bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left/Right Judgment Task for the Chest Region, Part 2: Evidence for Mental Maneuvering in Performance During Chest Versus Shoulder Regions
Authors: Boyd Benjamin S. , Smoot Betty J. , Nee Robert J. 
Published: March 2022

Background:
Left/right judgment tasks (LRJTs) theoretically require mental maneuvering one's body to reorient and match a viewed image. Mental maneuvering strategies may include spatial transformation and/or motor imagery. LRJT performance outcomes do not inherently distinguish between mental maneuvering strategies used to accomplish the task. Orientation difference (OD) describes the difference between the observer's position and the body orientation within an image. Evaluating whether LRJTs elicit mental maneuvering has traditionally been based upon the premise of an inverse linear relationship between LRJT performance and OD (“exact match” hypothesis). If true, larger ODs should lead to slower LRJT performance.

Objectives:
To evaluate the relationship between OD and chest and shoulder LRJT performance.

Design:
Observational, cohort study.

Method:
Associations between OD and LRJT accuracy and response time were evaluated in women with and without a history of unilateral breast cancer. Images from chest and shoulder LRJTs were categorized by various OD methods that assume more efficient (shortest path: OD(shortest path)) or less efficient (rotation by dimensions: (OD(rotation by dimensions)) participant mental maneuvering. Shoulder analyses also incorporated the angle between the arm and trunk (OD(shortest path + arm angle) and OD(rotation by dimensions + arm angle)).

Results:
Chest LRJT response time was most associated with OD(shortest path) (R
2 = 0.510). Shoulder LRJT response time was most associated with OD(rotation by dimensions + arm angle) (R
2 = 0.807). Both relationships were nonlinear.

Discussion:
Strong relationships between chest and shoulder LRJT and different OD models suggest these are discrete tasks that elicit mental maneuvering. The nonlinear nature of these relationships does not support the “exact match” hypothesis. Factors that can explain the remaining variance in LRJT performance need to be identified.
nnU-Net Deep Learning Method for Segmenting Parenchyma and Determining Liver Volume From Computed Tomography Images
Authors: Pettit Rowland W. , Marlatt Britton B. , Corr Stuart J. , Havelka Jim , Rana Abbas 
Published: March 2022

Background:
Recipient donor matching in liver transplantation can require precise estimations of liver volume. Currently utilized demographic-based organ volume estimates are imprecise and nonspecific. Manual image organ annotation from medical imaging is effective; however, this process is cumbersome, often taking an undesirable length of time to complete. Additionally, manual organ segmentation and volume measurement incurs additional direct costs to payers for either a clinician or trained technician to complete. Deep learning-based image automatic segmentation tools are well positioned to address this clinical need.

Objectives:
To build a deep learning model that could accurately estimate liver volumes and create 3D organ renderings from computed tomography (CT) medical images.

Methods:
We trained a nnU-Net deep learning model to identify liver borders in images of the abdominal cavity. We used 151 publicly available CT scans. For each CT scan, a board-certified radiologist annotated the liver margins (ground truth annotations). We split our image dataset into training, validation, and test sets. We trained our nnU-Net model on these data to identify liver borders in 3D voxels and integrated these to reconstruct a total organ volume estimate.

Results:
The nnU-Net model accurately identified the border of the liver with a mean overlap accuracy of 97.5% compared with ground truth annotations. Our calculated volume estimates achieved a mean percent error of 1.92% + 1.54% on the test set.

Conclusions:
Precise volume estimation of livers from CT scans is accurate using a nnU-Net deep learning architecture. Appropriately deployed, a nnU-Net algorithm is accurate and quick, making it suitable for incorporation into the pretransplant clinical decision-making workflow.
Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?
Authors: Karamian Brian A. , Levy Hannah A. , Boere Payton , Yalla Goutham R. , Canseco Jose A. , Chang Michael , Divi Srikanth N. , Fang Taolin , Millhouse Paul W. , Lendner Mayan , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Markova Dessislava Z. , Schroeder Gregory D. 
Published: March 2022

Study Design:Prospective cohort study.Objective:The aim was to determine the relationship between serum inflammatory mediators, preoperative cervical spine disease severity, and clinical outcomes after anterior cervical discectomy and fusion (ACDF).Summary of Background Data:Given the role of the inflammatory cascade in spinal degenerative disease, it has been hypothesized that inflammatory markers may serve as a predictor of patient outcomes after surgery.Materials and Methods:All patients over age 18 who underwent ACDF for cervical spondylosis with associated radiculopathy and/or myelopathy between 2015 and 2017 from a single institution were prospectively recruited. Preoperative serum inflammatory markers including interleukin (IL)-6, IL-8, tumor necrosis factor-α, high-mobility group box-1 (HMGB1), and white blood cells were measured and correlated to patient demographics, surgical characteristics, duration of symptoms, previous opioid use, and preoperative and 1-year postoperative patient-reported outcomes measures (PROMs) including the neck disability index (NDI), visual analog scale neck pain, visual analog scale arm pain, and Physical and Mental Component Scores of the Short Form-12 (PCS and MCS, respectively) using spearman’s rho coefficient.Results:A total of 77 patients were enrolled with follow-up PROMs available for 62% (n=48) of patients at a minimum of 1-year after ACDF. The absolute concentrations of IL-6 and tumor necrosis factor-α were found to be weakly correlated with one another (ρ=0.479). Preoperative symptoms lasting <1-year were weakly correlated with elevation in HMGB1 (ρ=0.421). All other patient demographics exhibited negligible correlation with the preoperative inflammatory markers. Lower preoperative PCS (ρ=0.355) and higher preoperative NDI (ρ=0.336) were weakly correlated with elevated HMGB1. Lower MCS (ρ=0.395) and higher NDI (ρ=0.317) preoperatively were weakly correlated with elevated white blood cells. Postoperative improvement in MCS (ρ=0.306) and MCS recovery ratio (ρ=0.321) exhibited a weakly positive correlation with IL-6.Conclusion:Preoperative cytokine levels demonstrated minimal correlation with preoperative symptoms or clinical improvement, suggesting that profiling of patient cytokines has limited utility in predicting outcomes after ACDF.Level of Evidence:Level III.
Methods for Phenotyping Adult Patients in Sepsis and Septic Shock: A Scoping Review
Authors: Li Han , Markal Asena , Balch Jeremy A. , Loftus Tyler J. , Efron Philip A. , Ozrazgat-Baslanti Tezcan , Bihorac Azra 
Published: March 2022

OBJECTIVE:
Despite its heterogeneous phenotypes, sepsis or life-threatening dysfunction in response to infection is often treated empirically. Identifying patient subgroups with unique pathophysiology and treatment response is critical to the advancement of sepsis care. However, phenotyping methods and results are as heterogeneous as the disease itself. This scoping review evaluates the prognostic capabilities and treatment implications of adult sepsis and septic shock phenotyping methods.

DATA SOURCES:
Medline and Embase.

STUDY SELECTION:
We included clinical studies that described sepsis or septic shock and used any clustering method to identify sepsis phenotypes. We excluded conference abstracts, literature reviews, comments, letters to the editor, and in vitro studies. We assessed study quality using a validated risk of bias tool for observational cohort and cross-sectional studies.

DATA EXTRACTION:
We extracted population, methodology, validation, and phenotyping characteristics from 17 studies.

DATA SYNTHESIS:
Sepsis phenotyping methods most frequently grouped patients based on the degree of inflammatory response and coagulopathy using clinical, nongenomic variables. Five articles clustered patients based on genomic or transcriptomic data. Seven articles generated patient subgroups with differential response to sepsis treatments. Cluster clinical characteristics and their associations with mortality and treatment response were heterogeneous across studies, and validity was evaluated in nine of 17 articles, hindering pooled analysis of results and derivation of universal truths regarding sepsis phenotypes, their prognostic capabilities, and their associations with treatment response.

CONCLUSIONS:
Sepsis phenotyping methods can identify high-risk patients and those with high probability of responding well to targeted treatments. Research quality was fair, but achieving generalizability and clinical impact of sepsis phenotyping will require external validation and direct comparison with alternative approaches.
Dermatofibrosarcoma Protuberans Recurrence After Wide Local Excision Versus Mohs Micrographic Surgery: A Systematic Review and Meta-Analysis
Authors: Martin Emma C. St. , Vyas Krishna S. , Batbold Sarah , Erwin Patricia J. , Brewer Jerry D. 
Published: March 2022

BACKGROUND
Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown.

OBJECTIVE
To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS).

MATERIALS AND METHODS
Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946–2018), Embase (1988–2018), Web of Science (1975–2018), and Scopus (1970–2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses.

RESULTS
Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710–3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%–2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%–11.3%; p < .001).

CONCLUSION
The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients
Authors: Gostimir Mišo , Liou Victor , Yoon Michael K. 
Published: March 2022

Purpose:
To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety.

Methods:
A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates.

Results:
Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95% CI, 1.33–1.77; p < 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p < 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups.

Conclusions:
The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors’ additional analyses provide a relative comparison of the impact of various treatment parameters on safety.
Dorsal horn volume loss and pain pathway changes in Cavalier King Charles Spaniels with syringomyelia, signs of pain, and phantom scratching
Authors: Mortensen Danny , Thoefner Maria Soendergaard , Agerholm Joergen Steen , Slumstrup Lasse , Jensen Troels Staehelin , Bjerrum Ole Jannik , Berendt Mette , Nyengaard Jens Randel 
Published: March 2022

Abstract
Central neuropathic pain is a core clinical sign of syringomyelia in humans and Cavalier King Charles Spaniel (CKCS) dogs. This histopathological study used spinal cords from CKCS dogs with syringomyelia to investigate the following conditions: (1) whether specific structural cervical spinal cord entities involved in nociception were affected by loss of neuroparenchyma or other pathological changes in CKCS dogs with pain-related behaviour and phantom scratching, (2) whether pain-related behaviour or phantom scratching correlated with loss of a specific anatomical entity or upregulation of glia cells, and (3) whether syringomyelia-related lesions affected specific functional spinal cord units of nociception. Spinal cord segments C1-C8 from CKCS dogs with magnetic resonance imaging–confirmed syringomyelia and clinical signs of pain and phantom scratching (n = 8) were compared with those from CKCS dogs without syringomyelia (n = 4). Dogs with unilateral scratching (n = 7) had a volume loss (P = 0.043) of the dorsal horn laminae I-III in the ipsilateral side compared with the contralateral dorsal horn. A clear pattern of ipsilateral changes in the dorsal root entry zone characterised by deafferentation and reorganization of first-order axons into deeper laminae was found in cases with lateralised scratching. Significant changes in cell number density were not found for astrocytes or microglia, suggesting that the dogs represented cases of end-stage syringomyelia and thus could not reveal astrogliosis and microgliosis, which may be involved in the early phases of syrinx development and phantom scratching. The present relationship between clinical findings and dorsal horn and pain pathway pathology in CKCS dogs suggests that these dogs may be of interest as a supplement to experimental model pain research.
Systematic review and meta-analysis of studies in which burrowing behaviour was assessed in rodent models of disease-associated persistent pain
Authors: Zhang Xue Ying , Barakat Ahmed , Diaz-delCastillo Marta , Vollert Jan , Sena Emily S. , Heegaard Anne-Marie , Rice Andrew S.C. , Soliman Nadia 
Published: March 2022

Abstract
Burrowing behaviour is used to assess pain-associated behaviour in laboratory rodents. To gain insight into how models of disease-associated persistent pain and analgesics affect burrowing behaviour, we performed a systematic review and meta-analysis of studies that assessed burrowing behaviour. A systematic search in March 2020 and update in September 2020 was conducted in 4 databases. Study design characteristics and experimental data were extracted, followed by a random-effects meta-analysis. We explored the association between burrowing and monofilament-induced limb withdrawal. Dose response relationship was investigated for some analgesics. Forty-five studies were included in the meta-analysis, in which 16 model types and 14 drug classes were used. Most experiments used rat (79%) and male (72%) animals. Somatic inflammation and trauma-induced neuropathy models were associated with reduced burrowing behaviour. Analgesics (nonsteroidal anti-inflammatory drug and gabapentinoids) attenuated burrowing deficits in these models. Reporting of measures to reduce risk of bias was unclear except for randomisation which was high. There was not a correlation (R
2 = 0.1421) between burrowing and monofilament-induced limb withdrawal. Opioids, gabapentin, and naproxen showed reduced burrowing behaviour at high doses, whereas ibuprofen and celecoxib showed opposite trend. The findings indicate that burrowing could be used to assess pain-associated behaviour. We support the use of a portfolio of composite measures including spontaneous and stimulus-evoked tests. The information collected here could help in designing experiments involving burrowing assessment in models of disease-associated pain.
Resistance training protects against muscle pain through activation of androgen receptors in male and female mice
Authors: Lesnak Joseph B. , Fahrion Alexis , Helton Amber , Rasmussen Lynn , Andrew Megan , Cunard Stefanie , Huey Michaela , Kreber Austin , Landon Joseph , Siwiec Travis , Todd Kenan , Frey-Law Laura A. , Sluka Kathleen A. 
Published: March 2022

Abstract
Resistance training–based exercise is commonly prescribed in the clinic for the treatment of chronic pain. Mechanisms of aerobic exercise for analgesia are frequently studied, while little is known regarding resistance training mechanisms. We developed a resistance training model in mice and hypothesized resistance training would protect against development of muscle pain, mediated through the activation of androgen receptors. Activity-induced muscle hyperalgesia was produced by 2 injections of pH 5.0 stimuli with fatiguing muscle contractions. Resistance training was performed by having mice climb a ladder with attached weights, 3 times per week. Resistance training acutely increased blood lactate and prolonged training increased strength measured via forepaw grip strength and 1 repetition maximum, validating the exercise program as a resistance training model. Eight weeks of resistance training prior to induction of the pain model blocked the development of muscle hyperalgesia in both sexes. Resistance training initiated after induction of the pain model reversed muscle hyperalgesia in male mice only. A single resistance training bout acutely increased testosterone in male but not female mice. Administration of the androgen receptor antagonist flutamide (200 mg pellets) throughout the 8-week training program blocked the exercise-induced protection against muscle pain in both sexes. However, single administration of flutamide (1, 3, 10 mg/kg) in resistance-trained animals had no effect on existing exercise-induced protection against muscle pain. Therefore, resistance training acutely increases lactate and testosterone and strength overtime. Eight weeks of resistance training prevents the development of hyperalgesia through the activation of androgen receptors in an animal model of muscle pain.
Practice scholarship satisfaction and impact as perceived by DNP-prepared nurses
Authors: Kesten Karen , Moran Katherine , Beebe Sarah L. , Conrad Dianne , Burson Rosanne , Corrigan Catherine , Manderscheid Amy , Pohl Elizabeth 
Published: March 2022

ABSTRACT

Background:
Today's health systems are complex and are challenged to strive for high-quality care that leads to optimal health outcomes. Doctor of Nursing Practice (DNP)-prepared nurses have the necessary competencies to influence health systems and delivery, that lead to safe and effective practice, by implementing practice scholarship, the translation of science to transform health care delivery, and clinical inquiry to improve practice.

Purpose:
The purpose of this study was to determine DNP-prepared nurses' satisfaction with their frequency of engagement in practice scholarship, and the relationship between the satisfaction and perceived impact of practice scholarship.

Methods:
In this cross-sectional study, DNP-prepared nurses (n = 309) were recruited from a U.S. national membership organization and were asked to complete an online survey.

Results:
Usable data findings (n = 269) revealed that 81% of participants reported feeling very, or moderately, satisfied with time spent engaging in practice scholarship or clinical inquiry in the areas of quality improvement, translation of research, and evidence-based practice; however, 19% expressed minimal satisfaction or dissatisfaction. There was a significant, moderate positive correlation between impact and satisfaction with time spent engaging in practice scholarship.

Conclusions:
Unclear roles and the lack of objective data measurement of practice scholarship are hindering the ability of DNP-prepared nurses to work to the full extent of their education and scope of practice.

Implications:
Further studies to develop processes and tools to measure the value and impact of DNP-prepared nurses on quality and safety, health care policies, systems, and population health are recommended.
Measuring the impact of a COVID-19 continuing education program
Authors: Roberts Eve N. , Smithing Robert T. , Tucker Paula 
Published: March 2022

ABSTRACT
The COVID-19 pandemic has led to a rapidly shifting health care environment, with frequent changes to best practices, which can lead to knowledge and practice gaps among health care providers, including nurse practitioners (NPs). The purpose of this paper was to describe a continuing education (CE) program developed to address COVID-19 knowledge gaps and to report on the changes in knowledge, competence, and confidence following program completion. The CE program was a 2.5 to 2.67 contact hour webinar delivered in July 2020, October 2020, and February 2021. Content included COVID-19 prevention, diagnosis, and management and was updated before the second and third webinars. Changes in content and webinar audience participation in the question and answer portion were reflected in the CE credit awarded. Preactivity and postactivity knowledge, competence, and confidence levels were assessed among activity completers. Changes between the preactivity and postactivity evaluation were compared. A total of 2,901 learners were included in the analysis, of whom 91.6% were NPs. Overall, baseline knowledge of COVID-19 transmission, diagnosis, and treatment was low. Substantial improvements in knowledge, competence, and confidence were reported from baseline to postactivity evaluation, with increases of 47–73% overall. Furthermore, learner confidence in identifying patients at risk for severe COVID-19 and counseling patients on prevention and transmission significantly increased. Despite plans to implement strategies to improve COVID-19 management, several barriers to uptake were identified. The rapid development of a COVID-19 CE program resulted in substantial gains in NP knowledge related to prevention, diagnosis, and management, with possible implications for nearly 68,000 patient encounters per month.