bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multicenter Comparison of Open Versus Arthroscopic Fixation for Pediatric Tibial Spine Fractures
Authors: Shimberg Jilan L. , Leska Tomasina M. , Cruz Aristides I. , Patel Neeraj M. , Ellis Henry B. , Ganley Theodore J. , Johnson Ben , Milbrandt Todd A. , Yen Yi-Meng ,   Tibial Spine Research Interest Group, Mistovich R. Justin 
Published: January 2022

Background:
When operative treatment is indicated, tibial spine fractures can be successfully managed with open or arthroscopic reduction and internal fixation (ARIF). The purpose of the study is to evaluate short-term treatment outcomes of tibial spine fractures in patients treated with both open and arthroscopic fracture reduction.

Methods:
We performed an Institutional Review Board (IRB)-approved retrospective cohort study of pediatric tibial spine fractures presenting between January 1, 2000 and January 31, 2019 at 10 institutions. Patients were categorized into 2 cohorts based on treatment: ARIF and open reduction and internal fixation (ORIF). Short-term surgical outcomes, the incidence of concomitant injuries, and surgeon demographics were compared between groups.

Results:
There were 477 patients with tibial spine fractures who met inclusion criteria, 420 of whom (88.1%) were treated with ARIF, while 57 (11.9%) were treated with ORIF. Average follow-up was 1.12 years. Patients treated with ARIF were more likely to have an identified concomitant injury (41.4%) compared with those treated with ORIF (24.6%, P=0.021). Most concomitant injuries (74.5%) were treated with intervention. The most common treatment complications included arthrofibrosis (6.9% in ARIF patients, 7.0% in ORIF patients, P=1.00) and subsequent anterior cruciate ligament injury (2.1% in ARIF patients and 3.5% in ORIF, P=0.86). The rate of short-term complications, return to the operating room, and failure to return to full range of motion were similar between treatment groups. Twenty surgeons with sports subspecialty training completed 85.0% of ARIF cases; the remaining 15.0% were performed by 12 surgeons without additional sports training. The majority (56.1%) of ORIF cases were completed by 14 surgeons without sports subspecialty training.

Conclusion:
This study demonstrated no difference in outcomes or nonunion following ARIF or ORIF, with a significantly higher rate of concomitant injuries identified in patients treated with ARIF. The majority of identified concomitant injuries were treated with surgical intervention. Extensive surgical evaluation or pretreatment magnetic resonance imaging should be considered in the workup of tibial spine fractures to increase concomitant injury identification.

Level of Evidence:
Level III.
Impacts of the Affordable Care Act’s Medicaid Expansion on Live Births
Authors: Gartner Danielle R. , Kaestner Robert , Margerison Claire E. 
Published: January 2022

Background:
We hypothesize that the Affordable Care Act’s (ACA) Medicaid expansion, which extended health insurance coverage to preconception, between-conception, and postconception periods for women meeting income eligibility guidelines, impacted the number of live births in the United States by increasing access to contraception and financial well-being. These impacts may differ by maternal socioeconomic and demographic characteristics.

Methods:
Using data from birth certificates aggregated to the state–year level and a difference-in-differences design, we estimated the association between Medicaid expansion and count of live births. We also examined whether associations differed by socioeconomic and demographic characteristics.

Results:
Overall, Medicaid expansion was not meaningfully associated with the count of births (difference-in-differences ß = 0.002; 95% confidence interval [CI] = –0.010, 0.015). However, among certain groups, Medicaid expansion was associated with meaningful changes in the count of live births, though all confidence intervals included the null value. The estimate of the relation between Medicaid expansion and the count of live births was –0.025 (95% CI = –0.052, 0.001) for those ages 18–24 years; –0.078 (95% CI = –0.231, 0.075) for those who were married, and –0.035 (95% CI = –0.104, 0.034) for those who were unmarried.

Conclusions:
Despite its potential to impact live births, our results indicate that the ACA’s Medicaid expansion was not, in general, associated with live births of US residents of reproductive age. However, for younger, married, and unmarried women, the magnitude of estimates supports the hypothesis of a potentially meaningful effect of Medicaid expansions on live births.
Cardiotoxicity of Chemotherapeutic Drugs: An Update and Future Perspectives
Authors: Bannister Clare , Cannata Antonio , Bromage Daniel I. , McDonagh Theresa 
Published: January 2022

Abstract:
Rapid advancements in oncological treatments over the past few decades have led to a significant improvement in cancer outcomes. Chemotherapeutic agents play a pivotal role in cancer treatment, with almost one-third of patients receiving them during their cancer treatment in the United Kingdom. The success of chemotherapeutic drugs has, however, resulted in an increasing incidence of cardiovascular side effects and complications. The most common cardiac manifestation is the development of cardiotoxicity, defined as the development of left ventricular systolic dysfunction, after treatment. This article provides an up-to-date review of the commonly used chemotherapeutic agents that cause cardiotoxicity and discusses current treatment options and evidence gaps.
ASSOCIATION OF PREDIABETES WITH RETINAL MICROVASCULATURE ON SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN THE ELDERLY
Authors: Wang You , Toyama Taku , Hashimoto Yohei , Kawai Hisashi , Azuma Kunihiro , Shiraya Tomoyasu , Kato Satoshi , Watanabe Yutaka , Hirano Hirohiko , Fujiwara Yoshinori , Ihara Kazushige , Kim Hunkyung , Numaga Jiro , Obuchi Shuichi , Ueta Takashi 
Published: January 2022

Purpose:
To investigate the retinal microvasculature in the elderly persons with prediabetes mellitus (preDM) and type 2 DM.

Methods:
This cross-sectional study included a total of 452 eyes without retinal pathologies of 301 elderly volunteers aged ≥65 years, and they were categorized into nonDM (225 eyes), preDM (177 eyes), and DM (50 eyes) groups based on their HbA1c. Fundus photography, swept-source optical coherence tomography and angiography, and comprehensive systemic examinations were conducted. Vessel density (VD) and foveal avascular zone in superficial and deep retinal microvasculature were investigated for their association with DM stages using linear mixed model.

Results:
Superficial VD (sVD) mean values in nonDM, preDM, and DM groups were 35.2%, 34.9%, and 34.8%, respectively. sVD in preDM was equivalent to sVD in DM, whereas significantly lower compared with sVD in nonDM (difference [95% CI] −0.19 [−0.33 to −0.049], P = 0.009). Deep VD (dVD) mean values in nonDM, preDM, and DM groups were 35.0%, 35.0%, and 34.4%, respectively. dVD in preDM was equivalent to dVD in nonDM, whereas significantly higher compared with dVD in DM (difference [95% CI] 0.31 [0.046–0.57], P = 0.02). There was no significant association between foveal avascular zone area and DM stages.

Conclusion:
Retinal microvasculature may be affected at the prediabetic stage in the elderly.
Antimicrobial Stewardship at Birth in Preterm Infants
Authors: Stritzke Amelie , Tierney Anne , Keister Faith , Srivastava Ankur , Dersch-Mills Deonne , Hamilton Claire , Lodha Abhay , Abou Mehrem Ayman 
Published: January 2022

Background:
Early-onset sepsis results in increased morbidity and mortality in preterm infants. Antimicrobial Stewardship Programs (ASPs) address the need to balance adverse effects of antibiotic exposure with the need for empiric treatment for infants at the highest risk for early-onset sepsis.

Methods:
All preterm infants <34 weeks gestational age born during a 6-month period before (January 2017–June 2017) and a 6-month period after (January 2019–June 2019) implementation of ASP in May 2018 were reviewed. The presence of perinatal sepsis risk factors, eligibility for, versus treatment with initial empiric antibiotics was compared.

Results:
Our cohort comprised 479 infants with a mean of 30 weeks gestation and birth weight of 1400 g. Demographics were comparable, with more Cesarean section deliveries in the post-ASP cohort. Any sepsis risk factor was present in 73.6% versus 68.4% in the pre- versus post-ASP cohorts (P = 0.23). Fewer infants were treated with antibiotics in the later cohort (60.4%) compared with the earlier cohort (69.7%; P = 0.04). Despite the presence of risk factors (preterm labor in 93% and rupture of membranes in 60%), 42% of infants did not receive initial antibiotics. Twenty percent with no perinatal sepsis risk factors were deemed low-risk and not treated.

Conclusions:
Implementation of a neonatal ASP decreased antibiotic initiation at birth. Antibiotic use decreased (appropriately) in the subgroup with no perinatal sepsis risk factors. Of concern, some infants were not treated despite risk factors, such as preterm labor/rupture of membrane. Neonatal ASP teams need to be aware of potentially unintended consequences of their initiatives.
Evaluating a Cluster and the Overall Trend of Invasive Haemophilus influenzae Serotype b in Alaska 2005–2019
Authors: Nolen Leisha D. , Topaz Nadav , Miernyk Karen , Bressler Sara , Massay Stephanie C. , Geist Mary , Zulz Tammy , Singleton Rosalyn 
Published: January 2022

Background:
In 2019, 5 cases of invasive Haemophilus influenzae serotype b (Hib) occurred in the Anchorage region of Alaska over a period of 16 days. No cases had occurred in Alaska in the preceding 26 months.

Methods:
Alaska Hib isolates from 2005 through 2019 were analyzed using whole-genome sequencing (WGS). Rates were compared with the CDC’s Active Bacterial Core surveillance (ABCs) data.

Results:
A total of 33 cases of invasive Hib occurred in Alaska from 2005 through 2019. Of the 5 cases associated with the cluster, 2 (40%) occurred in adults and all occurred in the Anchorage region. In contrast, only 14% (4/28) of the noncluster cases occurred in this region (P < 0.01). Two cluster cases were linked epidemiologically and the bacteria were nearly identical. The other 3 cluster cases were caused by 3 genetically distinct bacteria. When the full period was evaluated, the unadjusted rate of invasive Hib disease in Alaska was 15.5 times higher in Alaska Native (AN) people than non-AN people [1.3/100,000 vs. 0.07/100,000, 95% confidence intervals (CI): 10.2–22.5). The age-adjusted rate of invasive Hib disease in Alaska was 9.4 times higher than the ABCs rate (95% CI: 6.3–14.1).

Conclusions:
While clustered in time and space, the 5 cases in 2019 were not due to a single bacterial strain. AN people continue to have elevated rates of invasive Hib infection compared with both non-AN people in Alaska and the ABCs population.
Distinct Effects of Antidepressants in Association With Mood Stabilizers and/or Antipsychotics in Unipolar and Bipolar Depression
Authors: Moderie Christophe , Nuñez Nicolas , Comai Stefano , Saint-Laurent Marie , Fielding Allan , Low Nancy , Gobbi Gabriella 
Published: January 2022

Abstract

Purpose/Background
There is a dearth of studies comparing the clinical outcomes of patients with treatment-resistant unipolar (TRD) depression and depression in bipolar disorder (BD) despite similar treatment strategies. We aimed to evaluate the effects of the pharmacological combinations (antidepressants [AD], mood stabilizers [MS], and/or antipsychotics [AP]) used for TRD and BD at the McGill University Health Center.

Methods/Procedures
We reviewed health records of 206 patients (76 TRD 130 BD) with TRD and BD treated with similar augmentation strategies including AD with MS (AD+MS) or AP (AD+AP) or combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-time Hamilton Depression Rating Scale (HAMD-17), Quick Inventory of Depressive Symptomatology, and Clinical Global Impression-Severity of Illness at the beginning (T0) and after 3 months of an unchanged treatment (T3).

Findings/Results
Baseline HAMD-17 scores in TRD were higher than in BD (P < 0.001), but TRD patients had a greater improvement at end point (P = 0.003). Antidepressants with AP generated greater reductions in HAMD-17 in TRD compared with BD (P = 0.02). Importantly, in BD patients, the addition of AD compared with other treatment strategies failed to improve the outcome. The limitations of this study include possibly unrepresentative subjects from tertiary care settings, incomplete matching of BD and TRD subjects, nonrandomized treatment with unmatched agents, doses, and times, unknown treatment adherence, and nonblinded retrospective outcome assessments. Nevertheless, the findings may reflect real-world interactions of clinically selected pharmacotherapies.

Implications/Conclusions
Combination of augmentation strategies such as AD+AP and/or MS showed a better clinical improvement in patients with TRD compared with BD suggesting a limited evidence for AD potentiation in BD.
Mitigating COVID-19 Vaccine Waste Through a Multidisciplinary Inpatient Vaccination Initiative
Authors: Baumann Natalie , Chen Sara , McDonald Jay R. , Davis Matifadza Hlatshwayo , Petroff Courtney , McKelvy Patricia 
Published: January 2022

ABSTRACT
A multidisciplinary team at a tertiary care Veterans Health Administration medical center created a standardized process to identify medically stable inpatients, to notify inpatient staff of available COVID-19 vaccine doses, and to coordinate inpatient vaccine administration. The team's goals were to mitigate vaccine waste while safely vaccinating as many patients as possible. Using a unique set of exclusion criteria and clinical judgment, a quality improvement team reviewed patients admitted to medicine teams to determine medical stability. Eligible, interested patients were listed in a secure shared file, and outpatient vaccine clinic staff communicated with inpatient nurse leaders regarding the availability of unadministered doses. Doses were transported to the hospital from the clinic and administered by inpatient nurses. Between January 8 and April 26, 2021, 105 patients were vaccinated with either the Moderna or the Pfizer-BioNTech COVID-19 vaccine during admission. Sixty-nine percent of the patients received a first dose, 27% received a second dose, and 4% received both doses. Forty-two percent of the patients vaccinated while inpatient identified as Black or African American compared with 28% of the vaccinated outpatients. No vaccine-related safety events were reported. This process demonstrates a viable approach to mitigating waste of COVID-19 vaccines and safely, efficiently, and equitably vaccinating an inpatient population.
Translational control by heme-regulated elF2α kinase during erythropoiesis
Authors: Chen Jane-Jane , Zhang Shuping 
Published: January 2022

Purpose of review
HRI is the heme-regulated elF2α kinase that phosphorylates the α-subunit of elF2. Although the role of HRI in inhibiting globin synthesis in erythroid cells is well established, broader roles of HRI in translation have been uncovered recently. This review is to summarize the new discoveries of HRI in stress erythropoiesis and in fetal γ-globin expression.

Recent findings
HRI and activating transcription factor 4 (ATF4) mRNAs are highly expressed in early erythroblasts. Inhibition of protein synthesis by HRI-phosphorylated elF2α (elF2αP) is necessary to maintain protein homeostasis in both the cytoplasm and mitochondria. In addition, HRI-elF2αP specifically enhances translation of ATF4 mRNA leading to the repression of mechanistic target of rapamycin complex 1 (mTORC1) signaling. ATF4-target genes are most highly activated during iron deficiency to maintain mitochondrial function, redox homeostasis, and to enable erythroid differentiation. HRI is therefore a master translation regulator of erythropoiesis sensing intracellular heme concentrations and oxidative stress for effective erythropoiesis. Intriguingly, HRI-elF2αP-ATF4 signaling also inhibits fetal hemoglobin production in human erythroid cells.

Summary
The primary function of HRI is to maintain protein homeostasis accompanied by the induction of ATF4 to mitigate stress. Role of HRI-ATF4 in γ-globin expression raises the potential of HRI as a therapeutic target for hemoglobinopathy.
Experiences and Needs of Caregivers of Adult Patients With Hematologic Malignancies During Treatment
Authors: Husted Nielsen Iben , Piil Karin , Grønbæk Kirsten , Kjeldsen Lars , Jarden Mary 
Published: January 2022

Background
Family caregivers play a vital role in providing care and support for patients with life-threatening hematologic diseases. Extensive patient care needs and long-term treatment trajectories can negatively affect the health of caregivers. Despite the importance of supporting caregivers, few studies examine family caregivers’ experiences and support needs during treatment.

Objective
To explore the role, experiences, and needs of family caregivers of patients with hematologic malignancies during treatment.

Methods
An exploratory longitudinal qualitative study using serial semistructured interviews with caregivers of hematologic patients was carried out. Data were analyzed using thematic analysis.

Results
A sample of 16 caregivers completed 47 interviews. Three themes and 2 subthemes were identified: (1) committing to an unconditional mission while adjusting to a changeable situation: developing resilience over time; (2) being an invisible and inseparable sufferer: cultivating hope one day at a time; and (3) balancing between sacrificing one’s own needs and self-care.

Conclusions
During treatment, caregivers face long-term psychological and physical distress, social isolation, and loneliness due to the extended life-threatening situation imposing shifting challenges and needs. Future research should explore the concept of social support in caregiver resilience and investigate psychosocial interventions in hematologic caregivers.

Implications for Practice
Healthcare professionals should address caregiver needs throughout the patient’s treatment and provide new supportive initiatives to lessen the burden of care in hematologic caregivers. Facilitating peer support and deploying a family-oriented approach considering the patient-caregiver dyad as a subject for care have implications for clinical nursing practice.
Risk Factors for Ankle Fractures in Asian Adolescents Seen in a Pediatric Emergency Department
Authors: Cher Wenqi , Quek Samuel Enci , Badron Junaidah , Feng Jasmine , Ong Gene Yong-Kwang , Lee Khai Pin , Chong Shu-Ling 
Published: January 2022

Objectives
Pediatric ankle injuries remain one of the most common presenting complaints to the pediatric emergency department (PED). In this study, we aimed to describe risk factors associated with simple ankle fractures and ankle fractures that require surgery, among adolescents presenting to the PED with ankle injuries.

Methods
We analyzed a retrospective cohort study of adolescents 12 to 16 years old who presented to our PED with an acute ankle injury and received an ankle radiograph from November 1, 2016, to October 31, 2017. Demographic, anthropometric variables, physical examination findings including those of the Ottawa Ankle Rules were obtained. We recorded any surgical interventions required, as well as follow-up and to return to physical activity.

Results
Five hundred fifty-six cases of adolescent ankle injuries were reviewed, of which 109 adolescents had ankle fractures, whereas 19 had ankle fractures requiring surgery. Sports-related injuries remained the most common cause of ankle fractures. Age (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.56–0.83; P < 0.001), male sex (aOR, 2.12; 95% CI, 1.34–3.35; P < 0.001), clinical findings of tenderness over the lateral malleolus (aOR, 3.13; 95% CI, 1.74–5.64; P < 0.001) or medial malleolus (aOR, 3.55; 95% CI, 2.18–5.78; P < 0.001), and inability to walk (aOR, 3.09; 95% CI, 1.95–4.91; P < 0.001) were significant independent risk factors for ankle fractures.
Patients with a weight more than 90th centile for age were at greater risk of ankle fractures requiring surgery (aOR, 2.64; 95% CI, 1.05–6.64; P = 0.04).

Conclusions
We found that younger age, male sex, and clinical findings in the Ottawa Ankle Rules correlated well with predicting ankle fractures and are well suited for application in the Southeast Asian population. Weight greater than the 90th percentile for age was a significant risk factor for ankle fractures requiring surgery.
Reducing Phlebotomy, Length of Stay, Cost
Authors: Rinnan Jean Marie A. , Latreille Jacob , Nanassy Autumn D. , Gaughan John , Lindholm Erika B. , Grewal Harsh , Kassutto Zach , Arthur L. Grier 
Published: January 2022

Objectives
Blunt abdominal trauma (BAT) is a leading cause of morbidity in children with higher hemodynamic stabilities when compared with adults. Pediatric patients with BAT can often be managed without surgical interventions; however, laboratory testing is often recommended. Yet, laboratory testing can be costly, and current literature has not identified appropriate pathways or specific tests necessary to detect intra-abdominal injury after BAT. Therefore, the present study evaluated a proposed laboratory testing pathway to determine if it safely reduced draws of complete blood counts, coagulation studies, urinalysis, comprehensive metabolic panels, amylase and lipase levels orders, emergency department (ED) length of stay, and cost in pediatric BAT patients.

Methods
A retrospective review of levels I, II, and III BAT pediatric patients (n = 329) was performed from 2015 to 2018 at our level I, pediatric trauma center. Patients were then grouped based on pre-post pathway, and differences were calculated using univariate analyses.

Results
After implementation of the pathway, there was a significant decrease in the number of complete blood counts, coagulation studies, urinalysis, comprehensive metabolic panels, amylase, and lipase levels orders (P < 0.05). Postpathway patients had lower average ED lengths of stay and testing costs compared with the pre pathway patients (P < 0.05). There was no increase in rates of return to the ED within 30 days, missed injuries, or readmissions of patients to the ED.

Conclusions
Results displayed that the adoption of a laboratory testing pathway for BAT patients reduced the number of laboratory tests, ED length of stay, and associated costs pediatric patients without impacting quality care.