bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remission and Relapse of Hypertension After Bariatric Surgery: A Retrospective Study on Long-Term Outcomes
Authors: Fisher David P. , Liu Liyan , Arterburn David , Coleman Karen J. , Courcoulas Anita , Haneuse Sebastien , Johnson Eric , Li Robert A. , Theis Mary Kay , Taylor Brianna , Fischer Heidi , Cooper Julie , Herrinton Lisa J. 
Published: April 2022

Objectives:
To compare hypertension remission and relapse after bariatric surgery compared with usual care.

Background:
The effect of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission and relapse has not been studied in large, multicenter studies over long periods and using clinical blood pressure (BP) measurements.

Methods:
This retrospective cohort study was set in Kaiser Permanente Washington, Northern California, and Southern California. Participants included 9432 patients with hypertension 21–65 years old who underwent bariatric surgery during 2005–2015 and 66,651 nonsurgical controls matched on an index date on study site, age, sex, race/ethnicity, body mass index, comorbidity burden, diabetes status, diastolic and systolic BP, and number of antihypertensive medications.

Results:
At 5 years, the unadjusted cumulative incidence of hypertension remission was 60% (95% confidence interval [CI], 58–61%) among surgery patients and 14% (95% CI, 13–14%) among controls. At 1 year, the adjusted hazard ratio for the association of bariatric surgery with hypertension remission was 10.24 (95% CI, 9.61–10.90). At 5 years, the adjusted hazard ratio was 2.10 (95% CI, 1.57–2.80). Among those who remitted, the unadjusted cumulative incidence of relapse at 5 years after remission was 54% (95% CI, 51–56%) among surgery patients and 78% (95% CI 76–79%) among controls, although the adjusted hazard ratio was not significant (hazard ratio, 0.71; 95% CI, 0.46–1.08).

Conclusions:
Bariatric surgery was associated with greater hypertension remission than usual care suggesting that bariatric surgery should be discussed with patients with severe obesity and hypertension. Surgical patients who experience remission should be monitored carefully for hypertension relapse.
Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population
Authors: Holbrook Hayden S. , Bowers Alexander F. , Mahmoud Karim , Kelly Derek M. 
Published: April 2022

Background:
Newer cone-beam computed tomography (CT) technology has grown in popularity for evaluation of foot and ankle pathology in the weight-bearing (WB) position. Many studies have demonstrated its benefits within the adult population, but there is a paucity of its use within the pediatric literature. The purpose of this study was to describe the indications and clinical findings of WBCT within a pediatric population.

Methods:
A retrospective cohort of 68 patients (86 extremities) who underwent WBCT for a variety of conditions were compared with 48 patients (59 extremities) who underwent traditional supine nonweight-bearing (NWB) CTs. Clinical indications, demographic data, radiation doses, and cost were obtained from the medical record. WBCTs were obtained in a private outpatient orthopaedic clinic, and the conventional NWBCTs were obtained within a hospital-based system.

Results:
The most common indications for obtaining a WBCT and NWBCT in our study were fracture, tarsal coalition, and Lisfranc injury. The average WBCT radiation dose was 0.63 mGy for patients <100 lbs and 1.1 mGy for patients >100 lbs undergoing WBCT. For NWBCTs, the average radiation dose was 7.92 mGy for patients <100 lbs and 10.37 mGy for patients greater than 100 lbs. There was a significant reduction in radiation dose for all patients who underwent WBCT (P<0.0001 vs. 0.002). The average reimbursement for NWBCTs was $505 for unilateral studies and $1451 for bilateral studies. The average reimbursement for the WBCTs was $345 for unilateral studies and $635 for bilateral studies.

Conclusions:
WBCT offers a new modality for studying complex foot and ankle pathoanatomy in the pediatric population at a reduced radiation exposure and reduced cost.

Level of Evidence:
Level III—a retrospective comparative study.
Interobserver Agreement and Reliability of Intrapartum Nonreassuring Cardiotocography and Prediction of Neonatal Acidemia
Authors: Li Zhuyu , Wang Yan , Cai Jian , Zhao Peizhen , Chen Hanqing , Liu Haiyan , Shen Lixia , Chen Lian , Li Shufang , Zhao Yangyu , Wang Zilian 
Published: April 2022

Abstract

Objective:
To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography (CTG) interpretation and prediction of neonatal acidemia by obstetricians working in different centers.

Methods:
A retrospective cohort study involving two tertiary hospitals (The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital) was conducted between 30th September 2018 and 1st April 2019. Six obstetricians from two hospitals with three levels of experience (junior, medium, and senior) reviewed 100 nonreassuring fetal heart rate (FHR) tracings from 1 hour before the onset of abnormalities until delivery. Each reviewer determined the FHR pattern, the baseline, variability, and presence of acceleration, deceleration, sinusoidal pattern, and predicted whether neonatal acidemia and abnormal umbilical arterial pH < 7.1 would occur. Inter-observer agreement was assessed using the proportions of agreement (Pa) and the proportion of specific agreement (Pa for each category). Reliability was evaluated with the kappa statistic (k-Light's kappa for n raters) and Gwet's AC1 statistic.

Results:
Good inter-observer agreement was found in evaluation of most variables (Pa > 0.5), with the exception of early deceleration (Pa = 0.39, 95% confidence interval (CI): 0.36,0.43). Reliability was also good among most variables (AC1 > 0.40), except for acceleration, early deceleration, and prediction of neonatal acidemia (AC1 = 0.17, 0.10, and 0.25, respectively). There were no statistically significant differences among the three groups, except in the identification of accelerations (Pa = 0.89, 95% CI: 0.83,0.95; Pa = 0.50, 95% CI: 0.41,0.60, and Pa = 0.35, 95% CI: 0.25,0.43 in junior, medium and senior groups, respectively) and the prediction of neonatal acidemia (Pa = 0.52, 0.52, and 0.62 in junior, medium and senior groups, respectively), where agreement was highest and lowest in the junior-level group, respectively. The accuracy and sensitivity of the prediction for umbilical artery pH < 7.1 were similar among the three groups, but the specificity was higher in the senior groups (93.68% vs. 92.53% vs. 98.85% in junior, medium and senior groups, P = 0.015).

Conclusion:
Although we found a good inter-observer agreement in the evaluation of the most basic CTG features and FHR category statistically, it was insufficient to meet the clinical requirements for “no objection” interpretation for FHR tracings. Further specialized training is needed for standardized interpretation of intrapartum FHR tracings.
CTGNet: Automatic Analysis of Fetal Heart Rate from Cardiotocograph Using Artificial Intelligence
Authors: Zhong Mei , Yi Hao , Lai Fan , Liu Mujun , Zeng Rongdan , Kang Xue , Xiao Yahui , Rong Jingbo , Wang Huijin , Bai Jieyun , Lu Yaosheng 
Published: April 2022

Abstract

Objective:
This study investigates the efficacy of analyzing fetal heart rate (FHR) signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.

Methods:
A total of 43,888 cardiotocograph(CTG) records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University. After filtering the data, 2341 FHR records were used for the study. The ObVue fetal monitoring system, manufactured by Lian-Med Technology Co. Ltd., was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery. Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR. Our cardiotocograph network (CTGNet) as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals. The results of calculations were compared with the annotations provided by the obstetric experts, and ten-fold cross-validation was applied to evaluate them. The root-mean-square difference (RMSD) between the baselines, acceleration F-measure (Acc.F-measure), deceleration F-measure (Dec.F-measure), and the morphological analysis discordance index (MADI) were used as evaluation metrics. The data were analyzed by using a paired t-test.

Results:
The proposed CTGNet was superior to the best traditional method, proposed by Mantel, in terms of the RMSD.BL (1.7935 ± 0.8099 vs. 2.0293 ± 0.9267, t = −3.55 , P = 0.004), Acc.F-measure (86.8562 ± 10.9422 vs. 72.2367 ± 14.2096, t = 12.43, P <0.001), Dec.F-measure (72.1038 ± 33.2592 vs. 58.5040 ± 38.0276, t = 4.10, P <0.001), SI (34.8277±20.9595 vs. 54.8049 ± 25.0265, t = −9.39, P <0.001), and MADI (3.1741 ± 1.9901 vs. 3.7289 ± 2.7253, t = −2.74, P = 0.012). The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.

Conclusion:
The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data. It promises to be a key component of smart obstetrics systems of the future.
Evolving Frameworks for the Foundation and Practice of Electronic Fetal Monitoring
Authors: Evans Mark I. , Britt David W. , Evans Shara M. , Devoe Lawrence D. 
Published: April 2022

Abstract
Since the 1970s, electronic fetal monitoring (EFM) also known as cardiotocography (CTG) has been used extensively in labor around the world, despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral palsy. Part of EFM's poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests, subjective classifications of fetal heart rate (FHR) patterns that lead to large inter-observer variability in its interpretation, failure to appreciate early stages of fetal compromise, and poor statistical modeling for its use as a screening test. We have developed a new approach to the practice and interpretation of EFM called the fetal reserve index (FRI) which does the following: (1) breaking FHR components down into 4 components, (heart rate, variability, accelerations, and decelerations); (2) contextualizing the metrics by adding increased uterine activity; (3) adding specific maternal, fetal, and obstetric risk factors. The result is an eight-point scoring metric that, when directly compared with current American College of Obstetricians and Gynecologists EFM categories, even in version 1.0 with equal weighting of variables, shows that the FRI has performed much better for identifying cases at risk before damage had occurred, reducing the need for emergency deliveries, and lowering overall Cesarean delivery rates. With increased data, we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.
A Nonexercise Estimate of Cardiorespiratory Fitness Using a Symptom Questionnaire and Clinical Variables
Authors: Myers Jonathan , Chan Khin , Tan Isabelle M. C. , Bail Nicholas , Kamil-Rosenberg Shirit , Zell Hunter , Waheed Tabbasum , Mathew Pooja 
Published: April 2022

Purpose:
Cardiorespiratory fitness (CRF) has recently been recognized as a risk factor for mortality, but it is not routinely measured in clinical settings. The purpose of this study was to assess a nonexercise method to estimate CRF (eCRF) and its association with mortality in a clinically referred population.

Methods:
A symptom tool, termed the Veterans Specific Activity Questionnaire (VSAQ), and nonexercise clinical variables were obtained from 1545 clinically referred subjects (60 ± 13 yr), and followed for a mean of 5.6 ± 4.2 yr. The VSAQ along with nonexercise clinical and historical variables was used to develop a multivariate model to predict achieved CRF from maximal exercise testing. Proportional hazards analysis was used to assess the association between measured and eCRF and all-cause mortality.

Results:
The eCRF model was significantly associated with achieved CRF (multiple R = 0.67, P < .001). Mean achieved CRF from maximal treadmill testing and eCRF were similar (8.6 ± 5.0 metabolic equivalents [METs] vs 8.7 ± 4.7 METs respectively, P = .27). Achieved CRF and eCRF performed similarly for predicting mortality. After full adjustment, each 1 MET higher increment in achieved CRF and eCRF was associated with 19% and 26% reductions in mortality risk, respectively. Compared with the lowest fit group (<5 METs), the highest CRF groups (>11 METs) had 88% and 87% lower risks for mortality for achieved CRF and eCRF, respectively.

Conclusions:
A multivariable nonexercise model featuring a symptom questionnaire combined with clinical variables that are readily available during a typical clinical encounter had a reasonably strong association with achieved CRF and exhibited prognostic characteristics that were similar to achieved CRF.
Accuracy of newer intraocular lens power formulas in short and long eyes using sum-of-segments biometry
Authors: Shammas H. John , Taroni Leonardo , Pellegrini Marco , Shammas Maya C. , Jivrajka Renu V. 
Published: April 2022

Purpose:
To analyze the accuracy of newer intraocular lens power formulas in long and short eyes measured using the sum-of-segments biometry.

Setting:
Private practice, Lynwood, California.

Design:
Retrospective observational study.

Methods:
595 patients scheduled for cataract surgery had their eyes measured using the sum-of-segments biometry. The expected residual refractions were calculated using Barrett Universal II (B II), Barrett True Axial Length (BTAL), Emmetropia Verifying Optical (EVO), Hill-RBF, Hoffer QST, Holladay 2, Holladay 2-NLR, K6, Kane, Olsen, PEARL-DGS, T2, and VRF formulas and compared with the traditional Haigis, Hoffer Q, Holladay 1, and SRK/T formulas.

Results:
In the 102 long eyes, all new formulas had a mean absolute error (MAE) equal or lower than the traditional formulas, ranging from 0.29 to 0.32 diopter (D). In the 78 short eyes, BTAL, EVO, Hoffer QST, K6, Olsen, and PEARL-DGS formulas had the lowest MAE (0.33 D, 0.33 D, 0.31 D, 0.36 D, 0.32 D, and 0.32 D, respectively), whereas all traditional formulas exceeded 0.36 D.

Conclusions:
All new formulas performed equal or better than the traditional formulas with the sum-of-segments biometry. The best overall results in the short and long eyes as well as in the very short and very long eyes were noted with the BTAL, EVO, Hoffer QST, K6, Olsen, and PEARL-DGS formulas, closely followed by the B II and Kane formulas.
Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals
Authors: Pritchard Verena E. , Rizkallah Sarah 
Published: April 2022

Objectives:
Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors.

Methods:
A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU).

Results:
The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level.

Conclusions:
Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.
Engaging Parents of Fragile Infants in the Design and Appraisal of Health Literature
Authors: Wyles Christina , Gephart Sheila M. , Nunez Francesco 
Published: April 2022

What Was Observed or Investigated:
The increased morbidity of diverse infants is unacceptable, and methods to reduce necrotizing enterocolitis (NEC) in their communities are needed. This article discusses the importance of the Español toolkit; provides a backstory of how the Español toolkit came about and how it was verified and validated; and concludes with impressions from involving parents in the research process.

Subjects and Methods:
After research evidence was translated from English into Spanish, a cross-sectional exploratory, descriptive, mixed-methods study was conducted, guided by the knowledge translation into practice (Translating Research Into Practice [TRIP]) framework. Twenty bilingual English-Spanish parents of fragile infants evaluated the NEC-Zero Español toolkit from a single neonatal intensive care unit.

Results and Conclusions:
The NEC-Zero Español toolkit was found to be easy-to-use and useful and provided information that can be used to augment information sharing. Having access to health information offers a meaningful way to start a conversation and may even impact positive behaviors such as breastfeeding promotion. To lessen Spanish speakers' linguistic barriers, providing materials in Spanish can help meet their information needs and initiate conversations with healthcare providers. This is particularly important because Hispanic infants are at high risk for NEC.
Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations
Authors: Amore Alexis Dunn 
Published: April 2022

Introduction:
Maternal morbidity and mortality rates are on the rise in the United States, particularly among Black populations. Recently, there has been an uptick in research funding to identify and address root causes, particularly among at-risk groups. However, given the historical trauma experienced by Black populations in research settings, novel approaches built firmly on ethical principles and grounded in a framework of reproductive justice are necessary to minimize harm and center the research process on maintaining the dignity and respect of research participants.

Methods:
Ethical principles as outlined by the American Nurses Association, Black Mamas Matter Alliance, and federal research guidelines are reviewed within the context of conducting maternal mortality-focused research. In addition, community developed research frameworks and methodologies are presented and discussed within the research context.

Conclusions:
Black pregnant people have reported mistreatment during clinical encounters; therefore, intentional protections to promote safety must be considered in the research setting. Ethical principles must be considered when designing and implementing research initiatives focused on addressing maternal mortality risk in Black communities.
Clinical Uniform Management and Contact Nursing Care to Children Under the Age of 3
Authors: Lomba Lurdes , Pereira Ana Laura , Oliveira Rafaela , da Luz Abreu Inês , Stein Backes Dirce , Graveto João 
Published: April 2022

Introduction
Nurses' clinical uniforms and scrubs may become a vehicle for the transmission and contamination of pathogenic microorganisms. This study aims to identify the relationship between nursing care, in which there is contact between the clinical uniforms or scrubs, and patients up to 3 years old, the way nurses manage their uniforms, and the microorganisms present.

Method
A quantitative, descriptive–correlational, cross-sectional study was conducted with a sample of 24 pediatric nurses, who filled out demographic surveys and from whom microbiological collections of their clinical uniforms were obtained. In this study, clinical uniforms refer to uniforms, specialized clothing, scrubs, laboratory coats, or whatever is worn by the pediatric nurse who is providing hands-on patient care.

Results
Factors contributing to contamination of clinical clothing (e.g., therapeutic procedures, holding, feeding, hygiene care) were analyzed. The methods for reusing and/or sanitizing the uniforms were studied. The nurses' uniforms had the following microorganisms found: Staphylococcus aureus (58.3%), Bacilli group (41.7%), and Streptococcus bacteria (41.7%), with a higher percentage of microorganisms in the abdomen and left thorax regions. A statistically significant relationship was found between contact during nursing care for the infant and the risk of microbiological contamination in the modified kangaroo method (clothed nurse holding infant to chest) and holding for comfort, transport, or restraint.

Discussion
Proper management of clinical clothing requires special care in its handling by pediatric nurses and the need to standardize practices and adapt behaviors to minimize the risk of contamination. The use of disposable personal protection equipment and the daily changing of uniforms and scrubs are recommended. Institutions should ensure proper management of uniforms.
Diagnostic accuracy of contrast-enhanced ultrasound for microvascular invasion of hepatocellular carcinoma
Authors: Chen Yanli , Qiao Haiyan , Lian Zhaoan , Li Chunlin , Xiang Yi 
Published: April 2022

Abstract

Background:
Microvascular invasion is an independent risk factor for the recurrence of hepatocellular carcinoma (HCC). Early detection and timely treatment can reduce the recurrence and prolong the overall survival of HCC. Contrast-enhanced ultrasound (CEUS) has been validated for their predictive potential of microvascular invasion in HCC patients, although the conclusion remains controversial. Therefore, a meta-analysis is necessary to be conducted to validate the diagnostic value of CEUS for microvascular invasion in HCC, thus supporting guideline development and clinical practice.

Methods:
Relevant studies reporting the potential diagnostic value of CEUS for microvascular invasion in HCC patients published before February 2022 will be searched in the PubMed, EMBASE, Cochrane Library, and Web of Science. Data will be extracted by 2 researchers independently. The risk of bias will be assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. All of the above statistical analysis will be carried out with Stata 14.0.

Results:
The results of this study will be published in a peer-reviewed journal.

Conclusion:
This study will comprehensively evaluate the diagnostic accuracy of CEUS for microvascular invasion in HCC patients, thus providing high-quality evidence to support clinical practice and guideline development.