bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is There an Inherited Contribution to Risk for Sporadic Unilateral Vestibular Schwannoma? Evidence of Familial Clustering
Authors: Gurgel Richard K. , Couldwell William T. , Patel Neil S. , Cannon-Albright Lisa A. 
Published: September 2022

Object
Unlike the autosomal dominant inheritance of neurofibromatosis 2, there are no known inherited risk factors for sporadic, unilateral vestibular schwannoma (VS), which comprise most VS cases. The authors tested a hypothesis positing a genetic contribution to predisposition to these lesions by analyzing familial clustering of cases.

Methods
Familial clustering of individuals with unilateral VS was analyzed in two independent genealogical resources with linked diagnosis data: the Veterans Health Administration Genealogy Resource and the Utah Population Database. Tests for excess relatedness, estimation of relative risks (RRs) in close and distant relatives, and identification of pedigrees with a significant excess of unilateral VS among descendants were performed.

Results
The average pairwise relatedness of the Veterans Health Administration Genealogy Resource VS cases significantly exceeded the expected relatedness (p = 0.016), even when close relationships were ignored (p = 0.002). RR for third- and fifth-degree relatives developing VS were significantly elevated (RR, 60.83; p = 0.0005; 95% confidence interval [CI], 7.37–219.73) and (RR, 11.88; p = 0.013; 95% CI, 1.44–42.90), respectively. No VS-affected first-, second-, or fourth-degree relatives were observed. In the Utah Population Database population, no first- or second-degree relatives with VS were observed. RR for fifth-degree relatives developing VS was significantly elevated (RR, 2.23; p = 0.009; 95% CI, 1.15–3.90).

Conclusion
These results provide strong evidence for an inherited predisposition to sporadic, unilateral VS. This study exhibits the value of genealogical resources with linked medical data for examining hypotheses regarding inherited predisposition. The high-risk unilateral VS pedigrees identified in two independent resources provide a powerful means of pursuing predisposition gene identification.
Factors Associated with Prolonged Extubation after Total Intravenous Anesthesia in Patients Undergoing Vestibular Schwannoma Resection
Authors: Xia Junming , Ran Guo , Chen Kaizheng , Shen Xia 
Published: September 2022

Objective
To identify factors associated with prolonged tracheal extubation after vestibular schwannoma resection in patients receiving propofol-remifentanil–based total intravenous anesthesia (TIVA).

Study Design
Single-center retrospective study of vestibular schwannoma resection performed by a single neurosurgeon between July 2018 and September 2021.

Setting
Tertiary academic medical center.

Patients
Adults receiving TIVA for vestibular schwannoma resection, classified according to extubation time: non-prolonged extubation (<15 min) and prolonged extubation (≥15 min).

Main Outcome Measures
Time from end of surgery to extubation, demographic parameters, intraoperative variables, and familiarity between the anesthesia provider and the neurosurgeon were analyzed. Predictors for prolonged extubation were analyzed via multivariate analysis. The primary outcome was the incidence of prolonged extubation. The secondary outcome was factors associated with prolonged tracheal extubation.

Results
A total of 234 cases were analyzed. The median (interquartile range) extubation time was 9.4 minutes (7.2, 12.2 min). Extubation was prolonged in 39 patients (16.7%). Factors predicting prolonged extubation were significant blood loss (odds ratio [OR], 12.8; 95% confidence interval [CI], 2.6–61.7; p = 0.002), intraoperative neuromuscular blocking drug infusion (OR, 6.6; 95% CI, 2.8–15.7; p < 0.001), and lack of familiarity between the anesthesia provider and neurosurgeon (OR, 4.4; 95% CI, 1.5–12.3; p = 0.005).

Conclusion
Significant blood loss, intraoperative neuromuscular blocking drug infusion, and lack of familiarity between anesthesia provider and neurosurgeon were associated with prolonged extubation following TIVA for vestibular schwannoma resection.
Glymphatic MRI techniques in sleep and neurodegenerative diseases
Authors: Lee Hyochul , Choi Seung Hong , Anzai Yoshimi 
Published: September 2022

Purpose of reviewThe purpose of this review article is to summarize the current in-vivo imaging techniques for the evaluation of the glymphatic function and discuss the factors influencing the glymphatic function and research directions in the future.Recent findingsThe glymphatic system allows the clearance of metabolic waste from the central nervous system (CNS). The glymphatic pathway has been investigated using intrathecal or intravenous injection of a gadolinium-based contrast agent (GBCA) on MRI, so-called glymphatic MRI. The glymphatic MRI indirectly visualizes the dynamic CSF flow and evaluated the glymphatic function in the animal and human models. Several clinical and preclinical studies using glymphatic MRI have confirmed that the glymphatic function is impaired in neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and idiopathic normal pressure hydrocephalus. Furthermore, physiologic process such as sleep facilitates the glymphatic clearance, thus clearing accumulation of protein deposition, such as amyloid or tau, potentially delaying the progression of neurodegenerative diseases.SummaryThe glymphatic system plays a crucial role in clearing metabolic wastes in the brain. Glymphatic MR imaging using GBCA administration serves as a functional imaging tool to measure the glymphatic function and investigate various pathophysiologies of neurodegenerative diseases.
Counseling Tobacco Smoke Exposure Reduction Measures in Pediatrics: A Quality Improvement Project
Authors: Ferguson Kevin , Krishnan Sankaran , Sullivan Emily , Bhela Shyall , Dozor Allen J. , Welter John J. 
Published: September 2022

Introduction:
With over 40% of children in the USA exposed to tobacco smoke, the AAP recommends tobacco smoke exposure (TSE) assessment during clinic visits. We aimed to increase the rates of TSE screening and provider counseling regarding TSE reduction using an evidence-based approach.

Methods:
We conducted the project at a large pediatric pulmonology practice. Baseline caregiver surveys and medical record review of TSE documentation took place in July/August, 2019. From September 2019 to July 2021, PDSA cycles were conducted to increase TSE screening and reduce counseling.

Results:
Before starting the project, 18% of smoking caregivers acknowledged smoking in the home and 41% in the car. While caregivers strongly desired to decrease TSE (median 9.4/10 on Likert scale), physician counseling of TSE reduction was offered only to 44%. PDSA cycles led to refining our patient passport, a document used during patient intake, which increased screening of TSE from 46% to 85%. Creating an educational handout in our electronic record addressing TSE increased TSE reduction counseling from 44% to 80% of children with smokers in the home.

Conclusions:
Incorporating TSE screening into established nursing documentation of vital signs led to the sustained screening of TSE among children in a pediatric pulmonology practice. Embedding educational material in our electronic record and changes in clinic processes increased TSE reduction counseling. Similar changes could improve rates of counseling caregivers of other guidelines aimed to improve the children’s health.
Facial Scars: Do Position and Orientation Matter?
Authors: Zapatero Zachary D. , Workman Clifford I. , Kalmar Christopher L. , Humphries Stacey , Kosyk Mychajlo S. , Carlson Anna R. , Swanson Jordan W. , Chatterjee Anjan , Taylor Jesse A. 
Published: September 2022

Purpose
This study tested the core tenets of how facial scars are perceived by characterizing layperson response to faces with scars. We predicted that scars closer to highly viewed structures of the face (i.e., upper lip and lower lid), scars aligned against resting facial tension lines, and scars in the middle of anatomic subunits of the face would be rated less favorably.

Methods
Voluntee s aged 18 and older from the United States were recruited through Amazon's Mechanical Turk to complete a face rating survey. Scars were digitally added in different locations and orientations for a total of 14 unique scars added to each face.
Each participant rated 50 different faces on confidence, friendliness, and attractiveness. Data were analyzed using linear mixed effects models (LMEMs).

Results
A total of 88,850 ratings (82,990 scarred, 93.4%) for attractiveness, friendliness, and confidence were analyzed. In univariate LMEMs, the presence of a facial scar did not significantly impact attractiveness (β=0.016, SE=0.014, z=1.089, p=0.276). A second set of LMEMs identified interactions between location, subunit placement, and orientation to facial tension lines. Scars located on the lower lid mid subunit perpendicular to facial tension lines were rated less attractive (β=-0.065, SE=0.028, z=-2.293, p=0.022).

Conclusions
On average, a single well-healed facial scar does not negatively affect first impressions of attractiveness, confidence, or friendliness. Specific scar location and orientation combinations, however, such as a perpendicular scar at the mid-lower eyelid, may result in lower perceived attractiveness, confidence, and friendliness.
Using Community Detection Techniques to Identify Themes in COVID-19–Related Patient Safety Event Reports
Authors: Boxley Christian , Krevat Seth , Sengupta Srijan , Ratwani Raj , Fong Allan 
Published: September 2022

Objectives
The COVID-19 pandemic has transformed how healthcare is delivered to patients. As the pandemic progresses and healthcare systems continue to adapt, it is important to understand how these changes in care have changed patient care. This study aims to use community detection techniques to identify and facilitate analysis of themes in patient safety event (PSE) reports to better understand COVID-19 pandemic’s impact on patient safety. With this approach, we also seek to understand how community detection techniques can be used to better identify themes and extract information from PSE reports.

Methods
We used community detection techniques to group 2082 PSE reports from January 1, 2020, to January 31, 2021, that mentioned COVID-19 into 65 communities. We then grouped these communities into 8 clinically relevant themes for analysis.

Results
We found the COVID-19 pandemic is associated with the following clinically relevant themes: (1) errors due to new and unknown COVID-19 protocols/workflows; (2) COVID-19 patients developing pressure ulcers; (3) unsuccessful/incomplete COVID-19 testing; (4) inadequate isolation of COVID-19 patients; (5) inappropriate/inadequate care for COVID-19 patients; (6) COVID-19 patient falls; (7) delays or errors communicating COVID-19 test results; and (8) COVID-19 patients developing venous thromboembolism.

Conclusions
Our study begins the long process of understanding new challenges created by the pandemic and highlights how machine learning methods can be used to understand these and similar challenges. Using community detection techniques to analyze PSE reports and identify themes within them can help give healthcare systems the necessary information to improve patient safety and the quality of care they deliver.
Contrast Enhancement Patterns in Pediatric Glioblastomas
Authors: Pokhylevych Halyna , Khose Swapnil , Gule-Monroe Maria K. , Chen Melissa M. , Fuller Greg , Gruschkus Stephen K. , Sadighi Zsila , Zaky Wafik , Sandberg David I. , McGovern Susan L. , Johnson Jason M. 
Published: September 2022

Background and Purpose
Brain tumors are the most common cause of cancer-related deaths among the pediatric population. Among these, pediatric glioblastomas (GBMs) comprise 2.9% of all central nervous system tumors and have a poor prognosis. The purpose of this study is to determine whether the imaging findings can be a prognostic factor for survival in children with GBMs.

Materials and Methods
The imaging studies and clinical data from 64 pediatric patients with pathology-proven GBMs were evaluated. Contrast enhancement patterns were classified into focal, ring-like, and diffuse, based on preoperative postcontrast T1-weighted magnetic resonance images. We used the Kaplan-Meier method and Cox proportional hazard regression to evaluate the prognostic value of imaging findings.

Results
Patients with ring-enhanced GBMs who underwent gross total resection or subtotal resection were found to have a significantly shorter progression-free survival (P = 0.03) comparing with other enhancing and nonenhancing glioblastomas.

Conclusions
In this study, we analyzed survival factors in children with pediatric glioblastomas. In the group of patients who underwent gross total resection or subtotal resection, those patients with focal-enhanced GBMs had significantly longer progression-free survival (P = 0.03) than did those with other types of enhancing GBMs (diffuse and ring-like).
The Impact of Virtual Monoenergetic Imaging on Visualization of the Cervical Spinal Canal
Authors: McComiskey David , Erdenebold Undrakh-Erdene , McInnes Matthew D.F. , Salameh Jean-Paul , Chatelain Robert , Torres Carlos , Chakraborty Santanu , Zakhari Nader 
Published: September 2022

Rationale and Objectives
Our purpose is to explore the role of dual-energy computed tomography (DECT) and virtual monoenergetic energy levels in reducing shoulder artifact to improve visualization of the cervical spinal canal.

Materials and Methods
A retrospective review of 171 consecutive DECT scans of the neck (95 male, 65 female; mean age, 60.9 years, ranging from 18 to 88 years; with 11 excluded because of nondiagnostic image quality) during an 8-month period was performed with postprocessing of monoenergetic images at 50, 70, 100, and 140 keV. Subjective comparisons and objective image noise between the monoenergetic images and standard computed tomography (CT) were analyzed by 1-way analysis of variance to determine the optimal DECT energy level with the highest image quality.

Results
Subjectively, 100-keV DECT best visualizes the spinal canal relative to standard CT, 50 and 70 keV (P < 0.01), and was superior to 140 keV for reader 1 (P < 0.01). Objectively, 100 keV demonstrated less noise relative to 50 keV (72.02; P < 0.01). There was no difference in noise between 100 keV and 70 keV, or between 100 keV and standard CT, which also demonstrated lower noise relative to 50-, 70-, and 140-keV levels (91.53, P < 0.01; 29.84, P < 0.01; and 22.66, P < 0.03).

Conclusion
Dual-energy CT at 100 keV may be the preferred DECT monoenergetic level for soft tissue assessment. Increasing energy level is associated with reduction in shoulder artifact, with no difference in noise between 100 keV and standard CT, although 100-keV images may be subjectively better.
Development of a Rubric to Evaluate Implementation Quality of Simulation-Based Courses
Authors: Nayahangan Leizl Joy , Konge Lars , Park Christine , Dubrowski Adam , Yudkowsky Rachel 
Published: September 2022

Introduction
Simulation-based education is a recognized way of developing medical competencies, and there is overwhelming scientific evidence to support its efficacy. However, it is still underused, which can often be related to poor implementation process. In addition, best practices for implementation of simulation-based courses based on implementation science are not widely known nor applied. The purpose of this study was to develop a rubric, the Implementation Quality Rubric for Simulation (IQR-SIM), to evaluate the implementation quality of simulation-based courses.

Methods
A 3-round, modified Delphi process involving international simulation and implementation experts was initiated to gather and converge opinions regarding criteria for evaluating the implementation quality of simulation-based courses. Candidate items for Round 1 were developed based on the Adapted Implementation Model for Simulation. Items were revised and expanded to include descriptive anchors for evaluation in Round 2. Criterion for inclusion was 70% of respondents selecting an importance rating of 4 or 5/5. Round 3 provided refinement and final approval of items and anchors.

Results
Thirty-three experts from 9 countries participated. The initial rubric of 32 items was reduced to 18 items after 3 Delphi rounds, resulting in the IQR-SIM: a 3-point rating scale, with nonscored options “Don't know/can't assess” and “Not applicable,” and a comments section.

Conclusions
The IQR-SIM is an operational tool that can be used to evaluate the implementation quality of simulation-based courses and aid in the implementation process to identify gaps, monitor the process, and promote the achievement of desired implementation and learning outcomes.
Video Messaging to Increase Vascularized Composite Allograft Donation Willingness in United States Military Veterans
Authors: Rodrigue James R. , Shenkel Jessica , Boger Matthew , Pomahac Bohdan , Fleishman Aaron 
Published: September 2022

Background.
Expansion of vascularized composite allograft (VCA) transplantation depends on the public’s willingness to donate VCA organs, including face, extremities, and genitourinary organs. This study evaluated the effectiveness of video messaging on VCA donation willingness in US military veterans, a key stakeholder in VCA transplantation.

Methods.
Participants (n = 556) were randomized to 1 of 3 VCA video messaging interventions (informational, testimonial, or blended), a general (non-VCA) organ donation video message, or a control (nondonation) video message. Questionnaires were completed at pre- and postintervention and at 3-wk follow-up.

Results.
Veterans exposed to any VCA video messaging were more likely to express VCA donation willingness (69%, n = 203/296) than those exposed to general donation messaging (53%, n = 47 of 89; P = 0.006) or No Donation Messaging (37%, n = 36 of 97; P < 0.001). A significantly higher proportion of participants who received Blended VCA Messaging were willing to be VCA donors, compared with the Informational VCA Messaging group (79% versus 61%, P = 0.006). Each VCA messaging video resulted in a significant pre- to postintervention increase in the proportion of participants willing to donate their own face, hands, and legs (P < 0.03).

Conclusions.
Brief educational videos focused on VCA transplantation can have a demonstrable and verifiable impact on rates of VCA donation willingness in veterans.
Determining Clinical Thresholds for Donor HLA Eplet Compatibility to Predict Best Outcomes Following Lung Transplantation
Authors: Hiho Steven J. , Walton Duncan C. , Paraskeva Miranda A. , Levvey Bronwyn J. , Diviney Mary B. , Snell Gregory I. , Sullivan Lucy C. , Westall Glen P. 
Published: September 2022

Background.
Currently, the assessment of immunological risk in lung transplantation (LTx) does not completely consider HLA compatibility at the molecular level. We have previously demonstrated the association of HLA eplets in predicting chronic lung allograft dysfunction following LTx; however, the associations between HLA eplet mismatch (epMM) loads and overall survival are unknown.

Methods.
In this retrospective, single-center study, 277 LTx donor-recipient pairs were high resolution HLA typed and analyzed for HLA epMMs using HLAMatchmaker (version 3.1). LTx pairs were also assessed for the presence of the previously described risk epitope mismatches DQ2-DQA1*05 and DQ7-DQA1*05.

Results.
HLA class I epMMs were not associated with deleterious outcomes; however, lower HLA class II (≤19), DQA1 (≤2), and combined HLA class I and II (≤29) epMM demonstrated an association with increased time to chronic lung allograft dysfunction and improved overall survival. The presence of a risk epitope mismatch was not associated with worse clinical outcomes.

Conclusions.
HLA epMM can risk-stratify LTx recipients and potentially guide donor-recipient matching and immunosuppression strategies.
Association between oral health and swallowing function
Authors: Yamano Takafumi , Nishi Kensuke , Omori Fumitaka , Wada Kaori , Yamaguchi Masahiro , Naito Toru 
Published: September 2022

AbstractObjectiveOral care is effective for preventing pneumonia, but objective evaluation of its effect on swallowing is lacking. Oral assessment scores, such as the Oral Health Assessment Tool (OHAT), are used to evaluate the oral environment to monitor oral care. Methods: We investigated the relationship between OHAT score and swallowing function in 24 patients aged 64–97 years.ResultsThe OHAT score did not correlate with the video endoscopy (VE) or video fluorography (VF) scores. Furthermore, the OHAT score was not significantly different between the multiple and no or single pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than that with no or a single episode of pneumonia (p < 0.01).ConclusionsOral assessment, VE, and VF scores are necessary to evaluate swallowing in patients with suspected dysphagia. In addition, recurrent pneumonia among patients with a good oral environment has multiple contributing factors, including subclinical aspiration, pharyngeal clearance, and delayed activation of the gag reflex.
Mapping and modeling human colorectal carcinoma interactions with the tumor microenvironment
Authors: Li Ning , Zhu Qin , Tian Yuhua , Ahn Kyung Jin , Wang Xin , Cramer Zvi , Folkert Ian W. , Yu Pengfei , Jou Justine , Adams-Tzivelekidis Stephanie , Sehgal Priyanka , Mahmoud Najia N. , Aarons Cary B. , Roses Robert E. , Thomas-Tikhonenko Andrei , Furth Emma E. , Stanger Ben Z. , Rustgi Anil , Haldar Malay , Katona Bryson W. , Tan Kai , Lengner Christopher J. 
Published: September 2022

SummaryThe initiation and progression of cancer are inextricably linked to the tumor microenvironment (TME). Understanding the function of specific cancer-TME interactions poses a major challenge due in part to the complexity of the in vivo microenvironment. Here we predict cancer-TME interactions from single cell transcriptomic maps of both human colorectal cancers (CRCs) and mouse CRC models, ask how these interactions are altered in established, long-term human tumor organoid (tumoroid) cultures, and functionally recapitulate human myeloid-carcinoma interactions in vitro. Tumoroid cultures suppress gene expression programs involved in promoting inflammation and immune cell migration through receptor-ligand interactions, providing a reductive platform for re-establishing carcinoma-immune cell interactions in vitro. Introduction of human monocyte-derived macrophages into tumoroid cultures instructs macrophages to acquire pro-tumorigenic gene expression programs similar to those observed in vivo. This includes hallmark induction of SPP1, encoding Osteopontin, an extracellular CD44 ligand with established oncogenic effects. Taken together, these findings offer a framework for understanding CRC-TME interactions and provide a reductionist tool for modeling specific aspects of these interactions.