bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global Validation of the AO Spine Upper Cervical Injury Classification
Authors: Vaccaro Alexander R. , Lambrechts Mark J. , Karamian Brian A. , Canseco Jose A. , Oner Cumhur , Benneker Lorin M. , Bransford Richard , Kandziora Frank , Shanmuganathan Rajasekaran , El-Sharkawi Mohammad , Kanna Rishi , Joaquim Andrei , Schnake Klaus , Kepler Christopher K. , Schroeder Gregory D. ,   AO Spine Upper Cervical Injury Classification International Members
Published: July 2022

Study Design.
Global cross-sectional survey.

Objective.
To determine the classification accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on an international group of AO Spine members.

Summary of Background Data.
Previous upper cervical spine injury classifications have primarily been descriptive without incorporating a hierarchical injury progression within the classification system. Further, upper cervical spine injury classifications have focused on distinct anatomical segments within the upper cervical spine. The AO Spine Upper Cervical Injury Classification System incorporates all injuries of the upper cervical spine into a single classification system focused on a hierarchical progression from isolated bony injuries (type A) to fracture dislocations (type C).

Methods.
A total of 275 AO Spine members participated in a validation aimed at classifying 25 upper cervical spine injuries through computed tomography scans according to the AO Spine Upper Cervical Classification System. The validation occurred on two separate occasions, three weeks apart. Descriptive statistics for percent agreement with the gold-standard were calculated and the Pearson χ2 test evaluated significance between validation groups. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility.

Results.
The accuracy of AO Spine members to appropriately classify upper cervical spine injuries was 79.7% on assessment 1 (AS1) and 78.7% on assessment 2 (AS2). The overall intraobserver reproducibility was substantial (κ=0.70), while the overall interobserver reliability for AS1 and AS2 was substantial (κ=0.63 and κ=0.61, respectively). Injury location had higher interobserver reliability (AS1: κ = 0.85 and AS2: κ=0.83) than the injury type (AS1: κ=0.59 and AS2: 0.57) on both assessments.

Conclusion.
The global validation of the AO Spine Upper Cervical Injury Classification System demonstrated substantial interobserver agreement and intraobserver reproducibility. These results support the universal applicability of the AO Spine Upper Cervical Injury Classification System.

Level of Evidence
4
OCULAR FACTORS RELATED TO PREOPERATIVE ENLARGEMENT OF IDIOPATHIC MACULAR HOLE DIAMETER
Authors: Terasaki Hiroto , Yamashita Toshifumi , Funatsu Ryoh , Shiihara Hideki , Yamashita Takehiro , Sakamoto Taiji 
Published: July 2022

Purpose:
To determine the preoperative factors that are significantly correlated with an enlargement of an idiopathic macular hole (MH) during the one-month preoperative period.

Methods:
This was a retrospective cross-sectional study of patients with MH who had undergone vitrectomy in the Kagoshima University Hospital. The stage of the MH was determined by using spectral domain optical coherence tomography. Patients who had optical coherence tomography images at two time points more than 14 days apart before the vitrectomy were studied.

Results:
The MH participants were at Stage 2 in 44 eyes, at Stage 3 in 58 eyes, and at Stage 4 in 38 eyes. The rate of increase of the hole diameter was 26.0 ± 42.3% at Stage 2, 5.52 ± 15.5% at Stage 3, and 8.04 ± 18.7% at Stage 4. The rate of change at Stage 2 was significantly greater than that at Stage 3 and Stage 4 (both P < 0.01). In Stage 2, the MH diameter at the initial visit was significantly and negatively correlated with the rate of MH enlargement (r = −0.35, P = 0.021).

Conclusion:
Patients with Stage 2 MHs, especially eyes with small hole diameter, should be considered for early surgery.
Physical Therapy Management of Functional Constipation in Adults Executive Summary: A 2021 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association's Academy of Pelvic Health Physical Therapy
Authors: LaCross Jennifer A. , Borello-France Diane , Marchetti Gregory F. , Turner Rose , George Susan 
Published: July 2022

Background:
Functional constipation, diagnosed by physicians utilizing the Rome criteria, is a nonpathologic bowel condition resulting in difficulty with defecation. Adults with functional constipation experience infrequent defecation and may strain and/or use manual maneuvers to produce a bowel movement. Physical therapy should be offered as part of conservative intervention. The goals of this guideline were to describe the available evidence and create a reference document of evidence for physical therapists managing adults with functional constipation symptoms.

Methods:
A systematic search of the literature was performed for articles published between 1990 and 2019 related to physical therapy interventions for adult functional constipation. A summary of details including benefits, risks, harms, and costs related to each intervention category is provided.

Results:
Strong evidence suggests that physical therapists should offer biofeedback interventions to their patients with functional constipation, including either electromyographic, rectal balloon catheter, or anorectal manometry biofeedback. Moderate evidence supports the use of manual therapy, whereas weak evidence was found to support the use of electrical stimulation to manage adult functional constipation. Finally, although we were not able to grade the evidence for the use of patient education and therapeutic exercise in the physical therapy management of functional constipation, we did provide a summary of these interventions in the literature.

Discussion/Conclusions:
Our findings suggest that physical therapists can confidently include biofeedback interventions into the plan of care for adults with functional constipation, as they are supported by strong evidence. Manual therapy also provided a degree of evidence suitable to recommend its use.
Sound Pressure Distribution in the Ear After Radical Mastoidectomy With Meatoplasty
Authors: Lee Chia-Fone , Hsu Ken-Hao , Chen Chin-Kuo 
Published: July 2022

Objective
We aimed to identify the sound pressure distribution along the external auditory canal after radical mastoidectomy with meatoplasty by combining real ear measurements and measurements obtained using a finite-element model.

Study Design
Case series with chart review.

Setting
Tertiary care university hospital.

Patients
We evaluated 16 patients who had undergone radical mastoidectomy with meatoplasty in one ear and had intact nonoperated contralateral ears, which served as the control group.

Intervention (Diagnostic)
Real ear measurements testing at specific frequencies were performed postoperatively.

Main Outcome Measure
Sound pressure gains were measured at five different depths along the external auditory canal, and a validated finite-element model was used to simulate the sound pressure distributions along the external auditory canals of the operated and nonoperated ears.

Results
The average peak resonant frequency near the tympanic membrane in operated ears was significantly lesser than that in nonoperated ears (2434.4 ± 616.4 versus 2935.9 ± 602.2 Hz; Wilcoxon signed-rank test, p < 0.05). The average peak resonant amplitude near the tympanic membrane showed no significant intergroup difference (paired-sample t test, p > 0.05). The peak resonant frequencies at different depths of the external auditory canal varied in the nonoperated ears (Kruskal-Wallis rank-sum test, 2880.9 ± 581.7 Hz, p = 0.02) but did not differ significantly in the operated ears (Kruskal-Wallis rank-sum test, 2464.4 ± 670.3 Hz, p = 0.75). In the finite-element model, the peak resonant frequencies along the depth of the external auditory canal varied in the normal ear and were homogeneous in the operated ear.

Conclusion
Radical mastoidectomy with meatoplasty altered the sound distribution in the external auditory canal. Our finite-element model successfully simulated the postoperative sound distribution in the external auditory canal and will facilitate development of wearable equipment for these patients.
Trends in Pediatric Acute Otitis Media Burden During the First COVID-19 Year
Authors: Marom Tal , Schwarz Yehuda , Gluck Ofer , Ginzburg Gabriel , Tamir Sharon Ovnat 
Published: July 2022

Objective
To study the changes in acute otitis media (AOM) pediatric emergency department (PED) visits and pediatric admission before and during the first coronavirus disease 2019 (COVID-19) year.

Study Design
Retrospective case review.

Setting
Secondary care center.

Patients
Children younger than 18 years with all-cause and AOM-related PED visits and pediatric admissions for 3 years (March 1, 2018–January 28, 2021) were identified. Children were categorized according to age (0–2, 2–6, and 6–18 yr) and their date of presentation: pre–COVID-19 (yearly average of visits/admissions during the 2 prepandemic years: March 1, 2018–February 28, 2019 and March 1, 2019–February 29, 2020) or COVID-19 year (visits/admissions between March 1, 2020–February 28, 2021).

Intervention
Pre– and post–COVID-19 emergence, alternating lockdowns, kindergarten and school closures, and increased hygiene measures.

Main Outcome Measure
Post– versus pre–COVID-19 AOM PED visit and pediatric admission incidence rate ratios (IRRs), using a generalized estimating equation model with a negative binomial regression calculation, while controlling for monthly fluctuations.

Results
Annual AOM visits/admissions during the pre–COVID-19 and COVID-19 years were 517 and 192 and 256 and 94, respectively (p < 0.05 for both). For children aged 0 to 2 years, AOM visits/admissions significantly decreased during the first COVID-19 year, compared with the pre-COVID years (β = −1.11 [IRR, 0.33; 95% confidence interval [CI], 0.26–0.42; p < 0.005] and β = −1.12 [IRR, 0.33; 95% CI, 0.25–0.42; p < 0.005]). Relatively to all-cause of children aged 0 to 2 years, AOM visits/admissions decreased during the first COVID-19 year versus the pre–COVID-19 years (β = −2.14 [IRR, 0.12; 95% CI, 0.08–0.17; p < 0.005] and β = −1.36 [IRR, 0.26; 95% CI, 0.23–0.29; p < 0.005]) and had monthly fluctuations coinciding with the lockdown/relaxation measures. For children aged 2 to 6 years, the reduction in AOM admissions was significant (β = −1.70, IRR, 0.18; 95% CI, 0.09–0.37; p < 0.005). No significant differences were observed for children aged 6 to 18 years because of the small sample size.

Conclusion
Pediatric AOM burden substantially decreased during the first COVID-19 year.
Are Speech Perception Scores in Cochlear Implant Recipients Consistent Across Different Tests?
Authors: Andresen Nicholas S. , Vohra Varun , Galaiya Deepa J. , Carver Courtney L. , Marsiglia Dawn D. , Yeagle Jennifer D. , Creighton Francis X. , Wang Nae-Yuh , Bowditch Stephen P. , Della Santina Charles C. , Sun Daniel Q. 
Published: July 2022

Objective
Cochlear implant (CI) candidacy and postoperative outcomes are assessed using sets of speech perception tests that vary from center to center, limiting comparisons across institutions and time periods. The objective of this study was to determine if scores on one speech perception test could be reliably predicted from scores on another test.

Study Design
Arizona Biomedical (AzBio) Sentence Test, Consonant-Nucleus-Consonant word (CNCw), and Hearing in Noise Test (HINT) scores in quiet for the implanted ear were collected for individuals who received a CI between 1985 and 2019. Scores collected during the same testing session were analyzed using Bland-Altman plots to assess agreement between testing methods. Simple linear regression with logit transformation was used to generate predictive functions and 95% confidence intervals for expected mean and individual scores.

Setting
Single academic medical center.

Patients
A total of 1,437 individuals with a median age of 59.9 years (range, 18–95 yr) and 46% (654 of 1,437) male.

Interventions
N.A.

Main Outcome Measures
Agreement as a function of test score, mean, variance, and correlation coefficients.

Results
A total of 2,052 AzBio/CNCw, 525 AzBio/HINT, and 7,187 CNCw/HINT same-session score pairings were identified. Pairwise test comparisons demonstrated limited agreement between different tests performed in the same session, and a score correlation between different speech tests revealed large variances.

Conclusion
Transformation functions between test batteries were predictive of mean scores but performed poorly for prediction of individual scores. Point-wise comparisons of scores across CI test batteries should be used with caution in clinical and research settings.
Otologic Manifestations of Psoriasis: A Systematic Review and Meta-Analysis
Authors: Jeong Seth S. , Shih Michael C. , Rizk Habib G. , Lambert Paul R. 
Published: July 2022

Introduction
Psoriatic skin lesions are often seen in the auricle and external auditory canal, but middle ear and inner ear manifestations are not easily identified. Several studies have indicated hearing loss and vestibular dysfunction with psoriasis, but the extent of association has not been well defined.

Methods
A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies described audiometric or vestibular assessment of psoriasis patients. Meta-analysis was represented with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals.

Results
A total of 13 studies with 589 psoriasis patients and 617 healthy controls were included. Age did not significantly differ between psoriasis patients (47.1 [12.4] yr) and healthy controls (45.4 [11.2] yr). Psoriasis area and severity index score was 9.9 (8.4), and body surface area scores was 7.9 (14.7). Pure-tone audiometry analysis showed higher mean hearing thresholds in psoriasis patients compared with healthy controls across all frequencies, with the greatest difference at 4000 Hz (MD, 7.70 [4.46–10.94]; p < 0.00001). Speech reception thresholds were worse with psoriasis (MD, 3.53 [1.56–5.49]; p < 0.0001). Abnormal stapedial reflex was more common in psoriasis (OR, 5.19 [1.68–15.99]; p = 0.004). Abnormal vestibular testing was more common in psoriasis for caloric testing (OR, 13.12 [2.88–59.84]; p < 0.0001). Two additional studies of 41,681 psoriasis patients and 80,273 healthy controls found that psoriasis patients were at higher risk for sudden sensorineural hearing loss (OR, 1.50 [1.25–1.80]; p < 0.0001).

Conclusion
Our study shows that psoriasis is associated with hearing loss and vestibular dysfunction, but clinical significance remains undefined. The trends noted in our study require more investigation, and the pathophysiologic mechanisms need to be defined.
Single-Center Experience Evaluating Clinical Outcomes of a Novel-Guided Drill System for Percutaneous Bone-Anchored Hearing Implant
Authors: Shoman Nael M. 
Published: July 2022

Objective
Evaluate intraoperative and postoperative outcomes of a novel guided drill system for percutaneous bone-anchored hearing implants.

Methods
Between January 2016 and February 2021, patients age ≥18 years deemed potential candidates for a bone-anchored hearing device, were formally assessed for candidacy and counseling. Those that qualified and opted to proceed were added to a prospectively maintained database, including demographic, clinical, and audiologic data. Intraoperative findings were reported, as were clinical outcomes at 7 days, 4 weeks, 3 months and 6 months postoperatively. The Holgers index was used to grade soft tissue reactions.

Results
One hundred patients underwent the procedure. There were 56 women, and mean age was 54 years (18–84 yr). Ninety-six were done under local anesthetic. Mean surgical time was 13 minutes (9–27 min). No significant intraoperative events were noted. There were nine cases of implant loss, all in the first 50 cases. Mean duration of implant loss was 3.6 weeks (range, 2–5 wk). At the first postoperative visit, 82 had Holgers 0, 16 Holgers 1, 2 Holgers 2, and none Holgers 3. At the second postoperative visit, excluding the 9 with implant loss, 83 (91%) had Holgers 0, 6 (7%) Holgers 1, and 2 (2%) Holgers 2. None were Holgers 3.

Conclusions
The current study represents, to our knowledge, the largest series on the novel guided drill technique. Results show it is safe and efficient with low soft tissue complication rates. Drill bit design and technical modifications may have helped lower implant loss rate in this series over time.
The Impact of the Location of Chorda Tymapni Nerve Origin on the Round Window Accessibility During Pediatric Cochlear Implantation: A Radioclinical Assessment
Authors: Elzayat Saad , Mandour Mahmoud , Elfarargy Haitham H. , Lotfy Rasha , Margani Valerio , Covelli Edoardo , Barbara Maurizio 
Published: July 2022

Objectives
This study assessed the impact of the location of the chorda tympani nerve (CTN) origin on the round window (RW) accessibility during pediatric cochlear implantation (CI). We also tried to validate the radiologic method to measure the length between the origin of the CTN from the facial nerve to the stylomastoid foramen (CF-SM).

Study Design
It was a prospective observational case-series study.

Settings
The included CI surgeries were performed at tertiary referral institutions from November 2018 to August 2021.

Subjects
We included 146 pediatric patients who were candidates for CI.

Intervention
We measured the CF-SM length in the parasagittal cut of the preoperative high-resolution computed tomography. We also classified the intraoperative RW according to the accessibility through the ordinary posterior tympanotomy approach into accessible or inaccessible.

Main Outcome Measure
We correlated the preoperative radiologic CF-SM length with the intraoperative RW accessibility.

Results
The radiologic CF-SM length ranged from 2.9 to 7.4 mm with a mean of 4.9 ± 1.03 mm. The RW was accessible in 107 patients and inaccessible in 39 patients. Spearman’s correlation coefficient revealed a significant relationship between the location of CTN origin and the RW accessibility as the p value was less than 0.0001.

Conclusions
We found a precise method to measure the CF-SM length in the parasagittal cut of the high-resolution computed tomography. We also found a significant impact of the location of the CTN origin on intraoperative RW accessibility. The radiologic CF-SM length of more than 5.4 mm had a powerful prediction capability of the RW inaccessibility.
First-Time Mothers' Invisible Presence Using Social Networking Sites
Authors: Elliott Gail M. C. , Letvak Susan , Côté-Arsenault Denise , Wallace Debra C. , Smith Julia Mendez 
Published: July 2022

Abstract

Purpose:
To describe first-time mothers' experiences with online social networking sites in the early postpartum period, explore how mothers use them to gain support, and to evaluate how their use can aid or hinder maternal role transition.

Study Design:
Qualitative descriptive study.

Methods:
This qualitative descriptive study, using convenience and snowball sampling, first-time mothers in the early postpartum period were recruited through social media. Semistructured interviews were conducted virtually where mothers were asked to describe their experiences with online social networking. Thematic analysis methods were used to develop themes from participant interviews.

Results:
Twelve first-time mothers ranging from 4 to 12 weeks postpartum participated in the study. Thematic analysis revealed four themes: 1) Habits of first-time mom using social networking sites, 2) New purpose online, 3) Taking it to the moms, and 4) Impact on motherhood.

Clinical Implications:
Maternal child nurses have opportunities to further customize support for first-time mothers online. Awareness of habits, trends, implications of early mothering during COVID-19, and the role social networking sites can play in supporting mothers in the early postpartum period offers new ways for nurses to support and empower the motherhood collective.
Acute Alcohol Intoxication in Pediatric Emergencies
Authors: Castro-Rodríguez Cristina , Lorente-Romero Jorge , Rivas-García Arístides , García-Loygorri Clara Ferrero , Vázquez-López Paula , Marañón Rafael 
Published: July 2022

Introduction
Alcohol intoxication in pediatrics is a growing problem in our environment. The objectives of this study are to define the prevalence of acute alcohol intoxication in the pediatric emergency department (PED) and to describe the associated symptoms and their relationship with potential risk factors.

Methods and Material
This cross-sectional study includes patients younger than 16 years with a diagnosis of acute alcohol intoxication between March 2010 and October 2018 in the PED of a tertiary hospital. Patients with concomitant intoxication by other substances were excluded. The association between qualitative variables was determined using the χ2 or Fisher exact test and quantitative with the Student t, Mann-Whitney U test, and simple linear regression.

Results
There were 136 episodes of alcohol intoxication, which represents a prevalence of 24.1/100,000 emergencies. After excluding 10 patients because of positive screening for other drugs, 126 patients with a mean age of 14.5 years (SD, 1.2 years) were included, 57.9% of whom were women. A total of 25.4% of the patients were younger than 14 years. Ethanolemia was determined in 88.9%, and its mean concentration was 195.7 mg/dL (SD, 56.5 mg/dL), with potentially serious levels (>300 mg/dL) being found in 3.6% of the patients. A relationship was found between the Glasgow Coma Scale score and ethanolemia (B = −12.7; 95% confidence interval, −8.1 to −17.4; P < 0.001), as well as with potassium (B = −31, 9; 95% confidence interval, −6.6 to −57.3; P = 0.014). No patient had seizures or hypoglycemia. A total of 10.3% of the patients required admission.

Conclusions
Alcohol intoxication is a rare consultation reason in the PED. They usually present with mild and self-limited symptoms, being the decrease in the level of consciousness and hypokalemia the most frequent symptom and analytical alteration.
Use of Minimally Invasive Radiofrequency-assisted Lipolysis as a Novel Treatment of Grade 2 and Grade 3 Cellulite.
Authors: Peters Mark H. 
Published: July 2022

Background:
Cellulite is a common condition and laxity in the superficial fascial system (SFS) contributes significantly to its appearance in the thigh and buttock areas. Components of the SFS such as the fibrous septae and adipose tissue are targets for an effective treatment to improve the appearance of cellulite. This preliminary report demonstrates the use of radiofrequency-assisted lipolysis (RFAL) as a novel treatment approach to improve the appearance of cellulite by tightening the SFS.

Methods:
Ten female patients with Grade II and Grade III cellulite of the thighs or buttocks were included in this study. Minimally invasive application of bipolar radiofrequency energy to the affected areas was performed. Predetermined internal thermal endpoints at multiple tissue levels and different directions were reached in the treated tissues. Aspiration of the coagulated adipose tissue was performed using a small diameter cannula to minimize damage to the connective tissues. Pre-treatment and 6 months post-operative photos of 70 different body areas were randomized and scored by five blinded evaluators.

Results:
Using the Photonumeric Cellulite Severity Scale (CSS), scoring of preoperative and postoperative photographs revealed statistically significant differences in all body area comparisons. The magnitude of the differences in all scored body areas were considered large and mean differences were all positive indicating an improvement across time.

Conclusions:
Grade 2 and Grade 3 cellulite of the thighs and buttocks can be effectively treated using RFAL technology to decrease the laxity of the SFS.