bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Defense of Vaccine Mandates: An Argument from Consent Rights
Authors: Wilkenfeld Daniel A , Johnson Christa M 
Published: March 2022

Abstract
This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19.
Prone Position Minimizes the Exacerbation of Effort-dependent Lung Injury: Exploring the Mechanism in Pigs and Evaluating Injury in Rabbits
Authors: Yoshida Takeshi , Engelberts Doreen , Chen Han , Li Xuehan , Katira Bhushan H. , Otulakowski Gail , Fujino Yuji 
Published: March 2022

Background
Vigorous spontaneous effort can potentially worsen lung injury. This study hypothesized that the prone position would diminish a maldistribution of lung stress and inflation after diaphragmatic contraction and reduce spontaneous effort, resulting in less lung injury.

Methods
A severe acute respiratory distress syndrome model was established by depleting surfactant and injurious mechanical ventilation in 6 male pigs (“mechanism” protocol) and 12 male rabbits (“lung injury” protocol). In the mechanism protocol, regional inspiratory negative pleural pressure swing (intrabronchial balloon manometry) and the corresponding lung inflation (electrical impedance tomography) were measured with a combination of position (supine or prone) and positive end-expiratory pressure (high or low) matching the intensity of spontaneous effort. In the lung injury protocol, the intensities of spontaneous effort (esophageal manometry) and regional lung injury were compared in the supine position versus prone position.

Results
The mechanism protocol (pigs) found that in the prone position, there was no ventral-to-dorsal gradient in negative pleural pressure swing after diaphragmatic contraction, irrespective of the positive end-expiratory pressure level (–10.3 ± 3.3 cm H2O vs. –11.7 ± 2.4 cm H2O at low positive end-expiratory pressure, P = 0.115; –10.4 ± 3.4 cm H2O vs. –10.8 ± 2.3 cm H2O at high positive end-expiratory pressure, P = 0.715), achieving homogeneous inflation. In the supine position, however, spontaneous effort during low positive end-expiratory pressure had the largest ventral-to-dorsal gradient in negative pleural pressure swing (–9.8 ± 2.9 cm H2O vs. –18.1 ± 4.0 cm H2O, P < 0.001), causing dorsal overdistension. Higher positive end-expiratory pressure in the supine position reduced a ventral-to-dorsal gradient in negative pleural pressure swing, but it remained (–9.9 ± 2.8 cm H2O vs. –13.3 ± 2.3 cm H2O, P < 0.001). The lung injury protocol (rabbits) found that in the prone position, spontaneous effort was milder and lung injury was less without regional difference (lung myeloperoxidase activity in ventral vs. dorsal lung, 74.0 ± 30.9 μm · min–1 · mg–1 protein vs. 61.0 ± 23.0 μm · min–1 · mg–1 protein, P = 0.951). In the supine position, stronger spontaneous effort increased dorsal lung injury (lung myeloperoxidase activity in ventral vs. dorsal lung, 67.5 ± 38.1 μm · min–1 · mg–1 protein vs. 167.7 ± 65.5 μm · min–1 · mg–1 protein, P = 0.003).

Conclusions
Prone position, independent of positive end-expiratory pressure levels, diminishes a maldistribution of lung stress and inflation imposed by spontaneous effort and mitigates spontaneous effort, resulting in less effort-dependent lung injury.

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Preintubation Sequential Organ Failure Assessment Score for Predicting COVID-19 Mortality: External Validation Using Electronic Health Record From 86 U.S. Healthcare Systems to Appraise Current Ventilator Triage Algorithms*
Authors: Keller Michael B. , Wang Jing , Nason Martha , Warner Sarah , Follmann Dean , Kadri Sameer S. 
Published: March 2022

OBJECTIVES:
Prior research has hypothesized the Sequential Organ Failure Assessment (SOFA) score to be a poor predictor of mortality in mechanically ventilated patients with COVID-19. Yet, several U.S. states have proposed SOFA-based algorithms for ventilator triage during crisis standards of care. Using a large cohort of mechanically ventilated patients with COVID-19, we externally validated the predictive capacity of the preintubation SOFA score for mortality prediction with and without other commonly used algorithm elements.

DESIGN:
Multicenter, retrospective cohort study using electronic health record data.

SETTING:
Eighty-six U.S. health systems.

PATIENTS:
Patients with COVID-19 hospitalized between January 1, 2020, and February 14, 2021, and subsequently initiated on mechanical ventilation.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Among 15,122 mechanically ventilated patients with COVID-19, SOFA score alone demonstrated poor discriminant accuracy for inhospital mortality in mechanically ventilated patients using the validation cohort (area under the receiver operating characteristic curve [AUC], 0.66; 95% CI, 0.65–0.67). Discriminant accuracy was even poorer using SOFA score categories (AUC, 0.54; 95% CI, 0.54–0.55). Age alone demonstrated greater discriminant accuracy for inhospital mortality than SOFA score (AUC, 0.71; 95% CI, 0.69–0.72). Discriminant accuracy for mortality improved upon addition of age to the continuous SOFA score (AUC, 0.74; 95% CI, 0.73–0.76) and categorized SOFA score (AUC, 0.72; 95% CI, 0.71–0.73) models, respectively. The addition of comorbidities did not substantially increase model discrimination. Of 36 U.S. states with crisis standards of care guidelines containing ventilator triage algorithms, 31 (86%) feature the SOFA score. Of these, 25 (81%) rely heavily on the SOFA score (12 exclusively propose SOFA; 13 place highest weight on SOFA or propose SOFA with one other variable).

CONCLUSIONS:
In a U.S. cohort of over 15,000 ventilated patients with COVID-19, the SOFA score displayed poor predictive accuracy for short-term mortality. Our findings warrant reappraisal of the SOFA score’s implementation and weightage in existing ventilator triage pathways in current U.S. crisis standards of care guidelines.
Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act”
Authors: Zbar Ross I. S , Zbar Denise , Canady John W. 
Published: March 2022

Background:
The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitration process is outlined for mediation between provider and payor if needed.

Methods:
Policy analysis demonstrates many plastic surgeons utilize a revenue stream including both fee-for-service cosmetic work and insurance-covered reconstructive intervention. For Maintenance of Certification from the American Board of Plastic Surgery and/or membership to the American Society of Plastic Surgeons, plastic surgeons must operate only in accredited facilities, which in turn require that similar privileges are held in a hospital.

Results:
Given rapidly developing economic pressures, hospitals no longer remain neutral sites for surgical privileging as they seek strategies to mitigate financial loss by directly competing for patients. A downstream consequence of the requirement for hospital privileging is that plastic surgeons are forced to manage increasing on-call responsibilities despite shrinking reimbursement. Plastic surgeons whose board certification was the first to be time-limited are now reaching the stage of practice where they may transition exclusively to out-patient services.

Conclusions:
Plastic surgeons in independent solo or small group practices are rendered vulnerable since they may not be able to find coverage of in-patient responsibilities at lower reimbursement rates. Rather than allowing loss of board certification in this population, rational alternatives on an organizational level are proposed for keeping the process equitable as plastic surgeons progress along the practice pathway.
Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review
Authors: Moshirfar Majid , Peterson Telyn , Ungricht Emilie , McCabe Shannon , Ronquillo Yasmyne C. , Brooks Ben , Towne Francina , Hoopes Phillip 
Published: March 2022

Abstract:
Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray–white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea's inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.
Diagnostic Accuracy of Artificial Intelligence in Glaucoma Screening and Clinical Practice
Authors: Chaurasia Abadh K. , Greatbatch Connor J. , Hewitt Alex W. 
Published: March 2022

Purpose:
Artificial intelligence (AI) has been shown as a diagnostic tool for glaucoma detection through imaging modalities. However, these tools are yet to be deployed into clinical practice. This meta-analysis determined overall AI performance for glaucoma diagnosis and identified potential factors affecting their implementation.

Methods:
We searched databases (Embase, Medline, Web of Science, and Scopus) for studies that developed or investigated the use of AI for glaucoma detection using fundus and optical coherence tomography (OCT) images. A bivariate random-effects model was used to determine the summary estimates for diagnostic outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy (PRISMA-DTA) extension was followed, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used for bias and applicability assessment.

Results:
Seventy-nine articles met inclusion criteria, with a subset of 66 containing adequate data for quantitative analysis. The pooled area under receiver operating characteristic curve across all studies for glaucoma detection was 96.3%, with a sensitivity of 92.0% (95% confidence interval: 89.0–94.0) and specificity of 94.0% (95% confidence interval: 92.0–95.0). The pooled area under receiver operating characteristic curve on fundus and OCT images was 96.2% and 96.0%, respectively. Mixed data set and external data validation had unsatisfactory diagnostic outcomes.

Conclusion:
Although AI has the potential to revolutionize glaucoma care, this meta-analysis highlights that before such algorithms can be implemented into clinical care, a number of issues need to be addressed. With substantial heterogeneity across studies, many factors were found to affect the diagnostic performance. We recommend implementing a standard diagnostic protocol for grading, implementing external data validation, and analysis across different ethnicity groups.
Predictors of Success on the National Physical Therapy Examination in 2 US Accelerated-Hybrid Doctor of Physical Therapy Programs
Authors: Reynolds Breanna , Unverzagt Casey , Koszalinski Alex , Gatlin Roberta , Seale Jill , Gagnon Kendra , Eaton Kareaion , Koppenhaver Shane L. 
Published: March 2022

Introduction:
Although predictors of success have been reported within Doctor of Physical Therapy (DPT) education previously, accelerated-hybrid models of DPT education have not been included and may yield different results. The purpose of this study was to examine predictors of National Physical Therapy Examination (NPTE) performance within 2 US-accredited accelerated-hybrid DPT programs.

Review of Literature:
Current evidence examining predictors of NPTE success have included admissions data (undergraduate or prerequisite grade point average [GPA] and Graduate Record Examination [GRE]), DPT program GPA, noncognitive variables, and program variables. Although results of the relationship of these variables to NPTE success are inconsistent, DPT program GPA seemed to be the most consistent finding.

Subjects:
Student records from the 2019 and 2020 graduating classes of 2 accelerated-hybrid DPT programs (4 classes total, n = 355).

Methods:
Preadmission, noncognitive, within-program, and NPTE preparatory variables were assessed to determine their relationship with NPTE score. The association between each variable and NPTE score was assessed using bivariate correlations. The most parsimonious predictive model was determined using stepwise linear regression analysis. After determining the best predictive threshold for continuous level variables, odds ratios were calculated between each variable and passing the NPTE on the first attempt.

Results:
Statistically significant associations with NPTE score were noted with most preadmission, within-program, and NPTE preparatory variables; the strongest association was midpoint program GPA (r = 0.576, P < .05). The most parsimonious predictive model consisted of midpoint program GPA, first attempt passing Practice Exam & Assessment Tool (PEAT; dichotomous outcome, passing score ≥600), Scorebuilders Online Advantage examination score, and combined GRE percentage, which accounted for 52.6% of the variance in NPTE scores. The odds of passing NPTE on the first try were 14 times higher in individuals who passed the PEAT examination on the first try and 8 times higher in students with a midpoint GPA of at least 3.35.

Discussion and Conclusion:
Midpoint program GPA was the strongest predictor of NPTE score, followed by the PEAT and Online Advantage (2 NPTE preparatory variables). Combined GRE percentage was the only admissions variable contributing to the prediction of NPTE score. These findings are not different from previous research examining predictors of NPTE success in other DPT education models.
Tectal Hemorrhage in the Setting of COVID-19 Infection
Authors: O’Brien Patrick F. , Johnson Erica C. , Graham Robert S. 
Published: March 2022

Introduction:
Coronavirus disease 2019 (COVID-19) has emerging evidence of a relationship to intracranial hemorrhage. The hemorrhages described to date often affect patients on anticoagulation, of advanced age, of nonwhite race, and requiring mechanical ventilation. Unusual or rare hemorrhage patterns have not as yet been described in the literature as being associated with COVID-19.

Case Report:
A 36-year-old Hispanic male with no significant past medical history presented with isolated tectal intraparenchymal hemorrhage with intraventricular hemorrhage in the setting of no identifiable risk factors other than COVID-19. His management required temporizing with external ventricular drainage and subsequent endoscopic third ventriculostomy for ongoing obstruction of the cerebral aqueduct following the hemorrhage. He was discharged and did clinically well. To our knowledge, this is the first report of an intraparenchymal hematoma of the brain isolated to the midbrain tectum with only COVID-19 as a risk factor.

Conclusion:
COVID-19 may predispose patients to rare types of intraparenchymal hematomas which remain amenable to standard management algorithms.
Therapeutic Plasma Exchange (TPE) Complications in Patients With Multiple Sclerosis (MS) and Clinically Isolated Syndrome (CIS)
Authors: Mavandadi Shirin , Moghaddami Mehran , Meysami Ali P. , Sahraian Mohammad A. , Paybast Sepideh , Ghajarzadeh Mahsa , Maemodan Farhad Golipoor , Nahayati Mohammad A. , Azimi Amirreza 
Published: March 2022

Background:
Therapeutic plasma exchange (TPE) is a conventional second-line treatment for patients with multiple sclerosis (MS) or clinically isolated syndrome with steroid-refractory relapses.

Methods:
MS and clinically isolated syndrome patients with a steroid-refractory relapse, who fulfilled the indications for TPE were enrolled in this study. An expert nurse recorded the data comprising age, sex, type of MS, disease modifying therapy, disease duration, relapse rate, vital signs at the beginning, during and at the end of each plasma exchange session, plasma exchange volume, normal saline volume, and TPE complications. Ultimately, the statistical association was estimated amongst the variables.

Results:
A total of 122 cases were assessed. Twelve cases (9.8%) received plasmapheresis for the second time. The mean age was 32.2±8.7 years and 107 (87.7%) were female. In total, 609 plasma exchange sessions were completed. Hypotension and skin reaction were the most clinical complications. Hemoglobin loss and hypokalemia were the most laboratory complications. Fifty-four cases (44.3%) had no complications, 40 (32.8%) had 1 complication, 21 (17.2%) 2 complications, 6 (4.9%) had 3 complications, and 1 (0.8%) disclosed 4 complications. The relapse rate in the past 12 months and the mean plasma volume exchange were significantly different between the groups.

Conclusions:
We revealed that TPE could be considered as a safe second-line therapy in MS relapses. Hypotension, skin reaction, hemoglobin loss, and hypokalemia were the most complications of TPE in our patients.
Rehabilitation for Total Hip Arthroplasty: A Systematic Review
Authors: Konnyu Kristin J. , Pinto Dan , Cao Wangnan , Aaron Roy K. , Panagiotou Orestis A. , Bhuma Monika Reddy , Adam Gaelen P. , Balk Ethan M. , Thoma Louise M. 
Published: March 2022

Abstract
We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005 through May 3, 2021. We included randomized controlled trials and adequately-adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence (SoE). Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low SoE). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs following THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.
Ultrasound-Guided Botulinum Toxin Injection for the Treatment of Teres Major Fasciculations: A Case Report
Authors: Cushman Daniel M. , Carefoot Andrea , Rees Mikayla R. 
Published: March 2022

Abstract
This case study presents a 31-year-old male weightlifter without known neuromuscular disease who presented with five weeks of atraumatic, constant fasciculations of his right teres major muscle without recent injury. Electromyography identified fasciculation potentials within the teres major and pronator teres suggesting an acute C6 radiculopathy, though a cervical MRI demonstrated no significant neuroforaminal stenosis. Trigger point injections and multiple medications failed to stop the fasciculations. Under electromyography and ultrasound guidance, he was focally injected with botulinum toxin to the teres major ten weeks from initial onset with subsequent complete resolution of the symptoms and no side effects.
Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa
Authors: George Gavin , Beckett Sean , Reddy Tarylee , Govender Kaymarlin , Cawood Cherie , Khanyile David , Kharsany Ayesha B.M. 
Published: March 2022

Background:
Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among schoolgoing adolescents. This study estimates the association between exposure to CSE and key biomedical and behavioural indicators among adolescent girls in South Africa.

Setting:
Four DREAMS implementation districts in Gauteng and KwaZulu-Natal provinces in South Africa.

Methods:
Data from a household-based representative sample of adolescent girls (between the ages 12–18 years) (n = 9673) was collected. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy, and sexual risky behaviour, including condom use, incidence of age-disparate relationships, and transactional sex.

Results:
Adolescent girls in school and who had attended CSE classes in the previous 12 months were associated with reduced adjusted odds of being HIV-positive [full sample: adjusted odds ratios (AOR): 0.76, 95% confidence interval [CI]: 0.61 to 0.95, P < 0.05; sexually active sample: AOR: 0.62, 95% CI: 0.40 to 0.96, P < 0.05]. Those in school who attended CSE in the previous 12 months were also more likely to get tested for HIV (AOR: 1.48, 95% CI: 1.32 to 1.65, P < 0.001).

Conclusions:
The results indicate that school attendance and exposure to CSE is associated with a reduction in risky sexual behaviour. Exposure to CSE is also associated with increased access to HIV testing for adolescent girls both in and out of school. Keeping adolescent girls in school produces the greatest positive sexual behavioural effect; this, coupled with the delivery of quality CSE, is a key strategy for reducing HIV risk.