bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Reported Outcomes in Keratoconus: A Save Sight Keratoconus Registry Study
Authors: Kandel Himal , Pesudovs Konrad , Nguyen Vuong , Chen Jern Yee , Poon Alexander , Mills Richard , Watson Stephanie L. 
Published: August 2022

Purpose:
The aim of this study was to evaluate the quality-of-life (QoL) status in keratoconus severity subgroups using the Keratoconus Outcomes Research Questionnaire (KORQ) and to determine the relationship between the QoL scores and the standard clinical variables.

Methods:
A cross-sectional study was conducted using prospective, web-based Save Sight Keratoconus Registry data. Rasch analysis was conducted on the KORQ data using the Andrich Rating Scale Model. Comparative analysis included Welch t test and 1-way ANOVA. Associations between visual acuity, corneal curvature, and minimum corneal thickness with KORQ scores were evaluated with Pearson correlation and multiple regression adjusted for age and sex.

Results:
The KORQ was completed by 542 patients with keratoconus (male, 67.7%; mean age, 31.6 years). Keratoconus severity, based on Kmax, was mild [<48 diopter (D)], moderate (48–55 D), and severe (>55 D) in 26.3%, 45.0%, and 28.7% of patients, respectively. Activity limitation (AL) and symptoms (SY) scales of the KORQ had robust psychometric properties including well-functioning response categories, unidimensionality, excellent measurement precision, and satisfactory fit statistics. In a group-wise analysis, the female patients had significantly lower AL and SY scores. Similarly, the severe keratoconus group had the worst AL and SY scores. Contact lens wearers had worse KORQ scores than the spectacles wearers. Overall, statistically significant but weak correlations between KORQ scores and visual acuity and corneal curvature (Kmax and K2) (Pearson r, 0.11–0.35) were observed. The correlations for SY were weaker than for AL scores.

Conclusions:
Female sex, contact lens wear, reduced visual acuity, and higher disease severity were associated with worse AL and SY scores in keratoconus. Although the correlations between clinical and QoL scores were statistically significant, the low magnitudes suggested a complex relationship between clinical parameters and patient-reported outcomes.
Spinal neurovascular coupling is preserved despite time-dependent alterations of spinal cord blood flow responses in a rat model of chronic back pain: implications for functional spinal cord imaging
Authors: Paquette Thierry , Eskandari Nasim , Leblond Hugues , Piché Mathieu 
Published: August 2022

Abstract
Functional magnetic resonance imaging has been used to investigate nociceptive processes in patients with chronic pain. However, the results may be confounded with changes in neurovascular coupling induced by chronic pain. The objective of this study was to examine spinal neurovascular coupling in a rat model of chronic back pain induced by muscle inflammation. Rats received 150 µL intramuscular injections of either complete Freund adjuvant (CFA: n = 18) or saline (control [CTL]: n = 18) in L5-L6 paravertebral muscles. Under 1.2% isoflurane anesthesia, spinal cord blood flow (SCBF) and local field potentials evoked by electrical stimulation of the sciatic nerve were recorded simultaneously in the lumbar enlargement of the spinal cord, 14 or 28 days after the injections. Mechanical hypersensitivity was observed in CFA rats compared with CTL rats for the back (P < 0.001) and hind paws (P < 0.01). Spinal cord blood flow response amplitude and local field potential amplitude were not significantly different between groups (day 14: P > 0.5; day 28: P > 0.6). However, the time course of SCBF responses was different between groups on day 14 (P < 0.001) and day 28 (P < 0.001). Nevertheless, neurovascular coupling was comparable between groups on days 14 and 28, whether neurovascular coupling was calculated with the amplitude or the area under the curve of SCBF responses (all P > 0.2). These results indicate that spinal hemodynamic changes reflect neuronal activity in this animal model, although the time course of SCBF responses is affected by chronic inflammatory back pain. This warrants a careful use of spinal functional magnetic resonance imaging in animal models and patients with chronic back pain.
Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis
Authors: Liu Pinyan , Wu Yitao , Xiao Ziyu , Gold Laura S. , Heagerty Patrick J. , Annaswamy Thiru , Friedly Janna , Turner Judith A. , Jarvik Jeffrey G. , Suri Pradeep 
Published: August 2022

Abstract
Conventional “1-variable-at-a-time” analyses to identify treatment effect modifiers are often underpowered and prone to false-positive results. This study used a “risk-modeling” approach guided by the Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement framework: (1) developing and validating a multivariable model to estimate predicted future back-related functional limitations as measured by the Roland–Morris Disability Questionnaire (RMDQ) and (2) stratifying patients from a randomized controlled trial (RCT) of lumbar epidural steroid injections (LESIs) for the treatment of lumbar spinal stenosis into subgroups with different individualized treatment effects on RMDQ scores at the 3-week follow-up. Model development and validation were conducted in a cohort (n = 3259) randomly split into training and testing sets in a 4:1 ratio. The model was developed in the testing set using linear regression with least absolute shrinkage and selection regularization and 5-fold cross-validation. The model was then applied in the testing set and subsequently in patients receiving the control treatment in the RCT of LESI. R

2
values in the training set, testing set, and RCT were 0.38, 0.32, and 0.34, respectively. There was statistically significant modification (P = 0.03) of the LESI treatment effect according to predicted risk quartile, with clinically relevant LESI treatment effect point estimates in the 2 quartiles with greatest predicted risk (−3.7 and −3.3 RMDQ points) and no effect in the lowest 2 quartiles. A multivariable risk-modeling approach identified subgroups of patients with lumbar spinal stenosis with a clinically relevant treatment effect of LESI on back-related functional limitations.
Difficulties With Executive Function Are Associated With Risky Health Behaviors Among Young Adult Congenital Heart Defect Survivors
Authors: Fox Kristen R. , Vannatta Kathryn , Jackson Jamie L. 
Published: August 2022

Background
Adults with congenital heart defects (CHDs) have an increased risk for cardiovascular complications, but few are in optimal cardiovascular health. Executive function deficits, which are elevated among CHD survivors, may contribute to engagement in behaviors that increase cardiovascular risk.

Objective
The aim of this study was to identify the association between executive function and the health risk behaviors of tobacco use, saturated fat intake, and insufficient physical activity among young adults with CHDs.

Methods
Young adults with CHDs completed the Behavior Rating Inventory of Executive Function–Adult Version, which yields composite and 9 individual domain scores (eg, inhibition, working memory). Participants also completed self-report measures of tobacco use, saturated fat intake, and physical activity. Linear and logistic regression models determined the association between executive function and risky health behaviors, adjusting for demographic factors, disease status, and emotional distress.

Results
One in 10 young adults with CHDs reported clinically significant difficulties with global executive function. Difficulties with global executive function were associated with increased tobacco use (P = .018) and greater saturated fat intake (P = .015) but not insufficient physical activity (P = .902). Difficulties with inhibition were specifically associated with increased tobacco use (P = .003) and greater saturated fat intake (P = .007), and problems with self-monitoring were associated with increased tobacco use (P = .017).

Conclusions
Executive function difficulties are associated with self-reported engagement in health risk behaviors among young adults with CHDs. Health behavior interventions for adult CHD survivors may require additional modifications that consider executive function problems, particularly difficulties with inhibition.
Do Hospitals Achieving “Leader in LGBTQ Healthcare Equality” Maintain Higher Patient Scores Compared To Nonleaders?
Authors: DiLeo Rita , Choi Seongwon , Hanneman Tari , Demirbas Ali Riza , Hearld K. Ria , Datti Paul , Borkowski Nancy 
Published: August 2022

ABSTRACT
The lesbian, gay, bisexual, transgender, and queer (LGBTQ) population deals with complex medical and behavioral issues coupled with barriers in accessing both healthcare and health insurance leading to poorer health outcomes as compared with the general population. Because this community is often overlooked in efforts to improve minority health disparities, in 2007, the Human Rights Campaign Foundation introduced the Healthcare Equality Index (HEI) for evaluating healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ patients, visitors, and employees. This study's aim was to determine whether the LGBTQ Healthcare Equality Leader institution designation advantage found by DiLeo et al (2020) has a continuing positive effect on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance. We found that patient scores for both Overall Rating and Willingness to Recommend were higher with noted improvement for HEI Leader institutions as compared with non-HEI Leader institutions over this study's 3-year period. Based on the findings of this study, it can be implied that hospitals do receive a return on their investment for achieving or maintaining the HEI Leader designation and this investment benefits all populations served by the organization inferred by their maintained higher patient experience scores.
Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity
Authors: White-Williams Connie , Bittner Vera , Eagleson Reid , Feltman Morgan , Shirey Maria 
Published: August 2022

ABSTRACT
Healthcare disparites exist in cardiovascular care, including heart failure. Care that is not equitable can lead to higher incidence of heart failure, increased readmissions, and poorer outcomes. The Heart Failure Transitional Care Services for Adults Clinic is an interprofessional collaborative practice that provides guideline-directed medical therapy and education to underserved patients with heart failure. Little is known regarding healthcare equity and quality metrics in relation to interprofessional teams. Thus, the purpose of this study was to examine if an interprofessional collaborative practice care delivery model can affect access to care and healthcare quality outcomes in underserved patients with heart failure. As evidenced by control charts over a two and a half year period, the Heart Failure Transitional Care Services for Adults Clinic was able to show improvements in access to care and quality metrics results without variation. An interprofessional collaborative practice can be an effective delivery model to address health equity and quality of care outcomes.
Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study
Authors: Stern Carrie S. , Plotsker Ethan L. , Nelson Jonas A. , Matros Evan , Kalandranis Eleni , Fatterusso Dana , Mooney Colette , Chen Yigu , Velzen Jeena , Mehrara Babak J. 
Published: August 2022

ABSTRACT
Deep inferior epigastric perforator (DIEP) flap surgery commonly involves multiday hospitalization, although data suggest 95% of complications after unilateral DIEP flap breast reconstruction occur within the first 24 hours. The aim of this study was to decrease hospitalization time and optimize care of patients undergoing unilateral DIEP flap breast reconstruction. Our study followed Six Sigma's DMAIC (define, measure, analyze, improve, control) framework. First, we delineated the stakeholders involved in the process and defined workgroups based on temporal relation to the operation. We measured performance according to project SMART (specific, measurable, achievable, relevant, time bound) goals and subsequently conducted an analysis of inefficiencies. We then created new interventions for quality improvement. Control will entail ongoing monitoring to ensure progress is sustained after study completion. Our interventions lasted 6 months and included 70 patients. By actively striving to advance patients through postoperative milestones during their inpatient stay and creating an outpatient nursing roadmap including aspects of inpatient care, we decreased the median length of stay from 67.8 to 44.8 hours (p < .001). After receiving nursing instruction, 77% of patients agreed that they felt ready to be discharged. Our study suggests that the DMAIC framework can decrease hospitalization time after DIEP surgery and spare resources for additional patients.
Response to Neoadjuvant Chemotherapy and Outcomes in Children With Wilms Tumor With Caval Thrombus: A Single Center Experience
Authors: Jain Vishesh , Krishnan Nellai , Agarwala Sandeep , Bishoi Akshay Kumar , Dhua Anjan , Bakhshi Sameer , Chauhan Sandeep , Biswas Ahitagni , Srinivas Maddur , Iyer Venkateswaran K. , Jana Manisha , Kandasamy Devasenathipathy , Yadav Devendra Kumar , Bajpai Minu 
Published: August 2022

Aim:
The aim of our study is to present our experience in the management and outcome of Wilms tumor with intracaval thrombus.

Materials and Methods:
All children with Wilms tumor with intracaval thrombus who presented to us from July 2000 to December 2017 were reviewed retrospectively. We evaluated the tumor stage, management, and outcomes in these patients.

Results:
Thirty-four patients were included in the study. The median age of presentation was 48 months (11 to 84 mo). Preoperative chemotherapy was given in 32 (94%), with a median duration of 8 weeks. Intracaval thrombus completely resolved in 9 (26%) children after neoadjuvant chemotherapy. Surgical intervention for residual inferior vena cava (IVC) thrombus was performed in 32 patients. The median follow-up was 30 months (5 to 150 mo). At the last follow-up, 24 patients (70%) were alive and disease free. The 5-year overall survival (OS) and event-free survival were 67% (95% confidence interval, 50% to 84%) and 59% (95% confidence interval, 42% to 76%). The OS in children with nonmetastatic disease (94%) was significantly higher than those with metastases (29%; P<0.01). The OS in children with complete resolution of IVC thrombus (100%) was significantly higher than those with persistent thrombus (48%; P=0.025). Analysis of survival outcomes in children with nonmetastatic disease (stage III) revealed no significant difference on comparison with cohort with stage III disease with absence of IVC thrombus. The P-value was 0.224 and 0.53 for 5-year OS and event-free survival, respectively.

Conclusion:
The management of Wilms tumor can be complicated by the presence of caval thrombus. Patients with metastasis have a significantly poor outcome. Patients in whom, there is complete resolution of intracaval thrombus on neoadjuvant chemotherapy have a significantly higher OS.
Respiratory Viral Infections in the Pediatric Hematopoietic Stem Cell Transplant Population
Authors: Demir Yenigurbuz Fatma , Atay Didem , Akinci Burcu , Akcay Arzu , Ozturk Gulyuz 
Published: August 2022

Background:
Respiratory viral infections (RVIs) are important complications in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT); however, risk factors for lower respiratory tract infections (LRTIs) are not well characterized. The aim of this study was to determine risk factors for the progression to LRTIs in pediatric patients with respiratory symptoms who underwent HSCT.

Patients and Methods:
This retrospective study included 87 pediatric patients with respiratory symptoms who underwent HSCT. Respiratory viral polymerase chain reaction samples were obtained from all patients. The evaluated data included risk factors to progression to LRTIs, long-term pulmonary complications, transplantation-related mortality, and overall survival.

Results:
Viral pathogens were detected in 31 (48.4%) patients with upper respiratory tract infections and 13 (56.5%) patients with LRTIs. There was a statistically significant difference between the groups in engraftment delay and lymphocytopenia. Also it was determined that engraftment delay (odds ratio: 7.46 [95% CI, 1.99 to 27.86]; P = 0.003) and COVID-19 infection had statistically significant effects on overall survival in general (odds ratio: 8.06 [95% CI, 2.63 to 24.64]; P <0.001]).

Conclusion:
Not only host and transplant-related factors but also viral agent type were found to be effective in progression to LRTIs. As the available therapy for respiratory viral infections remains limited, the focus should be on the prevention of infection.
Psychotic Symptoms After SARS-CoV-2 Infection
Authors: Fiks Gerardo , Duarte Juan Manuel , Lisi Gisela Roxana , Garro Marcelo , Appiani Francisco 
Published: August 2022

Abstract
This case series reports three middle-aged male patients with no prior history of psychiatric disorders who developed psychotic symptoms with manic characteristics after COVID-19 infection. They presented mystic and paranoid delusions associated with euphoria, logorrheic, insomnia, and bizarre behaviors. Two of them required psychiatric hospitalization and one received corticosteroids. Treatment with antipsychotic medication improved their symptoms in a few weeks. This case series reports the new-onset psychosis probably due to COVID-19 infection. Pathogenetic speculation about the probable causes of COVID-19 psychosis, such as inflammatory reaction and corticosteroid use, was done. Moreover, other probable causes of manic psychosis, such as late-onset bipolar disorder, were also considered and ruled out. There is a need for more research to determine the causality between psychotic symptoms and COVID-19 infection.
Stigma as a Source of Stress for Adolescent Mothers and Their Babies
Authors: Wittenberg Jean-Victor P. , Flaherty Lois T. , Becker Daniel F. , Harper Gordon , Crookall Jake M. , Vianna Natasha ,   Group for the Advancement of Psychiatry, Committee on Adolescence
Published: August 2022

Abstract
Adolescent pregnancy and the babies of teen mothers have been a focus of attention and concern for many years. The literature on the health of pregnant and parenting teens, however, is largely silent about the impact of stigma on them and their children. Stigma is a pervasive cultural attitude, which leads us to overlook potentially good outcomes for this vulnerable population and contributes to poor outcomes for these mothers and babies. Stigma is a cause of stress leading to well-known adverse effects on health and development for both mothers and babies. This article reviews manifestations of social stigma in our communities, in the offices of professionals, and in policies that embed bias in our social systems. The impact of inequity has been vividly revealed over the course of the global pandemic. We review findings related to interventions associated with better outcomes and offer suggestions for more humane care and policies.
COVID-19 Vaccine Knowledge, Attitudes, and Practices in Alabama: The Case for Primary Health Care Providers
Authors: Bassler John R. , Redden David T. , Hall Allyson G. , Ford Eric T. , Chrapah Sandra , Erwin Paul C. 
Published: August 2022

Objective:
To examine knowledge, attitudes, and practices about COVID-19 in Alabama, with a primary focus on vaccination perception and utilization.

Design:
We used a COVID-19 Knowledge, Attitudes, and Practices survey and recruited adult Alabama residents in April-May 2021.

Participants:
Initial surveys from 1324 Alabamian participants were considered for analysis; after careful review of incomplete responses, 953 were ultimately included for analysis.

Main Outcome Measure:
Vaccine behavior and hesitancy comprise a self-reported response contained in the survey instrument. Three primary vaccine groups were used to assess differences in demographic characteristics, health status, perception of susceptibility and severity of COVID-19, sources of information, and trust about COVID-19.

Results:
Of the 953 survey participants included for analysis, 951 had self-identified vaccine status in which 153 (16.1%) reported to have received the vaccine at the time of the survey, 375 (39.4%) were very likely or somewhat likely to get an approved COVID-19 vaccine if it was offered, and 423 (44.5%) were somewhat unlikely or very unlikely to get an approved COVID-19 vaccine. Health care providers were the most trusted sources of information, regardless of vaccine status. For participants unlikely to receive a vaccine, social media and local news sources were consistently more trusted and utilized than those who were vaccinated or were likely to be.

Conclusions:
The perceptions among unvaccinated participants are actionable and provide teachable opportunities to decrease vaccine apprehension.
Risks of Severe COVID-19 Outcomes Among Patients With Diabetic Polyneuropathy in the United States
Authors: Tuan Wen-Jan , Lennon Robert P. , Zhang Alice , Macherla Ajay , Zgierska Aleksandra E. 
Published: August 2022

Context:
Diabetic neuropathy (DN) affects more than 50% of diabetic patients who are also likely to have compromised immune system and respiratory function, both of which can make them susceptible to the SARS-CoV-2 virus.

Objective:
To assess the risk of severe COVID-19 illness among adults with DN, compared with those with no DN and those with no diabetes.

Setting:
The analysis utilized electronic health records from 55 US health care organizations in the TriNetX research database.

Design:
A retrospective cohort study.

Participants:
The analysis included 882 650 adults diagnosed with COVID-19 in January 2020 to June 2021, including 16 641 with DN, 81 329 with diabetes with no neuropathy, and 784 680 with no diabetes.

Outcome Measures:
The presence of health care utilization (admissions to emergency department, hospital, intensive care unit), 30-day mortality, clinical presentation (cough, fever, hypoxemia, dyspnea, or acute respiratory distress syndrome), and diagnostic test results after being infected affected by COVID-19.

Results:
The DN cohort was 1.19 to 2.47 times more likely than the non-DN cohorts to utilize care resources, receive critical care, and have higher 30-day mortality rates. Patients with DN also showed increased risk (1.13-2.18 times) of severe symptoms, such as hypoxemia, dyspnea, and acute respiratory distress syndrome.

Conclusions:
Patients with DN had a significantly greater risk of developing severe COVID-19–related complications than those with no DN. It is critical for the public health community to continue preventive measures, such as social distancing, wearing masks, and vaccination, to reduce infection rates, particularly in higher risk groups, such as those with DN.