bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Situation of the Metabolomics Techniques Used for the Metabolism Studies of New Psychoactive Substances
Authors: Manier Sascha K. , Meyer Markus R.
Published: August 2019

Purpose:

The purpose of this short overview is to summarize and discuss the English-written and PubMed-listed review articles and original studies published between January 2015 and April 2019 on the use of metabolomics techniques for investigating the metabolism of new psychoactive substances (NPS). First, a brief introduction is given on the metabolism of NPS and metabolomics techniques in general. Afterward, the selected original studies are summarized and discussed. Finally, a section dedicated to the studies on NPS beyond metabolism using metabolomics techniques is provided. Thereafter, both sections are concluded and perspectives are given.

Methods:

PubMed was searched for English-written literature published between January 1, 2015 and April 1, 2019.

Results:

The present short overview found that the current use of metabolomics techniques in investigating the metabolism of NPS is rather limited, but these techniques can support and facilitate traditional metabolism studies.

Conclusions:

Thus, there may be a certain potential for using metabolomics techniques in the field of NPS research, but a great challenge remains to thoroughly adopt the existing metabolomics methods.
DIAGNOSTIC CHALLENGES IN NECROTIC UVEAL MELANOMA
Authors: Peddada Krishi , Dalvin Lauren A. , Mashayekhi Arman , Shields Carol L.
Published: August 2019

Purpose:

To describe a case of ciliochoroidal melanoma with massive spontaneous hemorrhagic retinal and choroidal detachment that presented a diagnostic challenge because of poor fundus visualization and atypical imaging features.

Methods:

Case report.

Results:

A 71-year-old white man on apixaban for atrial fibrillation presented with sudden onset of pain and vision loss in the left eye. The patient was found to have total hemorrhagic retinal detachment and was referred for our opinion. On examination, visual acuity was 20/25 in the right eye and light perception in the left eye. Intraocular pressures were 10 mmHg in the right eye and 21 mmHg in the left eye. The unaffected right eye demonstrated only macular retinal pigment epithelial alterations. Evaluation of the left eye revealed dilated episcleral sentinel vessels superonasally, shallow anterior chamber, and total hemorrhagic retinal and choroidal detachment to the back of the crystalline lens. There was no view of the choroid. Transillumination demonstrated diffuse blockage of light from blood and no specific shadow. B-scan ultrasonography revealed total retinal and choroidal detachment with dense echoes of blood under the retina and in the suprachoroidal space with elevation of 12 mm and no definite mass or spontaneous vascular pulsations. Magnetic resonance imaging revealed diffuse high signals within the globe on T1-weighted images with no specific mass. On gadolinium enhancement, a localized enhancing area temporally of 12-mm thickness and a localized nonenhanced area nasally of 11-mm thickness was noted. Both areas showed low signal on T2-weighted images. Despite atypical features, suspicion for underlying ciliochoroidal melanoma and poor visual prognosis lead to enucleation. Histopathology confirmed an extensively necrotic, mushroom-shaped ciliochoroidal melanoma with total hemorrhagic retinal and choroidal detachment.

Conclusion:

Diagnosis of necrotic posterior uveal melanoma can be challenging, because these tumors can be camouflaged by overlying hemorrhagic retinal and choroidal detachment and can present with atypical features on ultrasonography and magnetic resonance imaging. Patients with spontaneous hemorrhagic retinal and choroidal detachment should be evaluated for possible underlying malignancy.
PARACENTRAL ACUTE MIDDLE MACULOPATHY FOLLOWING ORAL INTAKE OF SUMATRIPTAN
Authors: Zonnevylle Kirsten E. , Jacob Julie , Luyten Steven , Stanescu-Segall Dinu
Published: August 2019

Purpose:

The purpose of this report was to describe a case with paracentral acute middle maculopathy after oral intake of sumatriptan.

Methods:

Case presentation.

Results:

One patient showed typical findings on fundoscopic examination and optical coherence tomography consistent with paracentral acute middle maculopathy following oral intake of sumatriptan.

Conclusion:

Sumatriptan may be a trigger for paracentral acute middle maculopathy.
Promoting treatment for hepatitis C in people who inject drugs: A review of the barriers and opportunities
Authors: Pedlar Annie , Sandhu Prabjot (Jodie)
Published: August 2019

Background:

People who inject drugs (PWIDs) comprise a significant amount of the population who are also positive for hepatitis C virus (HCV) around the world. Even though there is evidence that patients who currently inject drugs do not display altered treatment adherence or medication effectiveness, health care providers are still hesitant to treat this patient population based on perceived threats and barriers.

Objectives:

This literature review informs of the perceived barriers associated with PWID in receiving HCV treatment and supports recommendations to address these barriers.

Data sources:

For this review, eight scholarly articles rated levels I A through II B using John Hopkins Evidence-Based Practicing ratings consisting of randomized controlled trials, systematic reviews, and meta-analyses were selected. Both qualitative and quantitative data contributed to identifying perceived barriers and suggested course of action that should be taken to increase HCV treatment uptake among PWID.

Conclusions:

The three main perceived barriers are evidence of barriers to treatment in the PWID populations and include increased risk of reinfection, low adherence to treatment, and decreased response to treatment. Removal of these barriers by increasing education about HCV disease and treatment options to both patients and health care workers and changing current policy in health care settings to provide enhanced access to HCV treatment for PWID can promote an opportunity for successful treatment of these patients.

Implications for practice:

There is a significant need for HCV treatment among PWID. Opportunities for successful treatment exist and should be adopted.
Burkitt lymphoma presenting with fever of unknown origin and isolated hypoglossal nerve palsy
Authors: Seneca Kathleen H. , Nahass Ronald G. , Adler Rachel H.
Published: August 2019

Fever of unknown origin (FUO) continues to present a clinical conundrum for even expert practitioners. The syndrome of FUO has over 200 possible etiologies. Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma with only 1,200 US adult cases reported annually. Fever, night sweats, and weight loss, otherwise known as B symptoms, are common early symptoms of BL. Nerve palsy, especially isolated hypoglossal nerve palsy (IHNP), is rarely seen as a presenting sign in any pathological condition. A case report of FUO and IHNP as the presenting manifestations of BL is presented. The rarity of IHNP and its clinical features delayed the recognition of this syndrome and emphasizes the value of a thorough understanding of the physical examination and the association of unusual clinical findings with a readily identifiable clinical syndrome.
Breast cancer risk assessment: Evaluation of screening tools for genetics referral
Authors: Himes Deborah O. , Zaro Maren L. , Williams Mary , Freeborn Donna , Eggett Dennis L. , Kinney Anita Y.
Published: August 2019

Background and purpose:

The United States Preventative Services Task Force (USPSTF) recommends breast cancer risk-screening tools to help primary care providers determine which unaffected patients to refer to genetic specialists. The USPSTF does not recommend one tool above others. The purpose of this study was to compare tool performance in identifying women at risk for breast cancer.

Methods:

Pedigrees of 85 women aged 40–74 years with first-degree female relative with breast cancer were evaluated using five tools: Family History Screen-7 (FHS-7), Pedigree Assessment Tool, Manchester Scoring System, Referral Screening Tool, and Ontario Family History Assessment Tool (Ontario-FHAT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to describe each tool's ability to identify women with elevated risk as defined by Claus Model calculations (lifetime risk ≥15%). Receiver operating curves were plotted. Differences between areas under the curve were estimated and compared through logistic regression to assess for differences in tool performance.

Conclusions:

Claus calculations identified 14 of 85 women with elevated risk. Two tools, Ontario-FHAT and FHS-7, identified all women with elevated risk (sensitivity 100%). The FHS-7 tool flagged all participants (specificity 0%). The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a NPV of 100%. Area under the curve values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools.

Implications for practice:

The Ontario-FHAT outperformed other tools in sensitivity and NPV; however, low specificity and PPV must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to genetics specialists.
Avoiding missed opportunities to screen for HIV
Authors: O'Byrne Patrick , Orser Lauren
Published: August 2019

HIV transmission is ongoing, primarily among men who have sex with men, injection drug users, and persons from HIV endemic regions. One prevention strategy has been prompt HIV diagnosis. Undermining these efforts is that some persons are diagnosed with HIV late in their infection because practitioners missed the diagnosis. In this article, the authors review the epidemiology and pathophysiology of HIV/AIDS, and provide a recommended clinical approach: (1) continue to screen persons who belong to the groups that are at-risk for HIV, and (2) appropriately rule out HIV infection in persons who present with HIV and AIDS-like symptoms.
Trends in Renal Function Among Heart Transplant Recipients of Donor-Derived Hepatitis C Virus
Authors: Zalawadiya Sandip K. , Lindenfeld JoAnn , Shah Ashish , Wigger Mark , Danter Matthew , Brinkley D. Marshall , Menachem Jonathan , Punnoose Lynn , Balsara Keki , Brown Sacks Suzanne , Ooi Henry , Perri Roman , Awad Joseph , Smith Sarah , Fowler Rachel , O’Dell Heather , Darragh Callie , Ruzevich-Scholl Shelly , Schlendorf Kelly
Published: August 2019

Donor-derived hepatitis C (dd-HCV) infection may increase the risk of renal impairment (RI) among heart transplantation (HT) recipients. Sofosbuvir, an integral component of HCV direct-acting antivirals (DAAs) has also been linked to RI. To date, no study has examined the trends in renal function for HT recipients of dd-HCV infection and assessed safety and efficacy of Sofosbuvir-based DAAs. Between September 2016 and June 2018, 46 HCV-naive patients and one patient with a history of HCV treated pretransplant, underwent HT from HCV-positive donors (follow-up available through October 10, 2018). Patients were treated with Ledipasvir-Sofosbuvir (genotype 1) or Sofosbuvir-Velpatasvir (genotype 3) for 12 or 24 weeks; no dose adjustments were made for renal function. Data on renal function were available for 23 patients who achieved a sustained virologic response at 12 weeks after the treatment (SVR12; cohort A) and 18 patients who completed 1 year of follow-up (cohort B). Treatment of dd-HCV infection was initiated at a median of 6 weeks post-HT. In both cohorts, a nonsignificant reduction in median estimated glomerular filtration rate (eGFR; ml/min/1.73 m2) was noted (cohort A: pretransplant eGFR: 62 [interquartile range {IQR}: 1–84] to SVR12 eGFR: 49 [IQR: 37–82]; p = 0.43; cohort B: pretransplant eGFR: 65 [IQR: 54–84] to 1 year post-HT eGFR: 56 [IQR: 39–75]; p = 0.29). Pretreatment renal function had no significant impact on changes in renal function during treatment. All patients tolerated DAAs well with 100% completion rate to the assigned therapy and duration and 100% success at achieving SVR12. In this first and largest reported case series to date of HT recipients with dd-HCV infection, we observed that neither the dd-HCV infection nor its treatment with Sofosbuvir-based DAAs increased the risk of RI. Sofosbuvir-based DAAs appear safe, tolerable, and effective for HCV treatment even in presence of severe RI.
Long-Term Health-Related Quality of Life After Venovenous Extracorporeal Membrane Oxygenation
Authors: O’Brien Serena G. , Carton Edmund G. , Fealy Gerard M.
Published: August 2019

This study examined the long-term health-related quality of life in adult patients treated with venovenous extracorporeal membrane oxygenation (V-V ECMO) for severe acute respiratory failure in Ireland. A retrospective, cross-sectional survey was conducted to elicit self-reported quality of life in V-V ECMO survivors who were discharged from the intensive care unit for ≥6 months. Twenty-nine patients with respiratory failure were treated with V-V ECMO from 2009 to 2013. Of the 19 (66%) patients who survived to hospital discharge, 13 participated in the study. The mean age was 44 ± 11 years, and seven were male. At a median follow-up of 36 (14−39) months, study participants reported decreased indices of physical health compared with age- and sex-matched general population in Ireland while their mental health was similar to age- and sex-matched general population in Ireland. Fifty-four percent of participants had symptoms of anxiety, 15 percent had symptoms of depression, while 23 percent of participants were at risk of posttraumatic stress disorder. Sixty-seven percent of previously employed participants had returned to work. This study highlights the protracted nature of physical and psychologic recovery in patients surviving up to three years after V-V ECMO for severe acute respiratory failure.
Practical Clinical Application of an Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Distress Syndrome and Acute on Chronic Respiratory Failure
Authors: Grasselli Giacomo , Castagna Luigi , Bottino Nicola , Scaravilli Vittorio , Corcione Nadia , Guzzardella Amedeo , Bonifazi Matteo , Rossi Nicola , Zanella Alberto , Pesenti Antonio
Published: August 2019

We retrospectively reviewed the medical records of 11 patients supported with a veno-venous low-flow extracorporeal carbon dioxide (CO2) removal (ECCO2R) device featuring a large gas exchange surface membrane lung (ML) (i.e., 1.8 m2). Seven patients suffered from exacerbation of a chronic pulmonary disease, while four subjects were affected by acute respiratory distress syndrome (ARDS). Twenty-four hours of ECCO2R treatment reduced arterial PCO2 from 63 ± 12 to 54 ± 11 mm Hg (p < 0.01), increased arterial pH from 7.29 ± 0.07 to 7.39 ± 0.06 (p < 0.01), and decreased respiratory rate from 32 ± 10 to 21 ± 8 bpm (p < 0.05). Extracorporeal blood flow and CO2 removal were 333 ± 37 and 94 ± 18 ml/min, respectively. The median duration of ECCO2R treatment was 7 days (6.5–9.5). All four ARDS patients were invasively ventilated at the time of treatment start, no one was extubated and they all died. Among the seven patients with exacerbation of chronic pulmonary diseases, four were managed with noninvasive ventilation at ECCO2R institution, while three were extubated after starting the extracorporeal treatment. No one of these seven patients was intubated or re-intubated after ECCO2R institution and five (71%) survived to hospital discharge. A low-flow ECCO2R device with a large surface ML removes a relevant amount of CO2 resulting in a decreased arterial PCO2, an increased arterial pH, and in a reduced ventilatory load.
The Effect of Additional Stepwise Venous Inflow on Differential Hypoxia of Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Lee Jin Gu , Kim Namo , Narm Kyoung Shik , Suh Jee Won , Hwang Jisung , Paik Hyo Chae , Yoo Young Chul
Published: August 2019

Use of femoral-femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support during lung transplantation can be inadequate for efficient distribution of oxygenated blood into the coronary circulation. We hypothesized that creating a left-to-right shunt flow using veno-arterio-venous (VAV) ECMO would alleviate the differential hypoxia. Total 10 patients undergoing lung transplantation were enrolled in this study. An additional inflow cannula was inserted into the right internal jugular (RIJ) vein for VAV ECMO. During left one-lung ventilation using a 1.0 inspired oxygen fraction (FiO2), the left-to-right shunt flow was incrementally increased from 0 to 500, 1,000, and 1,500 ml/min. The arterial oxygen partial pressure (PaO2) and oxygen saturation (SaO2) were measured at the proximal ascending aorta and right radial artery. The ascending aorta gas analysis revealed that six patients had a PaO2/FiO2 ratio less than 200 mm Hg at a 0 ml/min shunt flow. The PaO2 (SaO2) values were 48.5 ± 14.8 mm Hg (80.9 ± 11.6%) at the ascending aorta and 77.8 ± 69.7 mm Hg (83.3 ± 13.2%) at the right radial artery. As the left-to-right shunt flow rate increased over 1,000 ml/min, the PaO2 and SaO2 values for the ascending aorta and right radial artery significantly increased. In conclusion, femoral-femoral VA ECMO can produce suboptimal coronary oxygenation in patients unable to tolerate one-lung ventilation. A left-to-right shunt using VAV ECMO can alleviate the differential hypoxia.
Management of Aortic Insufficiency Using Transcatheter Aortic Valve Replacement in Patients with Left Ventricular Assist Device Support
Authors: Kar Biswajit , Prathipati Priyanka , Jumean Marwan , Nathan Sriram S. , Gregoric Igor D.
Published: August 2019

Left ventricular assist devices (LVADs) increase survival of patients with heart failure. However, long-term LVAD usage can result in aortic insufficiency (AI), thereby compromising LVAD efficiency. Transcatheter aortic valve replacement (TAVR) is an alternative for patients with high risk for surgical valve replacement. We present three cases that developed moderate to severe AI while on HeartMate II (Abbott Laboratories, Chicago, IL) LVAD support; hence, TAVR procedure was performed. Patients A and B (74 year old and 38 year old) developed severe AI and patient C (67 year old) developed moderate AI with cardiogenic shock, after 368, 1,288, and 342 days on LVAD support, respectively. Their aortic valve annulus sizes were 24.2, 24.6, and 23.3 mm, respectively. Oversized Edwards SAPIEN 3 valves (Edwards, Lifesciences, Irvine, CA) were implanted via a transfemoral approach. The patients were hemodynamically stable after the procedure with mild AI in patient A and no AI in patients B and C. Patients were all discharged to home. Follow-up in patients A and C have resulted in long-term (> 2 years) survival and patient B died 616 days after the procedure due to unrelated complications. Transcatheter aortic valve replacement may be an alternative way to manage AI in LVAD patients. Larger studies are needed to evaluate the long-term efficacy of this approach.
Thalidomide Use Reduces Risk of Refractory Gastrointestinal Bleeding in Patients with Continuous Flow Left Ventricular Assist Devices
Authors: Namdaran Parhum , Zikos Thomas A. , Pan Jennifer Y. , Banerjee Dipanjan
Published: August 2019

Gastrointestinal (GI) bleeding is a common complication seen in patients with implanted continuous flow left ventricular assist devices (CF-LVAD), often attributed to arteriovenous malformations (AVMs). Whether thalidomide reduces recurrent GI bleeding risk in CF-LVAD patients has been incompletely evaluated. We conducted a retrospective review of all CF-LVAD patients at our institution with GI bleeding from AVMs who had a trial both off and on thalidomide. The primary endpoint was time to rebleed, while secondary endpoints included overall GI bleeding events, packed red blood cell (PRBC) transfusion requirements, and adverse events related to thalidomide. We report on 24 patients with recurrent AVM-associated GI bleeding who met criteria for and received thalidomide therapy, of which 17 had sufficient follow-up to be ultimately included for final analysis. We found the risk of rebleeding was significantly reduced in those on thalidomide therapy versus off (hazard ratio = 0.23, p = 0.022). The median number of GI bleeds per year was reduced from 4.6 to 0.4 (p = 0.0008) and the PRBC requirement was lower (36.1 vs. 0.9 units per year, p = 0.004) in those on thalidomide therapy. The adverse event rate with thalidomide was 59%, with symptoms resolution in most following dose reduction without increased bleeding. Thalidomide reduced the risk of AVM-associated GI rebleeding, number of bleeding events, and PRBC requirements in CF-LVAD patients. When initiating therapy, potential side effects and overall clinical context should be considered.
SATB2-associated syndrome: first report of a gonadal and somatic mosaicism for an intragenic copy number variation
Authors: Grelet Maude , Mortreux Jérémie , Alazard Emilie , Sigaudy Sabine , Philip Nicole , Missirian Chantal
Published: August 2019

Gonadal mosaicism has been reported in a variety of dominant or X-linked conditions and should be considered in all cases of apparent de-novo variation. Recently, some cases of supposed parental germline mosaicism have been shown to result from low-level somatic mosaicism. In most of the cases, mosaicism has been reported for pathogenic single nucleotide variants with only a few cases of copy number variation mosaicism described so far. Herein, we present the first case of parental somatic and gonadal copy number variation mosaicism in the SATB2 gene. We report three brothers presenting with the SATB2-associated syndrome. They all carry the same 121-kb heterozygous intragenic deletion of SATB2. Parental somatic mosaicism was detected by array-comparative genomic hybridization on a maternal blood sample and confirmed by Fluorescence in situ hybridization analysis on blood and buccal cells. This clinical report highlights the importance of investigating for parental somatic mosaicism to estimate the proper recurrence risk for subsequent pregnancy.
Early body weight-supported overground walking training in patients with stroke in subacute phase compared to conventional physiotherapy: a randomized controlled pilot study
Authors: Brunelli Stefano , Iosa Marco , Fusco Francesca Romana , Pirri Carmelo , Di Giunta Claudia , Foti Calogero , Traballesi Marco
Published: August 2019

Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown. The primary aim of this study was to evaluate the efficacy of a rehabilitative program that combines conventional approach with an early overground body weight-support training, in terms of recovery of independent walking focussing on patients with subacute stroke. The secondary aim was to evaluate the impact of body weight-support also on functional mobility, overall disability, and gait endurance. A total of 37 participants were enrolled and randomized to experimental group or control group for the baseline evaluations. In the experimental group, body weight-supported overground walking was added to conventional physiotherapy for 4 weeks. The outcome measurements used were: Functional Ambulation Classification (FAC), Rivermead Mobility Index, Barthel Index, and the 6-minute Walk Test. At the evaluation 1 week after the end of the intervention period, experimental group reached a statistically significant increase of independent walking as detected by FAC (experimental group: 3 vs. control group: 2, P < 0.01). No differences were observed by the other evaluation outcome measures. We conclude that BWS training may be more effective than conventional therapy alone in improving walking autonomy in persons with subacute stroke.
An instrument to measure perceptions of people with disabilities regarding the application of international vocational rehabilitation standards
Authors: Al-Rashaida Mohammad , López-Paz Juan Francisco , Amayra Imanol , Martínez Oscar , Lázaro Esther , Berrocoso Sarah , García Maitane , Pérez Manuel , Rodríguez Alicia Aurora , Luna Paula María , Pérez-Núñez Paula , Fernández Paula
Published: August 2019

This study aimed to create a valid and reliable instrument to measure people with disabilities’ perceptions regarding the extent of application of international standards issued by the Council of Europe, International Labour Organization, and the International Classification of Functioning, Disability and Health in vocational rehabilitation centers in the Basque country, Spain. The instrument items were selected from international recommendations and conventions issued by the International Labour Organization, Council of Europe, International Classification of Functioning, Disability and Health, and a vocational rehabilitation literature review. The instrument was translated from English to Spanish, and the content validity index of an expert panel survey was used to assess content validity. For the Spanish version of the instrument, internal consistency reliability, confirmatory factor analysis and factor analysis were examined with 186 people with disabilities in 10 vocational rehabilitation centers in the Basque country. The coefficient alpha estimate was 0.945, indicating excellent internal consistency. Three factors were identified: job-related services, aims of vocational rehabilitation center, and vocational rehabilitation guidance. The instrument appears to have good validity and reliability but requires further validation. Support is provided for its use in both English and Spanish. Implications for vocational rehabilitation practice and suggestions for future research are provided.
Prefrontal Cortical Activation With Open and Closed-Loop Tactile Cueing When Walking and Turning in Parkinson Disease: A Pilot Study
Authors: Stuart Samuel , Mancini Martina
Published: August 2019

Background and Purpose:

Gait and turning impairments are common in people with Parkinson disease (PwPD). Tactile cues delivered in open- or closed-loop modalities may improve gait and turning in PwPD, but underlying mechanisms are unclear. Attention stemming from the prefrontal cortex (PFC) may play a role in cue response, but PFC contributions to specific cue modalities are unclear. Examining how open- and closed-loop cueing influences PFC activity during walking and turning in PwPD may elucidate mechanisms involved in cue response, which could advance development of effective therapeutics. We examined PFC activity during walking and turning in response to open- and closed-loop cueing in PwPD, and explored relationships between PFC activity and behavioral measures.

Methods:

A mobile functional near-infrared spectroscopy device measured PFC activity during walking and turning in 25 PwPD (n = 13 freezers, n = 12 nonfreezers). Participants performed 180° and 360° turns while walking, and a 2-minute walk under single- and dual-task (AX-CPT) conditions with and without an open- (metronome-like vibration) or closed-loop (biofeedback vibration) tactile cue.

Results:

PFC activity did not change when walking or turning in PwPD; freezing status or task demands did not influence PFC activity. With both open- and closed-loop cueing dual-task cost of gait significantly improved, whereas turning slowed.

Discussion and Conclusions:

Our preliminary results indicate that both open- and closed-loop cueing can improve gait without additional burden to the PFC beyond usual walking. However, turning while walking slowed with cueing with no PFC activity change. Further investigations are necessary to establish these findings in a larger cohort.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, the Video, available at: http://links.lww.com/JNPT/A280).
Data to Care Opportunities: An Evaluation of Persons Living With HIV Reported to Be “Current to Care” Without Current HIV-Related Labs
Authors: Hart-Malloy Rachel , Shrestha Tarak , Pezzulo Molly C. , Patterson Wendy , Gunn Jayleen K. L. , Johnson Megan C. , Tesoriero James M.
Published: August 2019

Background:

Data to care (D2C) is an effective strategy using HIV surveillance data to link/relink persons living with HIV into medical care. However, some appearing to be not in care (NIC) report being in care (persons “current to care”).

Setting:

New York State's Expanded Partner Services (ExPS) D2C program has identified many persons reported as “current to care.” This evaluation describes these persons after 24 months of follow-up and identifies HIV-related laboratory-based testing patterns and results to determine whether this cohort could benefit from further programmatic intervention.

Methodology:

Data from ExPS assignments from September 2013 to May 2016 were used. Persons “current to care” were compared with persons NIC on demographics, subsequent HIV-related laboratory-based testing, and viral load suppression status. Persons “current to care” receiving subsequent HIV-related laboratory-based testing were compared with those who did not receive HIV-related labs.

Results:

Persons “current to care” significantly differed from persons NIC on demographics and subsequent HIV-related laboratory-based testing (82% of persons “current to care” had subsequent HIV-related labs, versus 99% of those NIC who were relinked to care). Persons “current to care” were more likely to be virally suppressed at their subsequent lab than persons NIC who were relinked to care (72% vs. 47%). Minor differences were noted for persons “current to care” receiving subsequent HIV-related labs compared with those who did not.

Conclusions:

Persons “current to care” reflect a unique cohort who might benefit from further programmatic intervention. Although most received additional HIV-related labs, some were without labs for the duration of follow-up.
The Partnerships for Care Project in Massachusetts: Developing Partnerships and Data Systems to Increase Linkage and Engagement in Care for Individuals Living With HIV
Authors: Lewis Sophie , Morrison Monica , Randall Liisa M. , Roosevelt Kathleen
Published: August 2019

Background:

Before implementation of the Massachusetts Partnerships for Care (MA P4C) project, Massachusetts did not routinely provide HIV partner services to newly diagnosed individuals. Identification of individuals disengaged from HIV care and assistance for re-engagement relied on community- and clinic-based HIV medical case management services. Processes to identify individuals out of HIV care used either surveillance or clinic data, but did not combine both.

Methods:

The Massachusetts Department of Public Health collaborated with 6 community health centers to implement HIV partner services and out-of-care re-engagement services. Implementation of these services required development of both health department and community health center capacity. Capacity development strategies included the following: development and implementation of operational protocols, establishment of communication strategies and processes, training and education for health department and health center staff, and enhancement of disease surveillance systems.

Results:

Development of operational protocols supported implementation of public health services and collaboration with health centers. Health department–facilitated meetings, training, and technical assistance enhanced communication with health centers and promoted buy-in for collaboration. A strategy for combining clinic and surveillance data to identify individuals out of HIV care was implemented. Surveillance data system enhancements improved efficiency of out-of-care identification, assignment of cases for public health follow-up, and provided quality improvement tools.

Conclusions:

Collaboration between health departments and community health centers to identify and support patient engagement in HIV medical care is feasible and supports improved continuity of care. Use of surveillance and clinic data to identify out-of-care patients promotes efficiency in Data to Care activities.
Short-Term Outcomes and Lessons Learned From the Federal HIV Health Improvement Affinity Group for State Medicaid/Children's Health Insurance Program Agencies and State Health Departments
Authors: Davies Cathleen , Klein Pamela W. , Okoye Ijeamaka D. , Heitgerd Janet , Shapatava Ekaterine , Ihiasota Ijeoma , Browne Michelle N. C. , Viall Abigail , Stockmann Deirdra , Hauck Heather
Published: August 2019

Background:

Medicaid is the single largest source of health care coverage for people living with HIV (PLWH) in the United States. Therefore, high-quality HIV care and associated viral suppression among Medicaid beneficiaries have the potential to greatly impact the HIV epidemic. The HIV Health Improvement Affinity Group (HHIAG) supported state efforts to improve health outcomes for PLWH enrolled in Medicaid through new or enhanced collaborations between state public health departments and state Medicaid agencies.

Methods:

Supported by multiple federal health agencies for 1 year, state health department and Medicaid staff from 19 states participated in state-to-state learning and sharing of promising approaches. This evaluation assessed the HHIAG's processes, short-term outcomes, and lessons learned through review of state materials, a web survey, and telephone interviews.

Results:

Of the 19 states, 13 (68%) ultimately established new, or refined existing, data-sharing agreements between Medicaid and public health departments. Nearly all states with data-sharing agreements successfully matched the data or streamlined the data-matching process (n = 12/13). Two-thirds of states (67%, n = 8/12) with matched data generated an HIV care continuum for state Medicaid/Children's Health Insurance Program beneficiaries; 75% (n = 6/8) of these states also initiated quality improvement activities.

Conclusions:

The HHIAG created an unique opportunity for multiple federal agencies and states to collaborate and implement data-driven, state-specific solutions to improve care delivery and, ultimately, clinical outcomes for PLWH. The HHIAG model has the potential to be replicated to address other public health issues that cross agency and institutional boundaries, such as hepatitis C.
Improving HIV Surveillance Data by Using the ATra Black Box System to Assist Regional Deduplication Activities
Authors: Ocampo Joanne Michelle F. , Hamp Auntré , Rhodes Anne , Smart J. C. , Pemmaraju Raghu , Poschman Karalee , Hess Kristen L. , Bhattacharjee Reshma , Flynn Colin , Anderson Bridget J. , Dowling James E. , Maccormack Fred , Doshi Rupali , Lum Garret , Maddox Lorene , Moncur Brenda , Barnhart John E. , Maxwell Jason , Aurand Sahithi Boggavarapu , Hogan Vicki , Wills David , Prowell Stacy , Kassaye Seble G. , Karn Helen E. , Laffoon Benjamin T. , Collmann Jeff
Published: August 2019

Background:

Focused attention on Data to Care underlines the importance of high-quality HIV surveillance data. This study identified the number of total duplicate and exact duplicate HIV case records in 9 separate Enhanced HIV/AIDS Reporting System (eHARS) databases reported by 8 jurisdictions and compared this approach to traditional Routine Interstate Duplicate Review resolution.

Methods:

This study used the ATra Black Box System and 6 eHARS variables for matching case records across jurisdictions: last name, first name, date of birth, sex assigned at birth (birth sex), social security number, and race/ethnicity, plus 4 system-calculated values (first name Soundex, last name Soundex, partial date of birth, and partial social security number).

Results:

In approximately 11 hours, this study matched 290,482 cases from 799,326 uploaded records, including 55,460 exact case pairs. Top case pair overlaps were between NYC and NYS (51%), DC and MD (10%), and FL and NYC (6%), followed closely by FL and NYS (4%), FL and NC (3%), DC and VA (3%), and MD and VA (3%). Jurisdictions estimated that they realized a combined 135 labor hours in time efficiency by using this approach compared with manual methods previously used for interstate duplication resolution.

Discussion:

This approach discovered exact matches that were not previously identified. It also decreased time spent resolving duplicated case records across jurisdictions while improving accuracy and completeness of HIV surveillance data in support of public health program policies. Future uses of this approach should consider standardized protocols for postprocessing eHARS data.
Role of Intraoperative Clean Surgical Margin Determined With Lesion Size and Duration to Obtain Apropriate Histological Clean Surgical Margin in High-Risk Basal Cell Carcinoma Patients, According to National Comprehensive Cancer Network Criteria
Authors: Kurt Ozkaya Nese , Yeldir Nese , Yilmaz Sarper
Published: August 2019

We aimed to elucidate the role of intraoperative clean surgical margin (iCSM) determined according to lesion size and duration to obtain appropriate histological clean surgical margin (hCSM) in high-risk basal cell carcinoma (BCC) patients evaluated according to National Comprehensive Cancer Network (NCCN) criteria considering the tumor size and/or location. The contribution of lesion area to determine iCSM was also evaluated. Patients with high-risk BCC requiring surgical management were included. iCSM, hCSM, and clinical variables including sec, age, longest edge, location and area, and follow-up duration were recorded. In total, 96 lesions were evaluated. Lesions were mostly located in the mask area and other face region (93.8%). Lesions located on the nose comprised 50%, 34.1%, and 26.3% in the BCC-5, BCC-7, and BCC-10 lesions, respectively. The hCSMs were positive in 11.5%, 9.1%, and 3.8% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The deep surgical margin was positive in 15.4%, 4.5%, and 7.7% of the BCC-5, BCC-7, and BCC-10 lesions, respectively. The calculated risk for the positive surgical margin if the BCC-10 lesions were done like the BCC-7 was 15.4%. No recurrence was during follow-up duration. As supported by the findings of the present study, to obtain an adequate hCSM in the high-risk BCC lesions, the iCSM determined according to NCCN recommendations may not be optimal. Nevertheless, after their categorization according to lesion size and disease duration for excision with 5-, 7-, and 10-mm iCSMs, it is possible to obtain a small but important improvement in the outcome of patients.
Enophthalmos: Exploration of Quantitative Treatment With Retro-Orbital Fat Globules Injection
Authors: Ye Lingxiao , Zhang Lu , Zhu Yijia , Zhang Yuguang , Wu Wei , Zhang Ying
Published: August 2019

Craniomaxillofacial and plastic surgeons are often confronted with patients who present with enophthalmos caused mainly by trauma. In many patients, one-stage reconstruction repairs only the bony orbit, leaving intact the disfiguring enophthalmos. Thus, some filler is needed to restore the normal volume of the orbit. The authors describe a technique to correct such deformation safely and effectively. Data were collected from 30 enophthalmic patients (average age 36.67 ± 11.66 years) who underwent retro-ocular injections of fat globules between August 2014 and July 2018. CT helped identify a safe injection site, and specific CT measurements quantified the volume of fat globules required. There was a significant difference between the preoperative and postoperative values for lateral orbital protrusion (P < .01), superior orbital protrusion (P < .01), and orbital volume (P < .01). Most patients were satisfied with the outcome. There were no significant complications. Injecting fat globules into the retro-orbital area is an effective technique for correcting enophthalmos deformity.
Comprehensive Application of Autologous Costal Cartilage Grafts in Rhino- and Mentoplasty
Authors: Zhang Lu , Ma Wen-Shu , Bai Ji-Ping , Li Xing-Xing , Li Hong-Dong , Zhu Tao , Sun Jian-Yu , Ge Hong-Gang , Pang Yun , Xue Feng , Cheng Li-Ying , Jin Rong , Zhang Ying , Sun Xiao-Ming , Zhang Yu-Guang
Published: August 2019

Background:

Underdevelopment of nose and chin in East Asians is quite common. Rhinoplasty and mentoplasty are effective procedures to solve the above-depicted defects and can achieve remarkable cosmetic effects. An autologous costal cartilage graft has become an ideal material for rhinoplasty, especially for revision surgery. However, many problems in the clinical application of costal cartilage remain unresolved. This study is to investigate application strategies of autologous costal cartilage grafts in rhino- and mentoplasty.

Methods:

The methods involved are as follows: application of an integrated cartilage scaffold; comprehensive application of diced cartilage; and chin augmentation of an autologous costal cartilage graft.

Results:

In this study, satisfactory facial contour appearance was immediately achieved in 28 patients after surgery; 21 patients had satisfactory appearance of the nose and chin during the 6- to 18-month follow-up. Cartilage resorption was not observed. Two patients had nasal tip skin redness and were cured after treatment.

Conclusion:

This procedure can be used to effectively solve: curvature of the costal cartilage segment itself; warping of the carved costal cartilage; and effective use of the costal cartilage segment. The procedure has achieved satisfactory outcomes, and its application is worth extending to clinical practice.
Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data Bank
Authors: Wasicek Philip J. , Gebran Selim G. , Ngaage Ledibabari M. , Liang Yuanyuan , Ottochian Marcus , Morrison Jonathan J. , Rasko Yvonne , Liang Fan , Grant Michael P. , Nam Arthur J.
Published: August 2019

Background:

Contemporary description of facial fracture patterns and factors associated with early operative intervention at trauma centers is lacking. The purpose of this study was to characterize injuries and initial treatment patterns of patients suffering from facial fractures.

Methods:

Using the National Trauma Databank from 2007 to 2015, patients suffering from facial fractures were included. Demographics, injury characteristics, and outcomes including operative interventions were assessed.

Results:

Over 9 years, 626,270 patients were included: 74.5% were male, 39.0% suffered traumatic brain injury (TBI), and 23.3% severe noncraniofacial injuries (chest, abdomen, and/or extremity Abbreviated Injury Score ≥3). A total of 537,594 (85.8%) patients were admitted and 184,206 (34.3%) underwent operations for their facial injuries during the index hospitalization. The frequency and patterns of fractures varied by age, sex, race, and mechanism of injury. Operative intervention rates were highest for mandible (63.2%) and lowest for orbit fractures (1.0%). Multiple regression revealed that multiple factors were independently associated with the odds of early fracture repair including: female versus male (odds ratio [95% confidence interval]: 0.96 [0.94–0.98]), age >65 versus <18 years (0.62 [0.59–0.64]), non-white race (0.95 [0.94–0.97]), uninsured versus Medicaid (0.88 [0.86–0.90]), hospital bed size (>600 vs ≤200 beds, 1.67 [1.61–1.73]), TBI (0.70 [0.69–0.71]), and C-spine injury (0.93 [0.90–0.96]).

Conclusions:

Facial fractures are common among many demographic cohorts, and multiple patient and injury-specific factors influenced fracture patterns and management. Early operative intervention was highest for mandible fractures and lowest for orbit fractures. Multiple factors including age, sex, insurance status, hospital characteristics, and race/ethnicity were independently associated with early operative intervention, highlighting disparities in care.
Identifying Naturalistic Coaching Behavior Among Practicing Surgeons in the Operating Room
Authors: Pradarelli Jason C. , Delisle Megan , Briggs Alexandra , Smink Douglas S. , Yule Steven
Published: August 2019

Objective:

The aim of this study was to identify examples of naturalistic coaching behavior among practicing surgeons operating together by analyzing their intraoperative discussion.

Background:

Opportunities to improve surgical performance are limited for practicing surgeons; surgical coaching is one strategy to address this need. To develop peer coaching programs that integrate with surgical culture, a better understanding is needed of how surgeons routinely discuss operative performance.

Methods:

As part of a “co-surgery” quality improvement program, 20 faculty surgeons were randomized into 10 dyads who performed an operation together. Discourse analysis was conducted on transcribed intraoperative discussions. Themes were coded using an existing framework of surgical coaching principles (self-identified goals, collaborative analysis, constructive feedback, peer learning support) and surgical coaching content (technical skills, nontechnical skills). Coaching principles were cross-referenced with coaching content; c-coefficient measured the strength of association between pairs of themes.

Results:

Overall, 44 unique coaching examples were identified in 10 operations. Of the 4 principles of surgical coaching, only self-identified goals and collaborative analysis were identified consistently. Self-identified goals were most associated with discussions regarding technical skills of “tissue exposure,” “flow of operation,” and “instrument handling” and the nontechnical skill “situation awareness.” Collaborative analysis was most associated with discussions regarding technical skills of “respect for tissue” and “flow of operation” and nontechnical skills of “communication and teamwork.”

Conclusions:

In naturalistic discussions between practicing surgeons in the operating room, numerous examples of unprompted coaching behavior were identified that target intraoperative performance. Prominent coaching gaps—constructive feedback and peer learning support—were also observed. Surgical coach trainings should address these gaps.
Surgical Repair of Congenital Diaphragmatic Hernia After Extracorporeal Membrane Oxygenation Cannulation
Authors: Dao Duy T. , Burgos Carmen M. , Harting Matthew T. , Lally Kevin P. , Lally Pamela A. , Nguyen Hong-An T. , Wilson Jay M. , Buchmiller Terry L.
Published: August 2019

Objective:

To determine the optimal timing of congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) cannulation

Summary Background Data:

The timing of CDH repair after ECMO cannulation remains a controversial topic due to studies with low power or strong selection bias.

Methods:

This is a 2-aim retrospective cohort study based on the CDH Study Group registry for the period of 2007–2017. Aim 1—Compare On versus After ECMO repair. Aim 2—Compare Early versus Late repair on ECMO. In order to minimize selection bias and account for non-repairs, subjects in each aim were stratified into study groups based on their treatment center's characteristics. In each aim, the study groups were matched based on propensity score (PS). The main outcomes included mortality rate and incidence of non-repair.

Results:

In aim 1, 136 patients remained in each group after PS matching. Compared to the After ECMO group, patients in the On ECMO group demonstrated a lower mortality rate, hazard ratio (HR) 0.54 (0.38, 0.77) (P < 0.001), and lower incidence of non-repair, 5.9% versus 33.8% (P < 0.001). In aim 2, 77 patients remained in each group after PS matching. Compared to the Late group, Early repair of CDH on ECMO was associated with a lower mortality rate, HR 0.51 (0.33, 0.77) (P = 0.002), and lower incidence of non-repair, 9.1% versus 44.2% (P < 0.001).

Conclusions:

The approach of early repair after ECMO cannulation is associated with improved survival compared to delayed surgical correction.