Experimental studies have suggested that nitrous oxide-induced analgesia depends on interactions with opioids. On the basis of these results, we hypothesized that the effects of inhaled nitrous oxide/oxygen (N2O/O2) 50%-50% equimolar mixture (EMONO) on patients with neuropathic pain would be higher in those receiving concomitant opioids. To test this hypothesis, we did exploratory post hoc analyses of our recently published ProtoTOP study to compare the effects of EMONO and placebo in patients with or without concomitant opioid treatment. A total of 92 patients of the 221 (ie, 41.6%) included in the ProtoTOP study were concomitantly treated with opioids. In contrast with our previous analyses, average pain intensity was significantly decreased in comparison with placebo one week after the last treatment administration in patients treated with opioids, but not in those treated without opioid, and this effect was maintained over the 4-week follow-up period. Neuropathic pain symptom inventory (NPSI total and subscores) was also significantly more decreased after inhalation of EMONO in comparison with placebo only in patients receiving opioids. The proportion of patients with at least 30% pain reduction and of those reporting an overall improvement with the Patient Global Impression of Change were significantly higher only in this population of patients. In conclusion, these results complement our previous analyses with the identification of a specific population of responders to EMONO inhalation in patients with neuropathic pain. As suggested by experimental studies, we hypothesized that these long-lasting analgesic effects could depend on the anti-N-methyl-D-aspartate properties of N2O.