bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Activity and the Link Among Stress, Burnout, and Well-Being in Athletic Trainers
Authors: Pacewicz Christine E. , Rowley Taylor W. , Savage Jennifer L. 
Published: July 2022

Context
Stress is a leading cause of burnout in working professionals, including athletic trainers (ATs). One consequence of burnout for ATs is lower perceptions of well-being, which have implications for mental and physical health. Physical activity is known to help reduce stress. Thus, activity may help reduce stress and burnout in ATs while enhancing well-being.

Objective
To examine a theoretically based mediating model whereby leisure time physical activity was linked to subjective well-being by way of ATs’ perceived stress and burnout.

Design
Cross-sectional study.

Setting
Online survey during the fall sports season.

Patients or Other Participants
Practicing certified ATs (N = 163; mean age = 30.5 ± 6.7 years).

Main Outcome Measure(s)
Via a secure link, participants completed a survey that measured leisure time planned physical activity, work-related stress, burnout, and perceived life satisfaction. Latent variable analysis was used to examine the hypothesized mediating model.

Results
Minutes spent in moderate or vigorous activity were not associated with stress. Minutes spent walking were negatively associated with perceived stress (β = −0.18, P &lt; .001). Stress was positively associated with exhaustion (β = 0.89, P &lt; .001), negatively associated with personal accomplishment (β = −0.70, P &lt; .001), and positively associated with depersonalization (β = 0.71, P &lt; .001). Exhaustion was negatively associated (β = −0.57, P &lt; .001) and personal accomplishment was positively associated (β = 0.31, P = .013) with well-being. Minutes spent walking were positively linked to well-being via stress and exhaustion. The negative relationship between stress and well-being was mediated by exhaustion and personal accomplishment.

Conclusions
Leisure time walking was indirectly and positively linked to well-being. Walking could be a strategy to reduce stress and burnout in ATs and thereby improve well-being.
Experiences of Current National Collegiate Athletic Association Division I Collegiate Student-Athletes With Mental Health Resources
Authors: Young Reann D. , Neil Elizabeth R. , Eberman Lindsey E. , Armstrong Tara A. , Winkelmann Zachary K. 
Published: July 2022

Context
Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality.

Objective
To explore National Collegiate Athletic Association Division I SAs’ experiences with mental health and access to and experiences with mental health resources at their university.

Design
Consensual qualitative research study.

Setting
One-on-one interviews.

Patients or Other Participants
Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years).

Main Outcome Measure(s)
Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team.

Results
Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers.

Conclusions
Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.
Demographic Factors and Instantaneous Lower Extremity Injury Occurrence in a National Collegiate Athletic Association Division I Population
Authors: Kelley Elisabeth A. , Hogg Jennifer A. , Gao Lani , Waxman Justin P. , Shultz Sandra J. 
Published: July 2022

ContextTemporal prediction of the lower extremity (LE) injury risk will benefit clinicians by allowing them to better leverage limited resources and target those athletes most at risk.ObjectiveTo characterize the instantaneous risk of LE injury by demographic factors of sex, sport, body mass index (BMI), and injury history.DesignDescriptive epidemiologic study.SettingNational Collegiate Athletic Association Division I athletic program.Patients or Other ParticipantsA total of 278 National Collegiate Athletic Association Division I varsity student-athletes (119 males, 159 females; age = 19.07 ± 1.21 years, height = 175.48 ± 11.06 cm, mass = 72.24 ± 12.87 kg).Main Outcome Measure(s)Injuries to the LE were tracked for 237 ± 235 consecutive days. Sex-stratified univariate Cox regression models were used to investigate the association between time to first LE injury and sport, BMI, and LE injury history. The instantaneous LE injury risk was defined as the injury risk at any given point in time after the baseline measurement. Relative risk ratios and Kaplan-Meier curves were generated. Variables identified in the univariate analysis were included in a multivariate Cox regression model.ResultsFemale athletes displayed similar instantaneous LE injury risk to male athletes (hazard ratio [HR] = 1.29; 95% CI= 0.91, 1.83; P = .16). Overweight athletes (BMI &gt;25 kg/m2) had similar instantaneous LE injury risk compared with athletes with a BMI of &lt;25 kg/m2 (HR = 1.23; 95% CI = 0.84, 1.82; P = .29). Athletes with previous LE injuries were not more likely to sustain subsequent LE injury than athletes with no previous injury (HR = 1.09; 95% CI = 0.76, 1.54; P = .64). Basketball (HR = 3.12; 95% CI = 1.51, 6.44; P = .002) and soccer (HR = 2.78; 95% CI = 1.46, 5.31; P = .002) athletes had a higher risk of LE injury than cross-country athletes. In the multivariate model, instantaneous LE injury risk was greater in female than in male athletes (HR = 1.55; 95% CI = 1.00, 2.39; P = .05), and it was greater in male athletes with a BMI of &gt;25 kg/m2 than that in all other athletes (HR = 0.44; 95% CI = 0.19, 1.00; P = .05), but these findings were not significantly different.ConclusionsIn a collegiate athlete population, previous LE injury was not a contributor to the risk of future LE injury, whereas being female or being male with a BMI of &gt;25 kg/m2 resulted in an increased risk of LE injury. Clinicians can use these data to extrapolate the LE injury risk occurrence to specific populations.
Is Menstruation a Valid Reason to Postpone Cardiac Surgery?
Authors: Das Devishree , Hasija Suruchi , Chauhan Sandeep , Devagourou Velayoudam , Sharma Aparna K , Khan Maroof Ahmad 
Published: July 2022

ABSTRACT

Background:
Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.

Aims:
The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.

Settings and Design:
A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.

Patients and Methods:
The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.

Results:
The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).

Conclusion:
Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.
The Role of Transesophageal Echocardiography in Evaluation and Management of Hypoxia Following Lung Transplantation
Authors: Hemamalini P , Paramasivan Shanmugaperumal , Dutta Prabhat , Attawar Sandeep 
Published: July 2022

ABSTRACT
Pulmonary vein thrombosis (PVT) is a potentially fatal complication following lung transplantation (LT). The clinical presentation of PVT is nonspecific and mimics other common postoperative complications such as reperfusion injury, infection, and rejection. Transesophageal echocardiography (TEE) plays a pivotal role in detecting abnormalities of the pulmonary venous anastomosis in the perioperative period. Echocardiographic findings that warrant concern include a visible thrombus in pulmonary vein, pulmonary vein diameter <5 mm, turbulence on color Doppler, and peak systolic velocity >100 cm/s. Transplant centers should strongly consider TEE in individual patients with unexplained graft failure.
Outcomes Following the Use of Angiotensin II in Patients with Postoperative Vasoplegic Syndrome
Authors: Konkol Samuel B. , Morrisette Matthew J. , Hulse Matthew C. , Enfield Kyle B. , Mihalek Andrew D. 
Published: July 2022

ABSTRACT
Catecholamine-resistant postoperative vasoplegic syndrome (PVS) lacks effective treatment modalities. Synthetic angiotensin II was recently approved for the treatment of vasodilatory shock; however, its use in PVS is not well described. We report outcomes in six patients receiving angiotensin II for the treatment of isolated PVS. All patients achieved their MAP goal and the majority showed improvement in lactate and background catecholamine dose; however, variables of perfusion changed discordantly. Three of six patients survived to hospital discharge.
Computed tomography in secondary spontaneous pneumothorax
Authors: Singh Shankhneel , Bhalla Ashu S. , Naranje Priyanka , Mohan Anant 
Published: July 2022

Objectives:
To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP)

Methods:
Computed tomography (CT) chest of 37 patients (between October 2011 and January 2020) was evaluated by two radiologists. They were classified into ‘Infectious’ and ‘Non-infectious’ groups, based on cause of pneumothorax. A scoring system (score 0–10) was proposed based on parameters which were statistically significant

Results:
Out of 37 patients with pneumothorax, 18 could be attributed to infectious aetiology and remaining 19 were due to noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was chronic obstructive airway disease (COAD). Statistically significant difference was found for lesion wall thickness and presence of solid component between these two groups. No significant difference was found between both groups when comparing age, gender, lesion size and lesion distribution. The presence of pleural thickening, consolidation and mediastinal lymphadenopathy were statistically significant. Pleural effusion was never present in the noninfectious group. The area under receiver operating characteristic for differentiating patients in the two groups was 0.931 (standard error, 0.038; 95% CI, 0.856–1.000), and optimal threshold score for identifying patients with infectious causes was 4.5, with 77.8% sensitivity and 89.5% specificity

Conclusion:
Pneumothorax is almost equally common due to infectious and noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was COAD. Based on certain CT findings, we have proposed a scoring system to differentiate between these two groups.
A brief report on the mutational landscape in non-small cell lung cancer of South Asian patients
Authors: Roy Mohana , Bal Amanjit , Gupta Nalini , Prasad Kuruswamy T. , Wakelee Heather A. , Singh Navneet 
Published: July 2022

Background:
Various molecular underpinnings of lung cancer have been noted in Asian populations, especially with targetable oncogenic drivers such as EGFR mutations and ALK rearrangements, although they have been lesser described in South Asian/Indian patients

Methods:
Tumour molecular testing results from non-small cell lung cancer (NSCLC) patients with a name of South Asian origin and diagnosed from 2005 to 2019 at the Stanford Cancer Center in the United States were retrospectively reviewed and compared to the results of molecular testing from PGIMER in Chandigarh, India, from the patients diagnosed from 2011 to 2019

Results:
We identified 72 patients of South Asian (largely Indian) origin, of whom 64 patients (51% female) had mutational testing at Stanford. Of the tested patients, 33% of cases harboured either an EGFR exon 19 deletion or exon 21 L858R mutation, and 12.5% had ALK rearrangements. At PGIMER, a larger sample of 1,264 patients was identified (33% female), with 22.5% of patients having two main EGFR activating mutations, and 9.5% harbouring an ALK rearrangement

Conclusions:
South Asian, largely Indian, patients with NSCLC appear to have a higher chance of harbouring EGFR mutations and ALK translocation as compared to Caucasians. The percentage of South Asian patients with these molecular abnormalities was largely similar in two different geographical locations. These findings corroborate prior single-institution findings and emphasise the importance of molecular testing.
Is underuse of Inhaled Corticosteroids for Asthma in India contributing to 42% of global asthma deaths?
Authors: Salvi Sundeep , Madas Sapna , Ghorpade Deesha , Gadhave Swapnil , Barne Monica 
Published: July 2022

Background:
According to the 2019 Global Burden of Disease (GBD) report, India contributes to an estimated 12.9% of global asthma cases (34.3 million) but a disproportionate 42.3% of all global asthma deaths. Also, asthma causes 4.83 million disability-adjusted life years (DALYs) annually in India, four times more than China, which ranks second.

Hypothesis:
We hypothesised that this disproportionate increase in asthma deaths and suffering in India could be due to the under-use of inhaled corticosteroids.

Methods:
Using the estimated number of asthma cases in each state and union territory in India (34.3 million) from the 2019 GBD data, we calculated the expected sales of inhaled corticosteroids (ICS) for asthmatics in India. We assumed that 10% of asthmatics have mild intermitted disease and thus need only 4 units of ICS pMDI per year. The remaining 90% should ideally use 12 units of ICS pMDI or equivalent DPI. We also assumed that 30% of ICS sales in India would be accounted for by the 38 million COPD patients. State-wise actual sales of ICS in India were obtained from IQVIA.

Results:
The total amount of ICS sales in India for asthma obtained from IQVIA was 26.4 million versus the 384.16 million expected sales, which is only 6.8% of the required estimated sales. Moreover, when we correlated state-wise actual sales of ICS in India versus asthma mortality and DALYs (per 100,000 population), we found a significant negative correlation (R = −0.56; P < 0.001 for asthma deaths and R = −0.61; P < 0.001 for asthma DALYs).

Impact and Future Direction:
Policy-makers, health care providers, public health researchers, asthma sufferers and the people at large need to take cognizance of our findings and undertake appropriate measures, such as creating awareness and ensuring availability and regular use of ICS by asthmatics in India.
Chemical changes in root canal dentin of primary teeth after endodontic irrigation
Authors: Purakkal Aparna T. , Peedikayil Faizal C. , Vardhanan Y. Shibu , Chandru T. P. , Kottayi Soni , Melethil Bazanth Yahiya 
Published: July 2022

Background:
The current root canal irrigants used in dentistry are either antibacterial or decalcifying agents or their combinations. These agents can alter the chemical structure of dentin as well as change its permeability and solubility characteristics.

Aim:
The aim of this study was to evaluate the mineral content of root canal dentin after irrigating with five different endodontic irrigation solutions Materials and Methods: Sixty primary anterior teeth were selected for the study. Cleaning and shaping was done by step-back technique and divided randomly into six groups (n = 10): BioPure™ MTAD (Group 1), QMix™ 2-in-1 solution (Group 2), 0.9% normal saline (Group 3), coconut water (Group 4), and 5.25% NaOCl (Group 5) and the uninstrumented ten teeth were grouped as Group 6. After irrigation with final irrigants, the teeth were longitudinally divided into two halves. The levels of six elements calcium, phosphorus, oxygen, carbon, arsenic, and fluoride at the coronal and middle third in each specimen was assessed using scanning electron microscopy and energy-dispersive X-ray analysis. Statistical analysis was done by SPSS version 20 using one-way analysis of variance, and the comparison of means was conducted using post hoc Tukey test.

Results:
There was a statistically significant reduction in the calcium level at the coronal third of radicular dentin after irrigating with five different irrigants when compared with the uninstrumented teeth group. The phosphate level at the coronal third of the radicular dentin significantly increased in all the groups except for the saline group. The other elements such as oxygen, fluoride, and arsenic also showed significant differences in the coronal and middle levels after the irrigation.

Conclusion:
The endodontic irrigation by various irrigants changed the mineral levels in primary tooth dentin
Comparative analysis of staining efficacy of Leishman's stain with hematoxylin and eosin stain in the assessment of keratin pearl formation and mitotic figures in different grades of oral squamous cell carcinoma
Authors: Srilatha Tumpuri , Singh Jaya , Raja Dinesh , Jain Trupti , Chandra Akhilesh , Agrawal Rahul 
Published: July 2022

Background:
Keratin is an intermediate protein that structures the cytoskeleton of all epithelial cells. Keratin pearl is present in various pathological conditions such as oral squamous cell carcinoma (OSCC). Mitotic figures can be used as a valuable tool in assessing cellular proliferation and act as a prognostic indicator in dysplasia and malignancy of the oral cavity.

Aim:
The aim of this study was to compare the efficacy of Leishman's stain with hematoxylin and eosin (H and E) stain in assessing keratin pearls and mitotic figures.

Materials and Methods:
In total, 30 diagnosed cases of OSCC of three different histological grades were taken. In each case, two sections of 4–5-micron thickness were made and stained with routine H and E stain and Leishman's stain. Staining intensity and specificity results were analyzed statistically using the Chi-square test and P = 0.05 was considered to be statistically significant.

Results:
Both stains can distinguish three different types of OSCC histologically. Leishman's stain demonstrated staining intensity (P = 0.087) and specificity (P = 0.017) comparable to that of routine H and E.

Conclusion:
Leishman's stain distinctly stained the keratin pearl and mitotic figures with a higher intensity. However, H and E showed a higher specificity.
Modelling Insecticide Resistance of Malaria Vector Populations in Tanzania
Authors: Bisanzio Donal , Ally Mohamed , Ali Abdullah S. , Kitojo Chonge , Serbantez Naomi , Kisinza William N. , Magesa Stephen , Reithinger Richard 
Published: July 2022

ABSTRACT.
Anopheline mosquito insecticide resistance is a major threat to malaria control efforts and ultimately countries’ ability to eliminate malaria. Using publicly available and published data we conducted spatial analyses to document and model the geo-spatial distribution of Anopheles gambiae s.l. insecticide resistance in Tanzania at national, regional, district and sub-district levels for the 2011 – 2017 period. We document anopheline mosquito resistance to all four major insecticide classes, with overall mosquito mortality declining from 2011 to 2016, and mean reductions of 1.6%, 0.5%, 0.4%, and 9.9% observed for organophosphates, carbamates, organochlorines and pyrethroids, respectively. An insecticide resistance map modeled for 2017 predicted that anopheline vector mortality was still above the 90% susceptibility threshold for all insecticide classes, except for pyrethroids. Using the model’s output we calculated that resistance to organophosphates, carbamates, organochlorines, and pyrethroids is expected to exist in 11.6%, 15.6%, 8.1%, and 19.5% of Tanzania’s territory, respectively, with areas in the Lake Zone and eastern Tanzania particularly affected. The methodology to predictively model available insecticide resistance data can readily be updated annually, allowing policy makers and malaria program management staff to continuously adjust their vector control approaches and plans, and determine where specific insecticides from various classes should be used to maximize intervention effectiveness.
A Survey Assessing Antimicrobial Prescribing at United Nations Relief and Works Agency Primary Health Care Centers in Jordan
Authors: Orubu Ebiowei S. F. , Albeik Shatha , Ching Carly , Hussein Rana , Mousa Ayoub , Horino Masako , Naqa Rabie , Elayyan Mohammad , Saadeh Rawan , Zaman Muhammad H. 
Published: July 2022

ABSTRACT.
Antimicrobial resistance (AMR) is a public health emergency. There is insufficient information on AMR in the context of humanitarian settings. An understanding of behavioral and institutional-level factors can strengthen antimicrobial stewardship. This study used a semistructured questionnaire to assess both knowledge, attitudes, and practices (KAP) on antimicrobial use, resistance and stewardship, and options to improving prescribing, among prescribers at the Primary Healthcare facilities of the United Nations’ Relief and Works Agency Jordan field office. Responses to the KAP questions were evaluated using the Capability, Opportunity, Motivation, Behavior (COM-B) framework and Bloom’s cutoffs. For each framework component, Bloom’s cutoffs and interpretations were as follows: ≥ 80%, “good”; 60–79%, “moderate”; and < 60%, “poor.” Fourteen options to improve prescribing were each assessed using 5-point Likert scales from very unhelpful to very helpful, aggregated by helpful and very helpful and ranked as follows: > 90%, best/most acceptable; > 80–90%, acceptable; and 70–80% as maybe acceptable/good. The questionnaire response rate was 59% (37/63) with a completion rate of 92% (34/37). Aggregate scores for real knowledge on AMR was 97%; opportunity to improve prescribing 88%; and motivation 16%—participants did not believe that there was a connection between their prescribing and AMR or that they had a key role in helping control AMR. Good options (74% aggregate score) to improving prescribing were the availability of guidelines and resistance data. There was good knowledge of AMR and good opportunities, but poor motivation for rational prescribing or behavioral change. There is a clinical need for AMR data to promote rational antibiotic prescribing.